Lesion of supraspinatus tendon


What is a lesion of the supraspinatus tendon?

This is a tear of the upper bone muscle or supraspinatus, one of the tendons that forms the rotator cuff that serves the rotation of the shoulder.

The rotator cuff serves to keep the humerus united with the shoulder blade and the rest of the trunk. It is the muscles that prevent dislocation of the shoulder.

The supraspinatus initiates the lateral elevation of the arm to about 80-90°, the second part of the arm elevation is mainly carried out by the deltoid muscle.
Among the muscles of the rotator cuff, the supraspinatus is the one that suffers injury or rupture most easily, since it runs in a canal bounded by the humerus at the bottom and by the roof of the shoulder at the top.
The lesion or tear of the tendon of the supraspinatus occurs mainly in athletes when performing throwing techniques or in the gym, and in the elderly due to tissue degeneration or tendinoses, in which the parallel tendon fibers become confused and disordered.
Usually the lesion exists between the humeral head and acromion, rarely an insertional lesion develops.
In general, a partial and incomplete lesion is formed, which continues over time until there is a massive rupture of all layers if not treated.
If the tendon ruptures completely, the muscle tends to retreat and degenerate into adipose tissue.
In the elderly, the tendon tends to age and degeneration and calcifications or bone spurs form, because the inflamed tendon tends to deposit calcium salts.
Usually, a lesion occurs on the most stressed tendon, i.e. the right-sided tendon (in left-handers, the left-sided), rarely it occurs on both sides.

What are the causes of lesion or rupture of the supraspinatus of the shoulder?

The causes of a lesion of the supraspinatus tendon can be different, in some cases there is a susceptibility of the person concerned, in others it is the result of trauma or strains, but it can also be a slow process of chronic tendonitis and degeneration due to wear.
If the shoulder roof of a person is very close to the humeral head (distance less than 1 cm), the supraspinatus has less room for manoeuvre and grazes the opposite during movements, thus causing friction and inflammation, which is referred to as impingement syndrome or subacromial syndrome.
Adults or old people suffering from chronic inflammation of the supraspinatus experience degeneration and weakening of the tendon, which in the long run leads to fraying of the fibers.

Throwing and punching athletes (volleyball players, tennis players, basketball players, rugby players) can develop tendonitis with thickening of the supraspinatus tendon until it becomes larger than the canal through which it runs. Then it rubs against the roof of the shoulder during movements.
A violent movement can overstretch the supraspinatus, for example when throwing. In this case, the lesion occurs on the tendon when it is inflamed and thereby weakened and less elastic than the muscle.
Also, the nature of the profession can lead to degeneration of the tendon. Those who work with the elbow above shoulder height, like the painters, are more likely to develop chronic inflammation and a lesion of the supraspinatus.
The tendon rupture can have a post-traumatic origin. Thus, a fall on the acromion (the outermost part of the shoulder) can lead to a blow and compression of the supraspinatus, which can damage or tear it.
A shoulder dislocation is always associated with a strain of muscles and tendons of the rotator cuff, in the worst cases they can tear.

What are the symptoms of lesions of the supraspinatus tendon?

The main symptom is pain in the area affected by the lesion, but also in the front arm, because often a lesion of the supraspinatus is associated with inflammation of the tendon of the long biceps head.
The patient complains of such severe nocturnal pain that he cannot sleep as a result.
The most painful movements are lateral abduction of the arm, closing the bra, pulling out the wallet from the trouser pocket, combing, attaching a hair tie, etc. An accumulation of fluid forms in the joint, which is not visible.

The pain can radiate from the shoulder to the arm and neck due to poor posture and improper use. Stitches on the shoulder lead to loss of strength and restriction of movement.
It is possible that simultaneously with the lesion of the supraspinatus tendon, the patient also suffers tendinitis on the long biceps head or acromiohumeral bursitis.

How is a lesion or rupture of the supraspinatus tendon diagnosed?

The orthopedist is the appropriate specialist to evaluate a possible lesion on the shoulder, because he is also able to operate on it.
The most important device examinations are ultrasound compared to the other shoulder and magnetic resonance imaging, because they show the soft tissue, such as muscles, tendons and ligaments, while an X-ray shows only the bones.
Orthopedic examination includes inspection and palpation of the painful areas.
The shoulder joint is the most mobile of the human body, because it can perform the following movements: extension, flexion, abduction, adduction, internal and external rotation.
The specialist first examines the movement of the arm in all directions to check for any restrictions on movement, especially when lifting and circling.
In the second part of the visit, he will carry out specific muscle tests: If the Neer test, which is carried out by lifting the shoulder and then in abduction of about 30° and a turn inwards, causes severe pain, the test is positive.

The first Jobe test consists of lifting the arms in 90° flexion and 60° abduction at maximum internal rotation. The doctor causes resistance by pressing down. On the other hand, if there is a lesion of the supraspinatus, the patient cannot raise his arm.

The Hawkins test is passive. The doctor lifts the patient’s arm and inflects forward by 90° in the shoulder joint. From here, an internal rotation and the evaluation of the complaints indicated by the patient take place.
The Yocum test consists of supporting the hand of the aching arm on the other shoulder and raising the elbow against the resistance of the doctor, who evaluates the described pain.

The palm-up test is performed on the patient who has raised the arm with a 90° flexion and the palm upwards. The test is positive if the pain worsens with pressure on the forearm at the front of the shoulder and indicates tendinitis of the long biceps tendon.

Other tests are less common.

What is the therapy for a lesion or rupture of the supraspinatus tendon?

After careful consideration of the patient’s condition, the orthopedist will decide whether there is an indication for surgical intervention, depending on the age of the patient and what daily activities he wants to perform.
The reconstruction of the rotator cuff is more likely to be done in a young patient who can cope with rehabilitation. On the other hand, the procedure will be avoided in older people.
If the doctor considers surgical treatment unsuitable, he will refer the patient to physiotherapy and rehabilitation.
During the operation, the orthopedist checks and assesses the actual damage, as magnetic resonance imaging does not exactly reflect the internal situation.
After seeing the extent of the damage, the surgeon will clean the joint by clearing out the damaged or necrotic tissue. Then the tendon is tightened and fixed to the bone with small metal anchors and non-absorbable suture material.
Depending on the condition of the shoulder, the orthopedist can also perform cartilage scraping (cleaning) or reintegration of the cartilage.
Depending on the damage, the surgeon will decide on surgery by arthroscopy or a long incision. The advantage of arthroscopy is that no scar remains and thus no connective tissue adhesions occur.
When swimming, the shoulder must perform continuous rotational movements. It is therefore better to avoid this so as not to aggravate the situation.
Shock wave therapy is contraindicated, because its side effects include the lesion of the supraspinatus.

What rehabilitation needs to be done after rotator cuff reconstruction?

Postoperatively, the patient must wear an orthosis for a variable period of 20 to 40 days, depending on the type of surgery, the size of the lesion and the protocol chosen by the surgeon.
Once the orthosis is removed, it is necessary to begin rehabilitation exercises to regain painless movement, restoration of the range of motion of the joint and muscle strength.
The first stage of rehabilitation consists of loosening the shoulder blade backwards and passive movement of the shoulder joint to restore the elasticity of the tissue.

As soon as the orthopedist who operated on the shoulder gives permission, active movement and training against elastic resistance to strengthen the middle pectoral muscles, stabilizers and rotators (supraspinatus, infraspinatus muscle, subscapular and teres minor) must be started.
If the patient continues to suffer due to surgery, a physical therapy cycle (for example, Tecar therapy®) is recommended to reduce inflammation and pain.

Postoperative recovery periods after a lesion of the supraspinatus tendon

Recovery times are long, the orthosis must be worn for 20 days. After that, a long rehabilitation is carried out to restore movement and strength and reduce pain.
The patient usually returns to sedentary work after 2 months, and to physically heavy activity after about 4-5 months. However, he must be careful with the movements in the first 6 months after the operation.

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