Supraspinatus tendinitis

Have this patient which is causing some probs

Supraspiantus tendinitis for last year, never took any meds or physio services as never really believed in them.

On assessment, it was tender on palpation, no other inflammatory signs.

I was thinking of trying to relieve the inflammation, but since its been 1 yr, i think it has gone into a chronic inflammatory phase.

:hat Should i use cont US or heat modalities, and how long would you wait for stretching/commencement of strengthening exs (patient is an army recruit - quite strong!!)

Also, would low grade mobes help?

thanks ppl

Hi' yes Dear you can use constant us CZ pt enter chronic case 3 MHZ within 1 cm/2 and after inflammation sings disappear u can star stretching & strengthening exes,
after 3 session of pt start low grade mobes if still pain stop and renew for another 3 |I

inflammation for 1 year?! is that possible?! Histologicsl studies have shown that the tendons of so called "tendonitis" conditions have no inflammatory markers within them. Pain is due to a complex mix of nociception, peripheral and central sensitvity............there is some evidence emerging related to soft tissue degeneration and links have been made diet causing chemical imbalances within the tendons and subsequent pain ( Do some research!...type in tendonopathy or tendon pain into medline).

Also how the hell did you diagnose that it is the supraspinatous tendon affected? remember we treat patterns of pain...NOT ANATOMY.........unless you have opened the patient up removed some of his SS tendon and performed a histological study on it you don't know what structure is involved!......all you know is he has shoulder pain.

Steer clear of ultrasound and mobs and get a bit more pro active in your assessment and treatment of the shoulder joint complex

[physiosmith]

Tendinosis is the keyword you need to type in for your search. I agree with the last post, ultrasound is not your first choice of treatment, although mobs to the shoulder, thoracic and cervical may all be useful.

You should be looking at the biomechanics and recruitment patterns of the whole shoulder complex, together with the client's posture. From that you should be able to establish where you need to stretch, strengthen and stabilise in order to facilitate optimal recruitment patterns. Not easy in the shoulder as so many structures are involved, but you have to get beyond the basic us/mobs to give yourself a chance. When you get it right it is very rewarding for you, and the client thinks you're great.

[Physiobase]

I tend to agree that the mechanics of the shoulder joint are important. That said a true tendinitis is possible and could be diagnosed via a combination of MRI and a reduction of pain with an injection of local anesthetic into the tendon area. I find most tendinitis resolves with time and you are better off focusing on cervical mobs and neural mobilisations etc.

Releasing the subscapularis under the axilla is often very useful in reducing pain and increasing range of motion. Best of luck 8o

I agree with the tendinosis/tendinopathy. There is considerable research out there that debunks the "itis" . After 3 weeks there are rarely, histologically speaking , any inflammatory markers. See research by Karim Khan and Jill Cook.
Don't waste you time on ultrasound. Assess the muscular balance around the shoulder. Treat what is weak and then treat what is tight. But the key component is the movement pattern. Remember, force takes the path of least resistance, check HOW they are moving and correct the faults.