eMedicine Specialties > Sports Medicine > Shoulder

Supraspinatus Tendonitis: Differential Diagnoses & Workup

Author: Thomas M DeBerardino, MD, Director, John A Feagin Jr West Point Sports Medicine Fellowship, Orthopedic Surgery Service, Clinical Instructor in Surgery, Keller Army Community Hospital at West Point
Coauthor(s): Wing K Chang, MD, Musculoskeletal Spine Fellow, Department of Physical Medicine and Rehabilitation, University of Michigan Medical Center
Contributor Information and Disclosures

Updated: Jun 8, 2006

Differential Diagnoses

Acromioclavicular Joint Injury
Contusions
Bicipital Tendonitis
Infraspinatus Syndrome
Brachial Plexus Injury
Myofascial Pain in Athletes
Cervical Disc Injuries
Rotator Cuff Injury
Cervical Discogenic Pain Syndrome
Shoulder Dislocation
Cervical Radiculopathy
Shoulder Impingement Syndrome
Cervical Spine Sprain/Strain Injuries
Superior Labrum Lesions
Clavicular Injuries
Swimmer's Shoulder

Other Problems to Be Considered

Os Acromiale

Workup

Imaging Studies

  • Standard radiographic studies are used to rule out glenohumeral/acromioclavicular arthritis and Os Acromiale.
    • Anteroposterior view of the glenohumeral joint
    • Internal rotation view of the humerus with a 20° upward angulation to show the acromioclavicular joint
    • Axillary view - Most useful to rule out subtle signs of instability (eg, glenoid avulsion, Hill-Sachs lesion) and to visualize the presence of an os acromiale
    • Stryker notch view - Potential os acromiale is easily visualized and assessed when viewed through the humeral head
    • Supraspinatus outlet view - Most useful to assess the supraspinatus outlet space (If <7 mm, the patient is more at risk for impingement syndrome.) and helps assess morphology of the acromion (A hooked acromion is more at risk for impingement.)
       
  • MRI is considered the imaging study of choice for shoulder pathology.
    • Advantages

      • Noninvasive
      • No radiation
      • Can detect intrasubstance tendon degeneration or partial rotator cuff tears
      • Can detect inflammation, edema, hemorrhage, and scarring
      • Can be used with an intra-articular contrast agent (eg, gadolinium), improving its ability to detect partial rotator cuff tears
         
    • Disadvantages

      • Often cannot accommodate patients with claustrophobia
      • Often cannot accommodate larger patients
      • Cannot accommodate patients with pacemakers, other metal implants, or particles
      • Dependent on quality of the MRI machine
      • Dependent on the skill of the technician performing the imaging and the radiologist interpreting the images
      • High cost
         
  • For arthrography, dye is injected into the glenohumeral joint and postinjection radiographs are taken to assess the integrity of the glenohumeral joint.
    • Can be used to evaluate rotator cuff tears (A finding of dye escaping out of the joint and into the subacromial space is diagnostic of a full-thickness rotator cuff tear.)
    • Advantages - Can be used in conjunction with a CT scan to evaluate intra-articular pathology (eg, Bankart tears) and has a low cost
    • Disadvantages - Size of the tears cannot be quantified, patient is exposed to radiation and contrast dye, procedure is invasive
       
  • Diagnostic arthroscopy
    • Minimally invasive, visual, surgical procedure to assess shoulder pathology
    • Can visualize and assess most shoulder pathology
    • May afford the patient and physician a chance to diagnose and treat the pathology with one procedure
    • Disadvantage - May miss capsular-sided, partial-thickness tears
       
  • Note: A workup for other, more systemic processes may be included as clinically indicated.

More on Supraspinatus Tendonitis

Overview: Supraspinatus Tendonitis
Differential Diagnoses & Workup: Supraspinatus Tendonitis
Treatment & Medication: Supraspinatus Tendonitis
Follow-up: Supraspinatus Tendonitis
References
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References

  1. Andrews JR, Harrelson GL, Wilk KE, Lampert R, eds. Physical Rehabilitation of the Injured Athlete. 2nd ed. Philadelphia, Pa: WB Saunders Co; 1998:478-553.

  2. Bigliani LU, Morrison DS, April EW. The morphology of the acromion its relationship to rotator cuff tears. J Orthop Trans. 1986;10:228.

  3. Brotzman SB, ed. Clinical Orthopaedic Rehabilitation. First ed. London, England: Mosby; 1995:92-98.

  4. Fu FH, Stone DA, eds. Sports Injuries: Mechanisms, Prevention, Treatment. First ed. Philadelphia, Pa: Lippincott, Williams & Wilkins; 1994:895-923.

  5. Hawkins RJ, Kennedy JC. Impingement syndrome in athletes. Am J Sports Med. May-Jun 1980;8(3):151-8. [Medline].

  6. Miller MD, Cooper DE, Warner JJ, eds. Review of Sports Medicine and Arthroscopy. First ed. Philadelphia, Pa: WB Saunders Co; 1995:113-164.

  7. Neer CS 2nd. Anterior acromioplasty for the chronic impingement syndrome in the shoulder: a preliminary report. J Bone Joint Surg Am. Jan 1972;54(1):41-50. [Medline].

  8. Schmitt J, Haake M, Tosch A, Hildebrand R, Deike B, Griss P. Low-energy extracorporeal shock-wave treatment (ESWT) for tendinitis of the supraspinatus. A prospective, randomised study. J Bone Joint Surg Br. Aug 2001;83(6):873-6. [Medline].

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Further Reading

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Keywords

rotator cuff tendonitis, rotator cuff tendinopathy, rotator cuff tendinosis, shoulder impingement syndrome, shoulder pain, rotator cuff injury, rotator cuff tear, torn rotator cuff, shoulder injury, rotator cuff pathology, shoulder pathology, pitching injury, throwing injury

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Contributor Information and Disclosures

Author

Thomas M DeBerardino, MD, Director, John A Feagin Jr West Point Sports Medicine Fellowship, Orthopedic Surgery Service, Clinical Instructor in Surgery, Keller Army Community Hospital at West Point
Thomas M DeBerardino, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Medical Association, American Orthopaedic Association, and American Orthopaedic Society for Sports Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Wing K Chang, MD, Musculoskeletal Spine Fellow, Department of Physical Medicine and Rehabilitation, University of Michigan Medical Center
Wing K Chang, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American College of Sports Medicine, and Physiatric Association for Spine, Sports and Occupational Rehabilitation
Disclosure: Nothing to disclose.

Medical Editor

Craig C Young, MD, Medical Director of Sports Medicine, Departments of Orthopedic Surgery and Community and Family Medicine, Sports Medicine Fellowship Director, Associate Professor, Medical College of Wisconsin
Craig C Young, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Medical Society for Sports Medicine, Phi Beta Kappa, and Wilderness Medical Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Russell D White, MD, Professor of Medicine, Department of Community and Family Medicine, University of Missouri-Kansas City School of Medicine, Truman Medical Center Lakewood
Disclosure: Nothing to disclose.

CME Editor

Jon Whitehurst, MD, Consulting Staff, Rockford Orthopedic Associates
Disclosure: Nothing to disclose.

Chief Editor

William Jay Bryan, MD, Clinical Professor, Department of Orthopedic Surgery, Baylor University College of Medicine
William Jay Bryan, MD is a member of the following medical societies: Texas Orthopaedic Association
Disclosure: Nothing to disclose.

 
 
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