Diagnosis and treatment of shoulder tendon inflammation
The test for tendonitis of the supraspinatus tendon is positive if pain occurs during the abduction movement against resistance.
The pain curve occurs when the abducted arm is at about 70°-110°, because the tendon fibers are compressed here between the head of the humerus muscle and the acromion.
Neer Test : The examiner forcefully raises the patient’s outstretched, inwardly rotated arm over the shoulder and impinges the supraspinatus tendon against the inferior anterior aspect of the acromion. The test is positive if pain occurs.
Hawkins- Kennedy test : shoulder and elbow flexed at 90°; the examiner rotates the arm inward, impinging (pinching) the supraspinatus tendon against the coracoacromial ligament. The test is positive if pain occurs.
The examiner may inject 10 mL of lidocaine solution (1%) into the subacromial space and then repeat the impingement test. Elimination or significant reduction in pain is a positive sign of impingement.
Dropping Arm Test: The patient holds the arm over the shoulder as far as possible and then slowly lowers it. The test can be done after injecting lidocainerepeated into the subacromial space. A sudden fall of the arm indicates a rotator cuff laceration.
Jobe’s test : The patient rotates the arm inward with the thumb pointing toward the floor. Then he must raise the arm against resistance at 30° flexion and 90° abduction. The test is positive if the arm being examined shows weakness compared to the healthy side, suggesting a rupture of the supraspinatus tendon .
Differential diagnosis in inflammation of the shoulder tendon
- Diastase des Akromioclaviculargelenks
- Tendonitis of the long biceps tendon
- Brachial plexus lesion
- Cervical radiculopathy
- Distortion of the cervical spine
- collarbone injury
- Syndrome der Infraspinatussehne
- Rotator cuff lesions
- dislocation of the shoulder
- Shoulder Impingement Syndrome
- Lesions of the superior acetabular lip
- swimmer’s shoulder
Technical examinations in inflammation of the shoulder tendon
An x-ray can show calcium deposits (calcium crystals) in calcific tendonitis (T. calcarea). It is useful to identify any anatomical variations of the acromion that may not be apparent on soft tissue examinations.
It is often assumed that any calcium crystals are the cause of the pain and not the inflammation of the tendon. In these cases, the calcium deposits should be surgically removed. There may also be calcium deposits that do not cause any pain.
How is supraspinatus tendon inflammation treated?
In the early stages of tendonitis, rest is important to allow the inflammation to heal (pain relievers such as NSAIDs can also help).
Cortisone injections with local anesthetics can also be given directly into the subacromial bursa (subacromial bursa) or into the supraspinatus tendon (this can increase pain in the first 48 hours).
If the tendinitis is calcifying (calcium crystal formation on the tendon), the calcium deposits are aspirated under local anesthesia or, in other cases, surgically removed.
Surgical intervention for inflammation of the shoulder tendon
To prevent recurrence, an arthroscopic procedure (under anesthesia , a small camera is inserted into the joint through a minimal incision) called an acromoplasty can be performed. This procedure consists of reshaping the acromion, or dividing the coracoacromial ligament, with the aim of preventing recurrence.
This can also repair the rotator cuff tendons (this may be difficult if treated too late and the tendon has retracted).
Effect: tension-relieving. Shape: a “Y” stripe. Length: 20cm. Apply the tape without tension while rotating the arm inward; start from the shoulder and follow the course of the muscles.
Exercises for inflammation of the shoulder tendon
This exercise program is very effective when done regularly. The stretching realigns the fibers of the scar tissue so that they can heal completely; the exercises with progressively increasing weight loads, on the other hand, strengthen the tendons. The program needs to be done every day for 6-8 weeks to be successful.
If the patient is unable to perform the entire rehabilitation program on a regular basis, an attempt can be made to give him only the strengthening exercises.
Initially, exercises of an isometric nature should be performed, and only later,
elastic resistance exercises should be used.
External rotation : Fasten an elastic fitness band at stomach height (wall bars, door handle) and stand on the side. The hand away from the band grasps the band and holds it at chest level, with the elbow resting against the body. Twist your arm outward, away from your body, keeping your forearm parallel to the floor.
Internal rotation : Fasten an elastic fitness band at stomach height (wall bars, door handle) and stand on the side. The hand closest to the band grasps the band and holds it at chest level, the elbow is close to the body. Rotate your arm in toward your body, keeping your forearm parallel to the floor.
Bringing the shoulders closer : Fasten an elastic fitness band at head height (e.g. rung ladder) and place it on the side. The hand close to the band grasps the band and holds it at chest level, the arm is stretched out straight (90°) to the side. Now pull your arm down towards your body. Do not rotate the torso.
Seated Row : Position yourself correctly in a chair without a backrest. Grasp the band attached in front with both hands, arms stretched straight forward. Now pull the band to your chest, bringing your shoulder blades together at the back. Slowly return to the starting position.
Prognosis in inflammation of the shoulder tendon
Approximately 70% of patients with supraspinatus tendon inflammation can improve their condition within 5-20 days by self-mobilization of the shoulder, but physiotherapeutic treatment is still necessary (cortisone injections can also be helpful). More tendonitis and complete or incomplete tendon injuries can always occur in the future.
Whole lesions are treated surgically in young people, while surgery may be more difficult in older people due to the interaction with other conditions, such as osteoarthritis and rheumatoid arthritis.
Impingement and chronic trauma can lead to long-term osteoarthritis of the shoulder.
- Inflammation of the supraspinatus tendon
- Inflammation of the long biceps tendon of the shoulder
- Inflammation of the flexor tendons of the hand