JOURNAL READING

Supraspinatus tear

Presented by:
Marinda Dwi Anggrainie Supervisor :
111 2017 1011
dr. Arianto Arief, M. Kes, Sp.OT
A supraspinatus tear is a tear or rupture of the tendon of
the supraspinatus muscle. The supraspinatus is part of the rotator cuff of
the shoulder
 The shoulder joint is made up of three bones :
the humerus, scapula and clavicle
 The etiology of supraspinatus tears is multifactorial
Consisting of age-related degeneration
microtrauma and microtrauma
The incidence increases with the age to about 50% during the 80s
mostly affecting the dominant arm.

The most common risk factors for a tear consist of a history of trauma,
dominant arm and age.
 1. Fall on your outstretched arm

 2. cutting and landing from a jump

 3. Degenerative: Wear and tear of the tendon slowly over time Increases with the
age. More common in the dominant arm, When you have a degenerative tear in one
shoulder,
 Partial thickness: Incomplete disruption of muscle fibers[1]
 Can progress to complete tear - Increasing pain is normally the first sign of
progression of a tear
 Full thickness: Complete disruption of muscle ibers
 Large tears (1-1,5cm) have high rate of progression
 If progression is suspected in conservatively managed cases - further
investigation is warranted
 Smaller tears (<1cm) progress slowe
 Clinical
Examinations

Supraspin
atus tear

Surgery: Radiological
Rotator cuff Examination
repair s
 Subjective interview:
 Onset: Spontaneous or after injury
 Duration of pain
 Pain provocation/aggravating factors
 Night rest
 Same problems in the past?
 Activity limitations
 Localize pain
 Past medical history
 Recreational or sport activities (possible overhead activities)
 Observation
Any atrophy present
 Range of motion:
1. Expect reductions in flexion, abduction and external rotation
2. If passive abduction range is more than active range, it is an
indication of rotator cuff tear

 Muscle power
Test supraspinatus by resisting abduction at 90° and internal rotation
Scapular movement may be affected

 Palpation: Forearm behind back to palpate rotator cuff just anterior and
below the acromion
*Muscle atrophy present
*Tenderness
1. Drop-arm test: Active shoulder
abduction to 90°, then return
Positive: Dropping the arm down
with pain indicates a positive test
2. Jobe/supraspinatus/empty can test:
Resist shoulder abduction and
internal rotation
Positive: Pain/weakness
3. Full can test: Resisted shoulder
abduction in external rotation
Positive: Pain/weakness
MRI
 • Rest
Immediate After • Ice
Injury • Compression
• Elevation

• NSAID's:
• Ibuprofen

Conservative • Corticosteroid injections:

• Eliminate pain for a period of time, making physiotherapy management easier

Management • Tendon tissue can be weakened by these injections (which would have an adverse effect on the
outcome of a possible surgery)
• Limited to 2 injections
• Physiotherapy (see Physiotherapy management below)

Surgical Management • Arthroscopic Rotator Cuff Surgery

(LEFT)

(RIGHT)
(LEFT)

(RIGHT)
 Immobilization.
 Passive exercise
 Active exercise.

Active exercise during

rehabilitation may include
isometic external rotation
exercises, such as the one
shown here