eMedicine Specialties > Sports Medicine > Shoulder
Supraspinatus Tendonitis: Differential Diagnoses & Workup
Updated: Jan 21, 2010
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
Differential Diagnoses
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
- Advantages
- 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 |
| Further Reading |
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References
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].
Fu FH, Stone DA, eds. Sports Injuries: Mechanisms, Prevention, Treatment. Philadelphia, Pa: Lippincott, Williams & Wilkins; 1994:895-923.
Miller MD, Cooper DE, Warner JJ, eds. Review of Sports Medicine and Arthroscopy. Philadelphia, Pa: WB Saunders Co; 1995:113-64.
Lewis JS, Raza SA, Pilcher J, Heron C, Poloniecki JD. The prevalence of neovascularity in patients clinically diagnosed with rotator cuff tendinopathy. BMC Musculoskelet Disord. Dec 21 2009;10(1):163. [Medline].
Millar NL, Wei AQ, Molloy TJ, Bonar F, Murrell GA. Cytokines and apoptosis in supraspinatus tendinopathy. J Bone Joint Surg Br. Mar 2009;91(3):417-24. [Medline].
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.
Bigliani LU, Morrison DS, April EW. The morphology of the acromion its relationship to rotator cuff tears. J Orthop Trans. 1986;10:228.
Brotzman SB, ed. Clinical Orthopaedic Rehabilitation. London, England: Mosby; 1995:92-8.
Chae J, Jedlicka L. Subacromial corticosteroid injection for poststroke shoulder pain: an exploratory prospective case series. Arch Phys Med Rehabil. Mar 2009;90(3):501-6. [Medline].
Cumpston M, Johnston RV, Wengier L, Buchbinder R. Topical glyceryl trinitrate for rotator cuff disease. Cochrane Database Syst Rev. Jul 8 2009;CD006355. [Medline].
Denaro V, Ruzzini L, Longo UG, et al. Effect of dihydrotestosterone on cultured human tenocytes from intact supraspinatus tendon. Knee Surg Sports Traumatol Arthrosc. Oct 27 2009;epub ahead of print. [Medline].
Hawkins RJ, Kennedy JC. Impingement syndrome in athletes. Am J Sports Med. May-Jun 1980;8(3):151-8. [Medline].
Rees JD, Maffulli N, Cook J. Management of tendinopathy. Am J Sports Med. Sep 2009;37(9):1855-67. [Medline].
Schmitt J, Haake M, Tosch A, et al. 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].
Valen PA, Foxworth J. Evidence supporting the use of physical modalities in the treatment of upper extremity musculoskeletal conditions. Curr Opin Rheumatol. Dec 11 2009;epub ahead of print. [Medline].
Further Reading
Related eMedicine Topics
- The Approach to the Painful Joint [in the Rheumatology section]
- Overuse Injury [in the Physical Medicine and Rehabilitation section]
- Rotator Cuff Disease [in the Physical Medicine and Rehabilitation section]
- Rotator Cuff Injury [in the Sports Medicine section]
- Rotator Cuff Pathology [in the Orthopedic Surgery section]
- Shoulder, Rotator Cuff Injury (MRI) [in the Radiology section]
- Shoulder, Rotator Cuff Injury (Ultrasonography) [in the Radiology section]
- Shoulder Impingement Syndrome
- Shoulder Subacromial Injections [in the Clinical Procedures section]
- Tendonitis [in the Emergency Medicine section]
Clinical Trials
- All-Arthroscopic Versus Mini-Open Repair of Small or Moderate Rotator Cuff Tears
- Cascade PRFM Study: The Evaluation of Cascade Platelet-Rich Fibrin Matrix (PRFM) on Rotator Cuff Healing
- Comparison of 2 Doses of Corticosteroid Subacromial Injections for the Treatment of Painful Shoulder
- Platelet Rich Plasma on Rotator Cuff Repair
- Rotator Cuff Repair With Arthroscopic Acromioplasty (Shaving the Acromion Bone) Versus Repair Without Acromioplasty
- Subacromial Decompression Versus Subacromial Bursectomy for Patients With Rotator Cuff Tendinosis
Clinical Guidelines
- ACR Appropriateness Criteria® shoulder trauma. American College of Radiology - Medical Specialty Society. 1995 (revised 2005). 6 pages. NGC:004632
- The diagnosis and management of soft tissue shoulder injuries and related disorders. New Zealand Guidelines Group - Private Nonprofit Organization. 2004. 66 pages. NGC:003865
- Diagnostic imaging guideline for musculoskeletal complaints in adults - an evidence-based approach. Part 2: upper extremity disorders. Canadian Protective Chiropractic Association - Professional Association; l'Université du Québec à Trois-Rivières - Academic Institution. 2008 Jan. 31 pages. NGC:006702
- Rotator cuff tear. In: The medical disability advisor: workplace for guidelines for disability duration, sixth edition. REED Group - Private For Profit Organization. 2005 (revised 2009). 10 pages. NGC:007258
- Shoulder (acute & chronic). Work Loss Data Institute - Public For Profit Organization. 2003 (revised 2008 May 28). 217 pages. NGC:006566
Keywords
supraspinatus tendonitis, supraspinatus tendinitis, 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
