The supraspinatus tendon is responsible for attaching the muscle to the bone tissue. The supraspinatus tendon belongs to the rotator cuff or rotator cuff. It is involved in most of the movements performed by the upper limb: adduction and abduction, elevation and descent, rotation and rotation. The supraspinatus tendon is resistant to increased physical stress and consists of strong elastic fibers.
Violation of its integrity can be associated both with monotonous and monotonous hand movements, and with traumatic effects. Among the potential causes of damage to the tendon of the supraspinatus muscle of the shoulder joint are aseptic inflammation, tissue ischemia due to insufficient blood circulation, neuropathy, etc.
In this article we will look at the most common injuries to the supraspinatus tendon, which can lead to serious problems when moving the upper limb. It's worth starting with some anatomical information. The shoulder joint is supported by the so-called rotator cuff, which includes four muscles:
- the supraspinatus has a triangular shape and fills the entire cavity of the scapula;
- the subscapularis connects the chest to the scapula and shoulder joint;
- the teres minor is located between the scapula and the head of the humerus;
- The infraspinatus is located in the infraspinatus fossa of the scapula.
All these muscles have their own tendons - elements responsible for their attachment to bone structures. The muscle is covered with fascia made of connective tissue, at the ends the fascia passes into the tendon. It is attached to the bones using ankylosis. With a traumatic injury, the tendon fibers themselves are often damaged. Scarring and degenerative deformities can form in them. They worsen the physiological properties of the tendon, making it less resistant to negative factors.
In most cases, the supraspinatus tendon becomes deformed over a long period of time. Patients turn to the doctor in those periods when the disease is already in an advanced form. You should not wait for the moment when you cannot raise or lower your arm, make a rotational movement, or bring and abduct a limb away from you. You should see a doctor as soon as possible.
The article describes the main clinical symptoms of different types of lesions of the supraspinatus tendon. If you recognize any of the signs in yourself or your loved ones, then consult an orthopedist.
In Moscow, you can make an appointment for a free appointment with an orthopedist at our manual therapy clinic. Experienced doctors work here. They will be able to conduct a full examination and a number of diagnostic tests. After making an accurate diagnosis, they will develop an individual course of treatment for you. It will help restore full mobility of the upper limb.
You can make an initial free appointment with an orthopedist in our clinic using the feedback form, which you will find at the end of the page.
Causes of supraspinatus tendon rupture
Depending on the cause, supraspinatus tendon tears can be traumatic or degenerative.
Degenerative ruptures occur due to chronic microtrauma of muscles. People whose professional activities are in one way or another connected with the frequent position of the shoulder in a state of abduction (teachers, builders, some athletes) are most predisposed to such ruptures. This rupture mechanism also occurs in people with a genetic predisposition.
A traumatic rupture is an acute condition that occurs after a fall on the shoulder or as a result of a sharp abduction of the upper limb.
Traumatic ruptures of the supraspinatus tendon can be fresh, stale, or old.
The main risk factors that contribute to injury in sports:
- use of low-quality sportswear and protective equipment;
- muscle load that does not correspond to the level of adaptation of the body;
- Allocating insufficient time to warm up before training;
- conducting training in a state of mental or physical fatigue;
- technically incorrect execution of exercises.
Rehabilitation
After conservative or surgical treatment, a mandatory course of rehabilitation follows, the duration of which is 3-6 months. Rehabilitation is necessary to restore range of motion and strengthen the structures of the shoulder joint, maintain muscle tone, and improve blood circulation.
Reference. The main component of the recovery period is therapeutic exercises.
The table shows simple exercises for the supraspinatus muscle and the technique for performing them:
| No. | Initial position | Doing exercises | Number of repetitions |
| 1. | Sitting, back straight, arms in front of you | Bend - straighten your fingers. | 10 times |
| 2. | Sitting, back straight, arms in front of you | Perform circular movements with your hands in and out. | 8 times in each direction |
| 3. | Standing, back straight, feet shoulder-width apart, arms down | Make pendulum movements forward and backward. | 12 times |
| 4. | Standing, back straight | Bend the affected arm at the elbow using your healthy arm. | 6 times |
| 5. | Standing, arms straight in front of you at shoulder level | Make cross movements with your hands (“scissors”). | 6 times |
Over time, as the muscles adapt, the load is gradually increased, moving on to more active and complex exercises using various sports equipment: dumbbells, a gymnastic stick, an expander, a ball.
Swimming, leading an active lifestyle, and proper nutrition enriched with vitamins and minerals have a positive effect on the recovery process.
Main symptoms of injury
- Pain in the shoulder area. The intensity of the pain is directly proportional to the extent of the rupture. The pain intensifies when the shoulder is abducted at an angle of more than 70 and can radiate to the elbow.
- Limitation of mobility in the joint. The degree of limitation of mobility depends on the number of damaged fibers (with a complete rupture, there is a complete inability to move the arm to the side).
If the first symptoms of injury occur, you should immediately consult a sports doctor.
Old ruptures are much more difficult to treat than fresh ones. The sooner treatment is prescribed, the higher the chances of recovery and return to sports.
At the end of our article are the addresses of the best sports clinics.
Diagnostics
When going to the hospital, the patient is sent for examination to clarify all the features of the injury.
Reference. If the tendon is damaged, contact a traumatologist, orthopedist or surgeon.
At the initial stage, the specialist conducts a survey and examination of the patient regarding the nature of the symptoms, the circumstances of their manifestation, and the presence of visual changes in the shoulder area. Also performs functional tests to determine range of motion and degree of limitation.
Next, to confirm the preliminary diagnosis, the following diagnostic techniques are prescribed:
- X-ray. Allows you to assess the condition of bones and joints, identify possible displacement, deformation, growths.
- CT and MRI (computer and magnetic resonance imaging). They are used to assess the condition of all structures, identify the location of the rupture, clarify its size, and determine the possible presence of concomitant pathologies of the joint.
- Ultrasound (ultrasound examination). Allows you to assess the condition of soft tissues and visualize the source of damage.
The obtained examination results help to establish the nature, severity, location of the damage and prescribe adequate treatment.
Supraspinatus tendon rupture: treatment
Treatment of a tendon rupture is carried out conservatively or through surgery.
Conservative treatment is used for subtotal ruptures of the supraspinatus tendon. It involves immobilization of the joint, physiotherapeutic procedures, anti-inflammatory therapy, intra-articular injections.
If the supraspinatus tendon is completely torn, surgery is the only way to restore function of the joint. Rotator cuff reconstruction surgery is performed openly or endoscopically.
Treatment of impingement syndrome.
Treatment of subacromial syndrome depends on the severity of clinical manifestations and the degree of development of the destructive process. If pain occurs at an early stage, it is important to rest your hand. The patient receives anti-inflammatory drug therapy by taking a course of non-steroidal anti-inflammatory drugs orally. For prolonged pain syndrome, blockades are performed with the introduction of glucocorticosteroids into the affected area. Sometimes injections of platelet-rich plasma are recommended for better regeneration of the damaged area. During the recovery period, therapeutic exercises are prescribed, aimed at returning the muscles to function. Loads are given gradually and already during the period when there is no pain syndrome. Physiotherapeutic procedures speed up the healing process and include shock wave therapy, electrophoresis, magnetic therapy, electrical myostimulation). In the second and especially third degree, when degenerative changes in muscle tendons, ligaments and bone structures are observed, surgical treatment is indicated, since conservative therapy can provide relief only for a while.
Surgical intervention is performed using arthroscopy, which is the most gentle in relation to surrounding tissues. In addition, rehabilitation after arthroscopy is much faster than after open access operations. During arthroscopy, a revision of the subacromial space is performed; at the second stage, subacromial decompression is most often performed, including the intersection of the coracoacromial ligament with anterior acromionoplasty; at the third stage, osteophytes are removed along the lower surface of the acromial process of the scapula and the integrity of the tendons is restored by suturing or plastic surgery. Rehabilitation measures after arthroscopy are prescribed after 1-2 weeks, when tissue swelling decreases. They include physical therapy. Exercises are given by a rehabilitation doctor with a gradual increase in load. Kinesio taping and the use of fixatives help regulate the inclusion of certain muscles in work. Physiotherapeutic methods accelerate the healing process and contribute to the speedy restoration of joint function.
In cases where physical therapy and medications do not bring results, you still have to resort to surgery. At the SportClinic you will be able to undergo it with the best surgeons in Russia. You will also have access to effective rehabilitation and a full range of services in the field of sports medicine.
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Chechil Sergey Vyacheslavovich - Chief physician of the clinic. The main direction is the musculoskeletal system. He has 24 years of medical experience: managing the medical service of a nuclear submarine, managing the special training department of the Paratunka military sanatorium in Kamchatka.
Kovtun Yuri Vadimovich - neurologist, chiropractor, specialist in the selection and installation of orthopedic individual insoles. Certified Kinesto Taping Specialist.
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Anatomical structure of a normal shoulder joint.
The shoulder joint is formed by three bones: the head of the humerus, the glenoid cavity of the scapula and the clavicle, which is not anatomically connected to the joint, but significantly influences its function. The head of the humerus corresponds in shape to the glenoid cavity of the scapula, also called the glenoid cavity (from the Latin term cavitas glenoidalis - glenoid cavity). Along the edge of the glenoid cavity of the scapula there is an articular lip - a cartilaginous roller that holds the head of the humerus in the joint.
The strong connective tissue that makes up the shoulder capsule is essentially a system of glenohumeral ligaments that helps the head of the humerus stay in the correct position relative to the glenoid cavity of the scapula. The ligaments are firmly fused with the thin joint capsule. These include the coracobrachial and articular-brachial ligaments (has three bundles: upper, middle and lower). The shoulder joint is also surrounded by powerful muscles and tendons that actively provide stability through their efforts. These include the supraspinatus, infraspinatus, teres minor, and subscapularis muscles, which form the rotator cuff. Each of these muscles performs its own function: the subscapularis rotates the arm inward, the supraspinatus raises the shoulder and “anchors” it, i.e. presses the head of the humerus into the glenoid cavity of the scapula when the shoulder is abducted to the side. In this case, the main force of abduction is determined by the deltoid muscle, and the supraspinatus muscle works as a commander, directing the efforts of the deltoid muscle. The infraspinatus muscle rotates the shoulder outward, and the teres minor also rotates outward and brings the arm to the body.
All together they function as the rotator cuff of the shoulder.
FORMATION OF A LATERAL ROW OF SUTURES, FIXATION USING NONDULAR POPLOK FASTENERS.
After the formation of the medial row of sutures, for the purpose of more anatomical fixation and creating a larger area of attachment of the tendon to the bone, a lateral row of sutures is formed. PopLok, ConMed Linvatec, and thread locks are used in this presentation. (photo 13) The advantage of these clamps is the possibility of nodal fixation of several threads from different anchor clamps and the possibility of their separate tension. Using a special tool, channels are formed for the insertion of fixatives. The threads are crossed and inserted into the PopLok. (photo 14) After this, the latch is inserted into the canal, the threads are stretched, tightly pressing the fixed tendon, and the latch and threads are blocked. (photo 15-16) As a result, a strong two-row fixation is achieved. (photo 17)
In the postoperative period, the arm is fixed with an orthotic bandage, and restorative treatment is prescribed.