Supraspinatus Rupture

Supraspinatus Rupture: Causes, Symptoms, Diagnosis, Treatment

This is a painful condition of the shoulder in which there is a tear or rupture of the tendons of the Supraspinatus Muscle. This condition is relatively common and generally extremely painful. This condition is usually developed as a result of a direct blow to the shoulder like when falling on the shoulder or other sporting injuries.

Supraspinatus Rupture

What is Supraspinatus Muscle?

Supraspinatus muscle originates at superior portion of shoulder blade known as scapula. The opposite end of muscle turns in to tendon and attaches to greater tubercle of humerus. Tendon is form by tough fibers tissue.

What is the Function of Supraspinatus Muscle?

Contraction of supraspinatus muscle pulls the upper arm away from the side of the body. Such movement is known an abduction. Supraspinatus muscle also assist in internal rotation of upper arm. The function of a tendon is to connect muscles to bones and pull the bone when muscles contracts and pulls the tendon.

What is Supraspinatus Rupture?

Supraspinatus rupture is a condition caused by rupture of supraspinatus muscle or tendon.1 Supraspinatus Rupture causes microscopic tear, major tear and dislocation from its attachment to humerus and scapula. The major tear causes separation of muscle or tendon into two torn segment of muscles or tendons.

What Causes Pain Following Supraspinatus Tendon or Muscle Rupture?

The tear causes severe pain and pain intensity increases when muscle contract. The muscle laceration, injury and tear exposes sensory nerve receptors and also causes injury of nerve fibers. Such injury causes pain a rest, palpation of injured muscle and with contraction of muscle. The contraction of supraspinatus muscle does not assist abduction or internal rotation movement of upper arm. Tendon rupture in most cases causes loss of abduction and internal rotation of upper arm mobility of the humerus bone.

What is Rotator Cuff?

There are several muscles around shoulder joint. The group of four muscles are known as rotator cuff.2

Which Muscles Form Rotator Cuff?

The four muscles known as supraspinatus, infraspinatus, teres minor, and subscapularis forms the rotator cuff. The contraction of these muscles causes shoulder joint rotation and movement.

Which Rotator Cuff Muscle Is Frequently Injured?

Supraspinatus muscle is most frequently injured or torn. Usually, the supraspinatus tendon is quite strong, but repeated shoulder joint rotation causes weakness in muscle and tendon fibers. In most cases direct trauma and repeated shoulder joint movement causes minor tear and minor separation of tendon from its attachment to humerus and scapula.

Who Suffers With Supraspinatus Rupture Or Rotator Cuff Tear?

Supraspinatus or rotator cuff rupture is very common in golfer, tennis player, manual worker as well as recreational weight lifter. Shoulders joint is the most active joint in human body.

What Are The Risk Factors That Causes Supraspinatus Rupture?

Following risk factors are involved in supraspinatus rupture and rotator cuff tear.3

  • Age- More often seen in elderly people
  • Sex- Few menopausal females suffer with osteoporosis and such condition can cause rupture and tear of tendon.
  • Profession- Tennis player, Golfer, manual worker and body builder.
  • Dominance upper arm- Most rupture is observed in dominant arm.
  • Smoker- The tendon and muscle tear is common among the smoker
  • Osteoporosis– Osteoporosis causes weakness in bone and attachment of tendon to the bone.

Causes of Supraspinatus Rupture

  1. Tendon degenerative changes,
  2. Weak shoulder girdle anatomy (structure),
  3. Shoulder joint rotation and abnormal biomechanics,
  4. Joint ischemia and
  5. Dehydration
  6. Repeated shoulder joint movement

Studies indicate that there are six important causes that results in Supraspinatus Rupture. Some causes can be avoided or prevented by modification of life style or performing regular shoulder joint stretching exercises.

  1. Tendon Degenerative Changes:

    The Supraspinatus Tendon tends to get weak as the individual ages and becomes prone to tears. Most of Supraspinatus Ruptures have been found in people above the age of 40 but individuals involved in the sporting field or are involved in motor vehicle accidents which can cause direct trauma to the shoulders can also develop this condition.

  2. Weak Shoulder Girdle Anatomy (Structure)

    The individual shape of bony structures within shoulder joint play a vital role in determining whether a tendon is able to move freely or gets impinged between structures with frequent elevation of arms. Most shoulder joint pain is caused by pinch or torsion of supraspinatus tendon. The anatomical abnormalities are diagnosed using MRI images and surgically treated.

  3. Shoulder Joint Rotation and Abnormal Biomechanics:

    Supraspinatus Muscle is a part of the rotator cuff muscles. Rotator cuff facilitates stability to the shoulder joint. Repeated shoulder joint movement that involves abduction and internal rotation need near perfect coordination. Sometime lack of concentration or stretching arm outward during the act of fall causes over abduction or hyper internal rotation of the upper extremity. Such lack of coordination frequently causes rupture of supraspinatus muscle or tendon.

  4. Joint Ischemia

    Occasionally because of cardiac and vascular disease blood supply to muscles of shoulder joint is compromised. Such condition is rare but caused by arterial embolism or thrombosis. The decreased blood flow to supraspinatus muscle or tendon causes ischemic changes that results in muscle atrophy and degeneration. Muscle become fragile and easily tear under pressure.

  5. Dehydration

    Generalized dehydration causes decreased water content in muscle and tendon. Muscle and tendon then undergoes metabolic and degenerative changes. The metabolic and degenerative changes in muscles causes weakness in muscle that results in uncoordinated contraction. Dehydration also makes the tendon weak and weak tendon under pressure is prone to get injured.

  6. Repeated Shoulder Joint Movement-

    Supraspinatus Rupture also occurs with sporting activities, which involve powerful repeated shoulder joint movements. Such action is observed in individual involved in manual work, tennis player, golfer and throwing baseball. Manual worker working in occupations which require heavy lifting overhead are also prone to Supraspinatus Rupture.

Symptoms of Supraspinatus Rupture

Excruciating pain in shoulders joint- Individual feels severe pain during initiation of shoulder joint abduction or rotation.3 Pain continues at rest and intensity increases with shoulder joint movements.

Restricted Shoulder Joint Movement- Individual suffering with rotator cuff tear or supraspinatus muscle or tendon rupture, avoids any movement of shoulder joint because of increased intensity of pain. Severe pain in the shoulder joint restricts the abduction and internal rotation movements.

Shoulder Joint Stiffness- The restricted shoulder joint eventually become stiff. Stiff joint because of muscle atrophy is unable to move for prolonged period if treatment is delayed.

Shoulder Joint Crepitation- Individual hears soft crackling or crepitation during shoulder joint movement. The symptom is mostly observed when tendon or muscle is partially torn or dislocated from its attachment to bones.

Diagnosis of Supraspinatus Rupture

In order to diagnose a Supraspinatus Rupture, the physician will begin with a detailed physical examination of the shoulders joint. Examination includes palpation examination of the joint to rule out abnormal bony protrusion. Bony protrusion suggests fracture or dislocation of shoulder joint. Injured person is asked to move the arm in different directions to assess for range of motion. The physician will then look for any palpable tenderness or deformity in the shoulder area. The physician will also check the strength of the arm to look for any sort of muscle weakness.

Investigations to Diagnose Supraspinatus Rupture –

  • X-rays. X-Ray does not show soft tissue inflammation or tear. Thus isolated supraspinatus rupture is difficult to diagnose with X-Ray. X-Ray helps to rule out fracture or dislocation of shoulder joint.
  • MRI Scan/Ultrasound. These studies are more sensitive and the images show the muscle or tendon swelling and tear. The rotator cuff anatomy is also easy to read on the image. The diagnosis is confirmed when MRI shows the tear, separation of tendon or muscle and dislocation of tendon from its attachment to humerus and scapula.
  • Ultrasound Examination- Ultrasound image shows the details of muscles and tendons of the shoulders. The hematoma muscle swelling and tear is seen on ultrasound image.

Treatment For Supraspinatus Rupture

Supraspinatus Ruptures can be treated both surgically as well as conservatively.5

  1. Conservative Treatment for Supraspinatus Rupture Includes:

    1. Cold Therapy
    2. Heat Treatment
    3. Massage therapy
  2. Medications

    1. NSAIDs– Motrin, Naproxen or Celebrex
    2. Tylenol
    3. Opioids- Vicodin, Oxycodone or Morphin
  3. Physical therapy

    1. Stretching exercise
    2. Ultrasound therapy
    3. Cold or hot treatment
  4. Interventional or injection therapy

    1. Cortisone injection
  5. Surgery

    1. Endoscopic surgery
    2. Repair of rupture supraspinatus tendon
    3. Reconstruction of shoulder joint
  6. Rehabilitation Treatment 5

Conservative management helps to relive pain and improve joint movement when tendon is partially torn. Physical therapy is the preferred choice of treatment following surgery. Physical therapy is also recommended when tendon is partially torn, so as to rebuild muscle strength and improve shoulder joint movement. The dislocated and completely torn supraspinatus tendon is treated with surgery. Rarely patient may need multiple attempt of surgery. If pain continues after multiple surgeries and tendon condition is deteriorated to the level one cannot use shoulder joint, then patient is considered for reconstruction of shoulder joint.

The repair of tendon tear is now a days performed using arthroscopic technique. The results are better after endoscopic (arthroscopic) surgery.6 The arthroscopic surgery is preferred because surgery causes minimum trauma and surgery is performed using small incision. The camera of endoscopy shows the structure of joint over large television screen. The larger image helps to identify important joint structure as well as nerves and blood vessels. The technique helps to prevent nerve damage as well as causes minimum bleeding.

Post Treatment Precautions-

  • Discontinue smoking
  • Do not lift heavy object for 12 weeks or longer
  • The individual suffering from Supraspinatus Rupture should limit shoulder joint movement during the healing phase.
  • Supraspinatus Rupture patient should continue physical therapy until one achieves optimum shoulder joint movement.

Studies reflect that smaller or medium sized Supraspinatus Ruptures heal in 6 to 8 weeks in about 75% of cases. Average recovery period of Supraspinatus Ruptures being about six months before the individual can return to normal activities.

References:

  1. Rotator cuff tears: An evidence based approach Senthil Nathan SambandamVishesh KhannaArif Gul, and Varatharaj Mounasamy, World J Orthop. 2015 Dec 18; 6(11): 902–918.
  2. ROTATOR CUFF TENDINOPATHY David Factor, DPT, EMT‐P1 and Barry Dale, PT, PhD, DPT, ATC, SCS, OCS, CSCS2.
  3. Clinical Examination of the Rotator Cuff Nitin B. Jain, MD, MSPH,1,2,3 Reginald Wilcox, PT,4 Jeffrey N. Katz, MD, MS,2,5 and Laurence D. Higgins, MD2,3, PM R. 2013 Jan; 5(1): 10.1016/j.pmrj.2012.08.019.
  4. Treatment Options for Rotator Cuff Tears: A Guide for Adults John M. Eisenberg Center for Clinical Decisions and Communications Science.
  5. Management of Rotator Cuff Injuries in the Elite Athlete Leigh J. Weiss,1 Dean Wang,2 Michael Hendel,2 Philip Buzzerio,1 and Scott A. Rodeo3 Curr Rev Musculoskelet Med. 2018 Mar; 11(1): 102–112.
  6. Outcomes of rotator cuff surgery: what does the evidence tell us? Aleem AW1Brophy RH., Clin Sports Med. 2012 Oct;31(4):665-74.

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