Most people have never heard of their supraspinatus muscle, but it's one of the muscles that make up the rotator cuff, which helps stabilize the shoulder and keep it in the right position, and the function of the muscle is to help the shoulder raise your arm out to the side and overhead. Baseball pitchers are very prone to this form of tendonitis, because of the repetitive motion of throwing the ball.
One of the most common types of rotator cuff tears is a tear in the supraspinatus tendon, which is because it comes right over the top of the shoulder, and due to its position it tends to be the muscle that helps stabilize the arm against contant gravity.
Differential Diagnosis
The shoulder joint has multiple muscles and tendons that work harmoniously to make the shoulder one of the most versatile and impressive joints. This is why shoulder injuries are often diagnosed. Most often supraspinatus tendonitis is misdiagnosed, and could be called one of the following injuries below:
Acromioclavicular Joint Injury
Bicipital Tendonitis
Brachial Plexus Injury
Cervical Disk Injuries
Cervical Discogenic Pain Syndrome
Cervical Radiculopathy
Cervical Spine Sprain/Strain Injuries
Clavicular Injuries
Contusions
Infraspinatus Syndrome
Myofascial Pain in Athletes
Rotator Cuff Injury
Shoulder Dislocation
Subacromial Impingement
Superior Labrum Lesions
Swimmers Shoulder
For Athletes
This injury is most commonly found in baseball players, as they spend a lot of time training and throwing the ball. That kind of repetitive motion on the supraspinatus muscle and deltoid muscle most often causes tendonitis.
What can an athlete do?
Rest until there is no pain. You must however continue pain free mobility exercises to keep full range of movement in the shoulder. Apply ice initially to ease the pain and inflammation. See a sports injury specialist or doctor who can advise on rehabilitation.
What can a sports injury doctor do?
A doctor may prescribe anti-inflammatory medication such as ibuprofen. A full rehabilitation program consisting of mobility, stretching and strengthening exercises will be advised. If bursitis is involved the doctor can aspirate or stick a needle into the bursa and suck out the extra fluid. A surgeon may operate with persistent problems.
Often, with modified training rehabilitation will take 1-3 weeks, but if it's not looked after, it will become chronic and cause more serious problems.
What Makes The Shoulder Joint Complex?
The shoulder is made up of three bones, which are connected by muscles, ligaments, and tendons. The large bone in the upper arm is called the humerus. The shoulder blade is called the scapula and the collarbone is the clavicle. The top of the humerus is shaped like a ball. This ball sits in a socket on the end of the scapula. The ball is called the "head of the humerus" and the socket is called the glenoid fossa. The shoulder socket has a rim of tissue around it called the glenoid labrum. With all of these pieces working together, makes the shoulder joint the most mobile in the body.
The glenoid fossa is surrounded by a large loose "bag" called a capsule. The capsule has to be large and loose to allow for the many movements of this joint. Ligaments reinforce the capsule and connect the bones together. The ligaments and muscles provide stability to the joint.
There are muscles that stabilize the scapula and others that help move the arm. The rhomboid muscles, tapezius muscle and serratus anterior muscle are a few of the stabilizing muscles. The pectoralis major muscle, deltoid muscle and the four muscles of the rotator cuff are the the muscles that move the arm. The upper part of the trapezius muscles will help with the "shrugging" motion. All of the muscles that are part of the shoulder complex work together in order to move the arm through its many possible ranges of movement.
Finally, a bursa is a fluid filled sac that decreases the frictionbetween two tissues. The bursae also protect tissues from boney structures. In the shoulder, the subacromial bursa covers the rotator cuff tendons and protects them from the overlying acromion process. Normally, this bursa has very little fluid in it but if it becomes irritated it can fill with fluid, and become painful and also irritate the surrounding rotator cuff tendons.
Rotator Cuff Tendonitis and Bursitis
Rotator cuff tendonitis is an inflammation of the tendons of the rotator cuff. Initially, microscopic tears form in the tendons. These tears trigger an inflammatory response, which causes pain. The supraspinatus tendon is the tendon that is most commonly affected. When the rotator cuff tendons become inflammed, the subacromial bursa may also become irritated and inflammed.
What Causes Rotator Cuff Tendonitis
Rotator cuff tendonitis often occurs as a result of overuse, mechanical impingement on the tendons of the rotator cuff, from age related degeneration of the rotator cuff or from all of the above. Rotator cuff tendonitis is often due to excessive overhead motions such as throwing or swimming.
What is Impingement Syndrome
Impingement syndrome is the term used to describe the pinching or "impingement" of the rotator cuff tendons and the subacromial bursa between the head of the humerus and the acromion process of the scapula. This causes irritation and inflammation of the rotator cuff and the bursa. The rotator cuff and sub-acromial bursa are most likely to become pinched during overhead activities.
Impingement of the rotator cuff and the bursa occurs to some degree in everyone's shoulder. Everyday activities that involve reaching above shoulder level cause some impingement. Continuously working with the arms raised overhead, repeated throwing activities, or other repetitive actions of the shoulder can also causes impingement. Impingement only becomes a problem when it causes irritation or damage to the rotator cuff tendons.
Usually, there is enough room between the acromion and the rotator cuff so that the tendons slide easily underneath the acromion as the arm is raised. But each time the arm is raised, there is a bit of rubbing or pinching on the tendons with the bursa. Raising the arm tends to force the humerus against the edge of the acromion process. With overuse, this can cause irritation and swelling of the bursa. If any other condition decreases the amount of space between the acromion process and the rotator cuff tendons, the impingement process may get worse.
What Does Rotator Cuff Tendonitis and Bursitis Feel Like?
Pain related to the rotator cuff tendonitis and bursitis usually occurs over the front and side aspect of the shoulder, often with radiating pain, which usually doesn't pass the elbow. Typically, the pain is aggravated by overhead activity and worsens at night. People often report a clicking or popping sensation in the affected shoulder. Biceps tendonitis frequently accompanies rotator cuff tendonitis and bursitis.
In the early stages rotator cuff tendonitis and bursitis causes a generalized shoulder ache. There may also be pain when raising the arm out to the side or in front of the body. Some people complain that the pain makes it difficult for them to sleep, especially when they roll onto the affected shoulder. As the condition worsens, the discomfort increases. The shoulder joint may become stiffer. Sometimes a catching sensation is felt when the arm is raised or lowered. Weakness and the inability to raise the arm may indicate that the rotator cuff tendons are actually torn.
Can Rotator Cuff Tendonitis Be Detected on X-Rays?
The diagnosis of rotator cuff tendonitis is usually made on the basis of the medical history and physical examination. Doctors may order an x-ray to look for a curved or hooked acromion process or bone spurs around the AC joint. An arthrogram or an MRI scan may be performed to rule out a tear of the rotator cuff. An MRI scan is a special imaging test that uses magnetic waves to create pictures that show the tissues of the shoulder in slices. The MRI can show tendons as well as bones. The MRI scan is painless and requires no needles. The arthrogram is an older test than the MRI, but it is still widely used. It involves injecting dye into the glenoid fossa and then taking several x-rays. If the dye leaks out of the glenoid fossa, it suggests that there is a tear in one of the rotator cuff tendons.
What Is The Treatment For Rotator Cuff Tendonitis?
Rotator cuff tendonitis is usually treated conservatively. Treatment may include stretches, strengthening exercises, anti-inflammatory medications, rest or activity modification, as well as heat/cold therapy. In some cases a cortisone injection may be recommended to help decrease the pain and inflammation, but should never be done. Cortisone injections further tear the tendons and ligaments. Finally, people who do not improve with conservative measures may benefit from surgery. Doctors and physical therapists that deal with people who have rotator cuff tendonitis can help outline a treatment program.
