The supraspinatus tendon syndrome describes a chronic pain syndrome of the shoulder muscles. It occurs mainly in old age after wear and tear processes, but is favored by certain anatomical peculiarities or injuries.
What is supraspinatus tendon syndrome?
In supraspinatus tendon syndrome, the tendon of the supraspinatus muscle (upper bone muscle) has undergone degenerative changes. This causes chronic, movement-dependent pain, especially when spreading the arm. For intellectual disability in English, please visit gradphysics.com.
The supraspinatus tendon syndrome is one of the individual diseases that are summarized under the generic term “impingement syndrome of the shoulder”.
In addition to the tendon of the supraspinatus muscle, surrounding structures such as bursae can also be affected by degeneration and inflammation.
The supraspinatus tendon syndrome can be explained by the anatomical location and the particular susceptibility to degeneration of the supraspinatus muscle. The muscle is part of the so-called rotator cuff, which holds the humerus in the socket of the shoulder blade and allows its range of motion.
The supraspinatus muscle pulls from the rear upper shoulder blade to the humerus. His tendon must pass under the bony acromion (acromion) and under a ligament between the acromion and the coracoid process (ligamentum coracoacromiale). This natural constriction can be additionally narrowed by individual anatomical conditions, after fracture healing or by inflammation.
In addition, the supraspinatus tendon is physiologically exposed to high pressure and friction loads and is therefore susceptible to degenerative wear and tear over the course of life. Along with the tendon itself, its supply structures also degenerate: This leads to circulatory disorders and increasingly poorly functioning repair measures until finally a fully developed supraspinatus tendon syndrome is present.
Typical Symptoms & Signs
- Arm pain, joint pain
- movement restrictions
- Shoulder pain when raising your shoulder or arms
Diagnosis & History
The first symptom of a supraspinatus tendon syndrome is pain when actively spreading (abducting) the arm, especially against resistance. Since the pain is most severe at an average degree of abduction of about 70-120 degrees, it is referred to as a “painful arch”.
Pressure pain in the anterior joint space and pain radiating into the outer upper arm are also typical of a supraspinatus tendon syndrome. The development of a supraspinatus tendon syndrome is usually phasic: painful irritation alternates with phases of – conscious or unconscious – rest, through which a temporary improvement can be achieved.
Over time, however, rest and regeneration become increasingly ineffective and the pain-free phases become shorter and shorter, until the pain and restricted movement finally become chronic. By sparing the supraspinatus muscle, muscular imbalances also develop, which promote an elevated position of the humeral head and further constriction of the supraspinatus tendon – a vicious circle.
To diagnose the supraspinatus tendon syndrome, it is first determined which movements in which arm position and to what extent the pain occurs. The actual degeneration processes are not easy to see in the X-ray image – but bony growths after fracture healing, calcifications or an already existing elevation of the humeral head may provide indications of a supraspinatus tendon syndrome.
The shoulder muscles and the surrounding soft tissue structures can be better assessed in an ultrasound examination. Magnetic resonance imaging is sometimes also used. A reflection ( arthroscopy ) of the shoulder joint – formerly often part of the diagnostics – is now more of a therapy due to improved imaging.
The supraspinatus tendon syndrome increasingly causes restricted mobility as it progresses. As the disease progresses, the phases of pain become longer and longer, eventually developing into a chronic syndrome. The affected person then usually performs evasive movements, which can lead to premature joint wear and tear and other malpositions.
The alternation between rest and pain phases also causes muscular imbalances, which can lead to the humeral head standing up. This can lead to further narrowing of the supraspinatus tendon. In the long term, chronic pain syndrome can lead to stiffening of the affected tendon and the surrounding bones and joints.
Such a severe course is usually associated with psychological suffering, which further restricts the well-being of the person concerned. Surgical complications are possible in the treatment of supraspinatus tendon syndrome. This can lead to bleeding and inflammation in the area of the operation.
In individual cases, nerve cords are injured, which can lead to symptoms of paralysis. The conservative therapy methods – i.e. cold and heat therapy as well as physiotherapy – occasionally cause temporary symptoms. Typical symptoms are circulatory disorders, tension, bruising or dizziness. Drug treatment is associated with other side effects and interactions.
When should you go to the doctor?
In the case of supraspinatus tendon syndrome, the affected person is dependent on a visit to a doctor. It cannot heal on its own, so a visit to a doctor is always necessary to alleviate the symptoms and prevent further complications.
The sooner a doctor is consulted for supraspinatus tendon syndrome, the better the further course of the disease will usually be. A doctor should be consulted for this disease if there is severe pain in the shoulders. This pain occurs for no particular reason and does not go away on its own. They can also occur in the form of stress pain or pain at rest and have a negative effect on the quality of life. Furthermore, severe limitations in movement can indicate the supraspinatus tendon syndrome and should also be examined by a doctor.
As a rule, an orthopedist or a general practitioner can be consulted for this disease. The further course always depends on the underlying disease, so that no general prediction can be made. As a rule, the life expectancy of the affected person is not reduced by this disease.
Treatment & Therapy
The treatment of the supraspinatus tendon syndrome can still be conservative in the early stages. The range of conservative therapy methods includes cold or heat therapy, diadynamic currents for muscle relaxation, medication to relieve pain and reduce inflammation, as well as physiotherapy and manual therapy.
The basic principle is to avoid heavy loads on the supraspinatus tendon, while at the same time securing the range of motion of the shoulder joint and avoiding muscular imbalances. Initially, an inpatient therapy program in an orthopedic rehabilitation facility can make sense. The patient can only keep the pain symptoms under control in the long term if he then regularly uses the exercises he has learned at home.
If the supraspinatus tendon syndrome proves to be resistant to all conservative therapy attempts, an operation must be performed: There are various surgical approaches, but all aim to expand the space under the acromion. Today, the operation of a supraspinatus tendon syndrome is usually carried out arthroscopically with a very low surgical risk.
Prevention of the supraspinatus tendon syndrome is difficult because the anatomical factors that promote it cannot be avoided. However, the course of a supraspinatus tendon syndrome can be positively influenced by taking pain seriously and combating it at an early stage with appropriate conservative therapy methods.
If the supraspinatus tendon syndrome is treated surgically, special follow-up care is required afterwards. As a rule, the patient spends the first three days after the procedure in the hospital. The affected arm is then immobilized with a bracelet for a period of four to six weeks. This is a special arm cushion, also known as an abduction bandage.
For smaller activities, the patient can take their arm out of the bandage right from the start. During the night hours, however, it is necessary to consistently put on the arm cushion. In this way, tendon overloads that happen unintentionally can be counteracted. The abduction bandage may also be removed to care for the body. However, intensive elbow movements should be avoided.
After around eight weeks, the rotator cuff of the shoulder is largely resilient again. This results in the post-treatment option of restoring mobility and strength to the affected arm. For this purpose, rehabilitation measures take place, which the patient carries out on an outpatient basis. They usually take at least three months.
About two months after the surgical intervention, running sports can be practiced again and after four to six months, ball sports are possible again. To treat the postoperative pain, the patient receives a pain catheter and intermittent local ice treatments, which have an anti-inflammatory effect.
You can do that yourself
Chronic pain syndromes such as the supraspinatus tendon syndrome can be treated by a number of self-help measures.
The first thing to do is to protect the affected limb. The injured tendon should not be heavily loaded for at least 14 days. The tendon can be cooled externally, because the cold slows down any inflammation and relieves the pain. After the acute symptoms have largely subsided, heat is recommended. In connection with moderate exercise, warm pads or wraps stimulate the metabolism and thus contribute to a speedy recovery. You can start exercising again when the pain has completely subsided and the doctor gives the okay. Then, above all, gentle sports such as swimming or slow walking are recommended.
The supraspinatus tendon syndrome usually progresses progressively. Therefore, the accompanying measures must be maintained in the long term. A healthy lifestyle reduces chronic pain and improves well-being. Patients suffering from the supraspinatus tendon syndrome should consult the doctor, who can give precise treatment measures. He may recommend attending a shoulder school that teaches the patient to move the shoulder below the pain threshold.