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Supraspinatus Tendonitis Workup

  • Author: Thomas M DeBerardino, MD; Chief Editor: Sherwin SW Ho, MD  more...
 
Updated: May 23, 2016
 

Imaging Studies

See the list below:

  • 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.

Sonoelastography (SE) is a new technique that can assess differences in tissue stiffness. A study investigated the performance of sonoelastography (SE) for the differentiation of supraspinatus (SSP) tendon alterations of tendinopathy compared to magnetic resonance imaging (MRI) and conventional ultrasonography (US). The study concluded that SE is valuable in the detection of the intratendinous and peritendinous alterations of the SSP tendon and has excellent interobserver reliability and excellent correlation with MRI findings and conventional ultrasonography findings.[6]  

A study by Lee et al evaluated the relationship between tendon stiffness on sonoelastography and the MRI tendinosis grade in patients with rotator cuff tendinopathy. The study found that the MRI tendinosis grade is associated with stiffness assessed using sonoelastography in patients with rotator cuff tendinopathy.[7]

 
 
Contributor Information and Disclosures
Author

Thomas M DeBerardino, MD Associate Professor, Department of Orthopedic Surgery, Consulting Surgeon, Sports Medicine, Arthroscopy and Reconstruction of the Knee, Hip and Shoulder, Team Physician, Orthopedic Consultant to UConn Department of Athletics, University of Connecticut Health Center

Thomas M DeBerardino, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Orthopaedic Society for Sports Medicine

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Arthrex, Inc.; Ivy Sports Medicine; MTF; Aesculap; The Foundry, Cotera; ABMT<br/>Received research grant from: Histogenics; Cotera; Arthrex.

Coauthor(s)

Wing K Chang, MD Physician, Peachtree Orthopaedic Clinic

Wing K Chang, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, Physiatric Association of Spine, Sports and Occupational Rehabilitation, American College of Sports Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Russell D White, MD Clinical Professor of Medicine, Clinical Professor of Orthopedic Surgery, Department of Community and Family Medicine, University of Missouri-Kansas City School of Medicine, Truman Medical Center-Lakewood

Russell D White, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Family Physicians, American Association of Clinical Endocrinologists, American College of Sports Medicine, American Diabetes Association, American Medical Society for Sports Medicine

Disclosure: Nothing to disclose.

Chief Editor

Sherwin SW Ho, MD Associate Professor, Department of Surgery, Section of Orthopedic Surgery and Rehabilitation Medicine, University of Chicago Division of the Biological Sciences, The Pritzker School of Medicine

Sherwin SW Ho, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, Arthroscopy Association of North America, Herodicus Society, American Orthopaedic Society for Sports Medicine

Disclosure: Received consulting fee from Biomet, Inc. for speaking and teaching; Received grant/research funds from Smith and Nephew for fellowship funding; Received grant/research funds from DJ Ortho for course funding; Received grant/research funds from Athletico Physical Therapy for course, research funding; Received royalty from Biomet, Inc. for consulting.

Additional Contributors

Craig C Young, MD Professor, Departments of Orthopedic Surgery and Community and Family Medicine, Medical Director of Sports Medicine, 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

Disclosure: Nothing to disclose.

References
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  4. Millar NL, Wei AQ, Molloy TJ, Bonar F, Murrell GA. Cytokines and apoptosis in supraspinatus tendinopathy. J Bone Joint Surg Br. 2009 Mar. 91(3):417-24. [Medline].

  5. 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. 2009 Dec 21. 10:163. [Medline]. [Full Text].

  6. Seo JB, Yoo JS, Ryu JW. Sonoelastography findings of supraspinatus tendon in rotator cuff tendinopathy without tear: comparison with magnetic resonance images and conventional ultrasonography. J Ultrasound. 2015 Jun. 18 (2):143-9. [Medline].

  7. Lee SU, Joo SY, Kim SK, Lee SH, Park SR, Jeong C. Real-time sonoelastography in the diagnosis of rotator cuff tendinopathy. J Shoulder Elbow Surg. 2016 May. 25 (5):723-9. [Medline].

  8. Mautner K, Colberg RE, Malanga G, et al. Outcomes after ultrasound-guided platelet-rich plasma injections for chronic tendinopathy: a multicenter, retrospective review. PM R. 2013 Mar. 5(3):169-75. [Medline].

  9. Moraes VY, Lenza M, Tamaoki MJ, Faloppa F, Belloti JC. Platelet-rich therapies for musculoskeletal soft tissue injuries. Cochrane Database Syst Rev. 2014 Apr 29. 4:CD010071. [Medline].

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  19. 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. 2001 Aug. 83(6):873-6. [Medline].

  20. Valen PA, Foxworth J. Evidence supporting the use of physical modalities in the treatment of upper extremity musculoskeletal conditions. Curr Opin Rheumatol. 2010 Mar. 22(2):194-204. [Medline].

 
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