If you have ever been diagnosed with a "rotator cuff injury", "shoulder calcifications", "early-stages frozen shoulder", "shoulder impingement" etc., then this is what was happening in your shoulder - supraspinatus tendinosis.
The supraspinatus muscle originates on the top third of the scapula (shoulder blade) and inserts onto the head of the humerus (upper arm bone). The bulk of the muscle sits over the upper back, but the tendon travels underneath a bony section of the scapula called the acromion (Ancient Greek word meaning "highest point") before attaching to the humerus. It uncommon for tendons to loop around a bone, and that particular quirk of anatomy is the reason that supraspinatus tendinosis is as common as it is.
When a healthy shoulder moves, the small space underneath the acromion (where the supraspinatus tendon sits) is kept open by 2 scapular stabilising muscles (serratus anterior, and the inferior fibres of trapezius). In a weak shoulder that space is often not kept open and the tendon will grind against the acromion causing lesions and adhesions on the surface of the tendon - that damage to the tendinous tissue is supraspinatus tendinosis.
Supraspinatus tendinosis is painful, restricts the range of motion of the shoulder and is a self-perpetuating injury - meaning that the adhesions thicken the tendon, which causes greater impingement, which causes yet more adhesions.
TREATMENT: STRENGTH AND CONDITIONING
The root-cause of this injury is the weakening of the scapular stabilisers, so any treatment of supraspinatus tendinosis needs to include strength exercises for the muscles of the shoulder and upper back.
The best professionals to speak to about an evidence-based strength and conditioning program is an exercise physiologist - their role in the health system is to prescribe exercise to rehabilitate muscle strength after an injury, and also to correct faulty movement patterns to prevent re-injury.
TREATMENT: ACUPUNCTURE/DRY NEEDLING
Although the cause of supraspinatus tendinosis is muscle weakness, the symptoms (i.e. pain, and poor range of motion) are due to the adhesions on the subscapularis tendon themselves. Treatment needs to break apart those adhesions to relieve the symptoms and prevent the injury from worsening.
A straightforward and cost-effective way to break apart tendinous adhesions is with a needle. In this particular procedure, an acupuncturist will thread a needle along the tendon, underneath the acromion and physically break apart the adhesions on the surface of the tendon. It's not a painless procedure, bruising is common, and there is often a temporary flare-up before the symptoms subside, but the research into needling these adhesions is very positive.
TREATMENT: OTHER THERAPIES
For very severe, chronic cases of supraspinatus tendinosis, there are more forceful approaches to breaking the adhesions.
If you have any questions about needling, or about supraspinatus tendinosis specifically, you can reach me via the CONTACT PAGE.
I work out of two natural health clinics in Melbourne: Nicholson Street Chiropractic & Natural Health, and South Yarra Spine & Sports Medicine. To book an acupuncture/dry needling consultation with me, contact the clinics directly on (03) 9486 4111 for NCNH, or (03) 9826 2122 for SYSSM.
Dr Mitch Clark