eMedicine Specialties > Sports Medicine > Shoulder
Supraspinatus Tendonitis: Follow-up
Updated: Jun 8, 2006
Follow-up
Return to Play
Return to play is restricted until full, painless range of motion is restored; both rest- and activity-related pain are eliminated; and provocative impingement signs are negative. Isokinetic strength testing must be 90% compared with the contralateral side. Resumption of activities is completed gradually, first during practice, to build up endurance, work on modified technique/mechanics, and simulate a game situation. Patients must be free of symptoms. To prevent recurrence, the patient should continue flexibility and strengthening exercises after returning to sports activities.
Complications
If rotator cuff tendonitis is not diagnosed and treated promptly and correctly, it can progress to rotator cuff degeneration and eventual tear. Other complications may include progression to adhesive capsulitis, cuff tear arthropathy, and reflex sympathetic dystrophy. Other complications may result from surgery, injections, physical therapy, or medications.
Prevention
Primary prevention should be considered an integral part of the treatment of rotator cuff tendonitis. Educating patients at risk can circumvent the development of rotator cuff tendonitis. Athletes, particularly those involved in throwing and sports involving overhead actions, and laborers with repetitive shoulder stress should be instructed in proper warmup techniques, specific strengthening techniques, and warning signs of early impingement.
Prognosis
In general, the prognosis is good for rotator cuff tendonitis that is promptly and correctly diagnosed and treated. Of patients, 60-90% improve and are free of symptoms with conservative treatment. Surgical outcomes are also very promising for patients in whom a full trial of conservative therapy fails.
Education
Patient education may improve the outcome because the patient is educated regarding avoidance of provocative activities, pathology, and proper shoulder arthrokinematics. Education should also stress proper warmup techniques, specific strengthening techniques, and warning signs of early impingement. A proper home exercise program should be formulated and encouraged to prevent recurrence of symptoms.
For excellent patient education resources, visit eMedicine's Breaks, Fractures, and Dislocations Center and Sports Injury Center. Also, see eMedicine's patient education articles Tendinitis and Rotator Cuff Injury.
Miscellaneous
Medicolegal Pitfalls
- If the diagnosis of a rotator cuff tendonitis is missed, no immediate catastrophic sequela occurs; although, without prompt and correct diagnosis and treatment, the patient may become progressively disabled. Other complications may include progression to adhesive capsulitis, cuff tear arthropathy, and reflex sympathetic dystrophy. Other complications may result from surgery, injection, physical therapy, or medications.
- With any complaint of shoulder pain, the clinician must rule out disorders that may have catastrophic consequences if action is not taken immediately, such as infection, cardiac etiologies, tumor, dislocation, fracture, vascular injury, peripheral neurologic injury, and cervical spine neurologic injury. These diagnoses must be kept in mind in the differential and tested for when assessing a shoulder problem in any patient.
Special Concerns
- Supraspinatus tendonitis is managed similarly in all populations. Whether it is managed more or less aggressively depends on the patient's activity level, reliance on the shoulder for an occupation or athletics (recreational or competitive), age, and comorbid medical illnesses.
- In pregnant women, nursing mothers, young children, and patients with comorbid medical illnesses, caution should be used when administering medications to ensure the medication chosen is compatible with the patient. Age, accompanying medical illnesses, low activity level, poor healing potential, poor anesthetic candidacy, and pregnancy status may preclude the patient from being a surgical candidate.
More on Supraspinatus Tendonitis |
| Overview: Supraspinatus Tendonitis |
| Differential Diagnoses & Workup: Supraspinatus Tendonitis |
| Treatment & Medication: Supraspinatus Tendonitis |
 Follow-up: Supraspinatus Tendonitis |
| References |
| « Previous Page |
References
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. First ed. London, England: Mosby; 1995:92-98.
Fu FH, Stone DA, eds. Sports Injuries: Mechanisms, Prevention, Treatment. First ed. Philadelphia, Pa: Lippincott, Williams & Wilkins; 1994:895-923.
Hawkins RJ, Kennedy JC. Impingement syndrome in athletes. Am J Sports Med. May-Jun 1980;8(3):151-8. [Medline].
Miller MD, Cooper DE, Warner JJ, eds. Review of Sports Medicine and Arthroscopy. First ed. Philadelphia, Pa: WB Saunders Co; 1995:113-164.
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].
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].
Further Reading
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
