Supraspinatus Tendinitis
(Rotator Cuff)

The Rotator Cuff is a term given to three main tendons that wrap around the shoulder joint, the supraspinatus tendon being the tendon coming off the shoulder blade in the top portion.

A patient with an injured rotator cuff will have pain and/or difficulty accomplishing either of the 2 dumbbell exercises outlined at the bottom of this page:

• The Dumbbell Shoulder Press
• The Dumbbell Lateral Raise

Many rotator cuff injuries occur gradually, though many are associated with sports injuries (especially baseball and swimming), falls on the shoulder, or an added injury due to shoulder dislocation in elderly folk. If you’ve ever been diagnosed with bursitis, it’s possible the Supraspinatus is the true source of your pain, not the shoulder bursa. In this case, the pain does not resolve with typically prescribed anti-inflammatory medications.

When treating a strained supraspinatus tendon, rest the area (this can be difficult to do, as many common daily activities work this tendon), apply ice for 10-20 minutes at a time for at least 3 times a day. Do this to the injured area for the first day to 3 days. Moist heat may be used after the acute swelling is improved and rest prevents further muscle injury. Ice will reduces initial inflammation and swelling and the moist heat circulates blood through the area to speed the healing process. This can be further helped by the use of Ultrasound applied over the affected area, as it reduces swelling quickly and increases blood flow to the area. If the patient gradually starting flexing and mobilising the area, the muscle would probably heal back close to normal.

However, this is not what typical person does; they may ice once or twice and rest a bit, but most often just take some Advil or Tylenol and continue to commence their activities. If the strain was minor, their body may be able to heal the muscle fibers normally. Unfortunately, this is not the usual result because the injured muscle is being used instead of rested. Because of the stress on the muscle, their body heals the injured muscle fibers by binding them together with fibrotic adhesions or scar tissue. This is done in an attempt to prevent further damage to the injured area. It is a normal protective response of their body.

To prevent this the patient should apply ultrasound treatment on the area up to three times daily. Ultrasonic energy will naturally "work" the tendon, increasing its flexibily while softening and breaking down scar tissue - which is not something you want in your tendon. Scar tissue is inflexible (non-elastic), and can quickly lead to reinjury of the tendon later down the road. If you choose to use steriod injections or are using steriod injections, do NOT treat the area with ultrasound until 30 days after the last injection. Steriod injections break down the tissue in the treated area in an attempt to get it to re-heal properly. Applying ultrasound over areas injected with steriods may increase the damage and can potentially tear the tendon.

The trick to any tendon injury is getting it to heal with minimal scar tissue formation and with as much realignment of tendon fibres as possible - something radiant energy and ultrasound are great at! Even with optimum healing there is always less elasticity in a previously injured tendon. The trick is to make sure you heal this the best you can, that way your chance of reinjury down the road is much lower than average - which is well over 50%.

Dumbbell Shoulder Press

Preparation
Position dumbbells to each side of shoulders with elbows below wrists.

Execution
Press dumbbells until arms are extended overhead. Lower and repeat.

Dumbbell Lateral Raise

Preparation
Grasp dumbbells in front of thighs. Bend over at hips slightly with knees bent.

Execution
With elbows slightly bent, raise upper arms to sides until elbows are shoulder height. Maintain elbows' height above or equal to wrists. Lower and repeat.

The most common cause of an tendon inflammation (tenosynovitis or tendonitis) is overuse of the affected tendon. Rest of the affected tendon is all that is required in some cases. Other treatments such as anti-inflammatory drugs or a steroid injection are sometimes needed. Infection of a tendon is an uncommon cause but needs treatment with antibiotics if it occurs.

What is tenosynovitis and tendonitis?

* Tendonitis means inflammation of a tendon. (It is sometimes spelled as tendinitis.)
* Tenosynovitis means inflammation of the sheath that surrounds a tendon (the sheath is called the synovium). Tenosynovitis can be caused by calcium deposits, repeated strain or trauma, high levels of blood cholesterol, rheumatoid arthritis, gout, or gonorrhea.
These two conditions often occur together.

Never use Ultrasound over an area injected with a steroid (ie. cortisone) for at least 30 days.

Never use Ultrasound after surgery until your physician recommends and approves of it.