Supraspinatus Tear

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.

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