SUPRASPINATUS TENDINITIS
DEFINITION
* In complete tear of Supraspinatus
– There will be total loss of active abduction at glenohumeral joint .
* In partial tear of Supraspinatus
– Results in painful arc syndrome ( felt at 90° of abduction)
√ It commanly causes impingement syndrome
√ Major site of compression : Anterior to angle of acromion
√ Also known as impingement syndrome or painful arc syndrome
• Types of Supraspinatus tendinitis
(1) Primary
(2) Secondary
(3) Posterior ( internal )
• Clinical features
– Many tears are asymptomatic
– Some may have stiffness and loss of abduction movement.
• Special tests
(1) Hawkins – Kennedy test
– Patient position : Sitting Position with 90° arm flexion and 90° elbow flexion
– Examiner then hold the proximal elbow with one hand and other hand hold the patient’s wrist proximally
– Then examiner will passively move the arm into the internal rotation
– If there is any pain in sub – acromial space indicates positive test
(2) Empty can test
– Patient position : Sitting position with shoulder at 90° and 0° rotation
– Shoulder abduction is resisted
– place the shoulder in empty can position i.e., Internal rotation and 30° of forward ( horizontal abduction). The patient thumb is pointing downward to the floor and resist shoulder abduction.
– Reproduction of pain and / or weakness of Supraspinatus tendon indicates positive test
(3) Neer’s impingement test
– Patient position : Sitting position and shoulder ka internally rotated and fully elevated ( passively )
– If there is any pain in Subacromial space indicates Positive test.
* Other diagnostic tests
– Active Test of ROM of shoulder abduction and slight overpressure is given at terminal point of movement
– Active resisted test for shoulder abduction
– Passive test of ROM of abduction
• Treatment
– Asymptomatic cases : no treatment is required
(1) Surgical treatment
– If there is Weakness and limitation of abduction , it may require surgical treatment
– Includes : Repair of torn tendon kr Subacromial decompression.
(2) PT management
* Strain / partial rupture :
– Resisted abduction
– Guided exercise with cryotherapy , heat or Ultrasound
*To prevent secondary adhesive capsulities : Relaxed full range passive movements can be given in supine position
* In Complete tear : Arm is immobilized for abductors after surgery.
* First 3 weeks :
– movements for elbow , forearm , hand and wrist .
– Static abductor contractions Initiated by 8-10 days if they are not pain full
* After 3 weeks :
Strengthening and re-education of shoulder abductors .
