Supraspinatus is one of the rotator cuff muscles that originates from
the scapula and inserts on the greater tubercle of humerus. It passes through
the subacromial space where it is liable to injury by hooked/curved acromion,
bony spurs or friction with the acromion process due to impaired scapular
movement. Supraspinatus tears can be an acute injury resulting from fall on
shoulder, throwing or any sudden overhead action. It can also be a gradual
process resulting from wear and tear due to constant irritation at the
subacromial space.
***** Much like the rotator cuff impingement, a supraspinatus tear may occur
due to ongoing impingement and repetitive movements hence wear and tear or from
a traumatic episode such as falling on the outstretched arm. Supraspinatus tear
is more common in patient population of over 40 years of age. ******
The patient complains of pain and inability to lift the arm especially in
abduction. Night pain while lying on affected side is common. Lifting and
overhead activity is extremely painful. Reduced muscle strength and decreased
ROM are evident on examination. There may swelling at the muscle insertion. A
tear of the supraspinatus tendon can be detected by the empty-can test or
full-can test: apply downward force to the arm in 90° scaption and in internal
rotation (thumb down). If there is a supraspinatus tear, the patient cannot
resist this force because of muscle weakness.
The main objective of physiotherapy treatment is reduction of pain and
inflammation followed by increasing ROM and muscle strength. Once the initial
phase of the injury has passed, within a couple days. Treatment would consist
of gentle passive movements, pendular exercises and active assisted ROM
exercises. Strengthening the postural muscles and correction of posture are key
to starting the rehabilitation process. Anteroinferiorglenohumeral glide can
also help to increase shoulder abduction and external rotation ROM. In case of
supraspinatus tendon rupture, surgery followed by intensive rehabilitation is
the preferred mode of treatment. Functional rehab is advised after shoulder ROM
is full and pain free and strength is optimum. The entire rehab period can
extend from 3 weeks to 6 months.