Supraspinatus tendon syndrome refers to a chronic pain syndrome of the shoulder muscles. It occurs mainly in advanced 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 (upper-bone) muscle is degeneratively altered. This results in chronic, motion-dependent pain, especially when the arm is splayed. Supraspinatus tendon syndrome is one of the individual disorders grouped under the umbrella term “impingement syndrome of the shoulder”. In addition to the tendon of the supraspinatus muscle, surrounding structures such as bursae may also be affected by degeneration and inflammation.
Causes
Supraspinatus tendon syndrome is explained by the anatomic location and particular susceptibility to degeneration of the supraspinatus muscle. The muscle is part of the so-called rotator cuff, which holds the humerus in the glenoid cavity of the scapula and allows its range of motion. The supraspinatus muscle pulls from the posterior superior scapula to the humerus. In doing so, its tendon must pass under the bony acromion and under a ligament between the acromion and the coracoacromial process (ligamentum coracoacromiale). This natural constriction may be additionally narrowed by individual anatomical conditions, after fracture healing, or by inflammation. In addition, the supraspinatus tendon is physiologically exposed to high compressive and frictional loads here and is thus susceptible to degenerative wear over the course of a lifetime. Along with the tendon itself, its supply structures also degenerate: circulatory disturbances and increasingly poorly functioning repair measures occur until a fully developed supraspinatus tendon syndrome is finally present.
Typical symptoms and signs
- Arm pain, joint pain
- Movement restrictions
- Shoulder pain when lifting the shoulder or arms
Diagnosis and course
First symtpom of supraspinatus tendon syndrome is pain during active abduction (abduction) of the arm, especially against resistance. Because the pain is most severe at an average degree of abduction of approximately 70-120 degrees, it is referred to as a “painful arc.” Also typical of a supraspinatus tendon syndrome are pressure pain at the anterior joint space and a radiating of the pain into the outer upper arm. Usually, the development of a supraspinatus tendon syndrome is phasic: painful irritation alternates with phases of – conscious or unconscious – rest, each of which can bring about a temporary improvement. Over time, however, sparing and regeneration become increasingly ineffective and the pain-free phases become shorter and shorter until the pain and movement restrictions finally become chronic. In addition, due to the sparing of the supraspinatus muscle, muscular imbalances develop, which promote an elevation of the humeral head and further constriction of the supraspinatus tendon – a vicious circle. To diagnose supraspinatus tendon syndrome, it is first determined during which movements in which arm position and to what extent the pain occurs. The actual degeneration processes cannot be seen well 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 surrounding soft tissue structures can be better assessed in an ultrasound examination. Magnetic resonance imaging is also used in some cases. Reflection (arthroscopy) of the shoulder joint – once a frequent component of diagnosis – is now more likely to be among the means of treatment because of improved imaging.
Complications
Supraspinatus tendinopathy causes increasing limitations of motion as it progresses. As the disease progresses, the periods of pain become longer and longer until they eventually develop into a chronic syndrome. The affected person then usually performs evasive movements, which can lead to premature joint wear and further deformities. The alternation between rest and pain phases also causes muscular imbalances, which can lead to an elevation of the humeral head.This can lead to further constriction of the supraspinatus tendon. In the long term, the 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 limits the well-being of the affected person. Surgical complications are possible in the treatment of supraspinatus tendon syndrome. For example, bleeding and inflammation may occur in the area of the operation. In individual cases, nerve cords are injured, which can result in paralysis. The conservative therapy methods – i.e. cold and heat therapy as well as physiotherapy – occasionally cause temporary discomfort. Typical symptoms are circulatory disturbances, tension, bruising or dizziness. Drug treatment is associated with other side effects and interactions.
When should you see a doctor?
In supraspinatus tendon syndrome, the affected person is dependent on a visit to a doctor. In this case, it cannot heal on its own, so a visit to a doctor must always take place to relieve the symptoms and prevent further complications. The earlier a doctor is consulted for supraspinatus tendon syndrome, the better the further course of the disease usually is. A doctor should be consulted for this condition when there is severe pain in the shoulders. This pain occurs without any particular reason and does not disappear on its own. They can also occur in the form of pain on exertion or also through pain at rest and have a negative effect on the quality of life. Furthermore, severe restrictions in movement can also 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 and therapy
Treatment of supraspinatus tendon syndrome can still be conservative in the early stages. The spectrum of conservative therapeutic methods includes cold or heat therapy, diadynamic currents for muscle relaxation, medications for pain relief and anti-inflammation, and physiotherapy and manual therapy. The basic principle is to avoid severe stress on the supraspinatus tendon while ensuring range of motion of the shoulder joint and avoiding muscular imbalances. Initially, an inpatient therapy program at an orthopedic rehabilitation facility may be useful. In the long term, the patient can only keep the pain symptoms in check if he or she then uses the learned exercises regularly at home. If the supraspinatus tendon syndrome proves resistant to all conservative therapy attempts, surgery must be performed: Various surgical approaches exist here, but all pursue the goal of expanding the space under the acromion. Today, surgery for supraspinatus tendon syndrome is usually performed arthroscopically with very low surgical risk.
Prevention
Prevention of supraspinatus tendon syndrome is difficult because the favoring anatomic factors cannot be avoided. However, the course of supraspinatus tendon syndrome can be positively influenced by taking pain seriously and addressing it early with appropriate conservative treatment methods.
Aftercare
If supraspinatus tendon syndrome is treated surgically, it requires special aftercare afterwards. Usually, the patient spends the first three days after surgery still in the hospital. After that, the affected arm is immobilized with a brace for a period of four to six weeks. This is a special arm cushion, also known as an abduction bandage. For minor activities, the patient can take the arm out of the bandage right from the start. During the night, however, the arm cushion must be applied consistently. In this way, tendon overloads that occur without intention can be counteracted. The abduction bandage may also be taken off to care for the body. However, intensive elbow movements should be avoided. After about eight weeks, the rotator cuff of the shoulder is largely able to bear weight again. This gives the post-treatment option of rebuilding mobility and strength of the affected arm.For this purpose, rehabilitation measures take place, which the patient exercises on an outpatient basis. They usually take at least three months. Running is allowed again about two months after the surgical procedure, and ball sports are also possible again after four to six months. To treat postoperative pain, the patient receives a pain catheter and local intermittent treatments with ice, which have an anti-inflammatory effect.
Here’s what you can do yourself
Chronic pain syndromes such as supraspinatus tendon syndrome can be self-treated through a number of self-help measures. The first thing to do is to take it easy on the affected limb. The injured tendon should not be subjected to heavy loads for at least 14 days. The tendon can be cooled externally, as the cold slows down any inflammation and relieves the pain. After the acute discomfort has largely subsided, heat is recommended. In conjunction with moderate exercise, warm compresses or wraps stimulate the metabolism and thus contribute to a rapid recovery. Sports may be resumed when the pain has completely subsided and the doctor gives the okay. Then gentle sports such as swimming or slow walking are particularly suitable. 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 supraspinatus tendon syndrome should consult the doctor who can give exact treatment measures. He may recommend attending a shoulder school, through which the patient learns to move the shoulder below the pain threshold.
