Supraspinatus Tendonitis

Primary care, sports medicine, and orthopedic surgeons commonly manage shoulder injuries and shoulder pain. Some reports in the literature cite that up to half of the clinical shoulder complaints are handled in a single visit by a primary care provider.[1] Rotator cuff pathologies are one common source of shoulder complaints. The rotator cuff consists of four muscles and their associated tendons: the supraspinatus, infraspinatus, teres minor, and the subscapularis.[2][3][3][3] Rotator cuff dysfunction is a common source of pain and disability in multiple patient populations.[4] Traditional thinking regarding rotator cuff injuries places patients on a continuum toward eventual rotator cuff failure and varying degrees of partial- to full-thickness tear patterns. The natural history, as described by Neer, was that the rotator cuff would come in contact with a pathologic acromial undersurface during certain motions.[4] The original thinking was that this is impingement phenomenon was the inciting event that would cause the eventual cascade of rotator cuff pathologies. Neer's description was the mainstay of impingement shoulder theory for years to come.[5] According to Neer, the supraspinatus would then undergo a predictable breakdown in three stages: edema and hemorrhage, fibrosis and tendonitis, and eventual tendon rupture.[6] More recent thinking and research have added continued complexity to Neer's theory, and there is research to call into question the validity of that pathway. Moreover, the evolution of Neer's theory has developed into a broader classification of rotator cuff syndrome and pathologies, including internal versus external impingement mechanisms.[7][4]