Treatment for Supraspinatus Tendinosis

Initial Conservative Management

The American Academy of Family Physicians recommends relative rest to reduce activities that cause repetitive loading of the supraspinatus tendon to prevent further damage and promote healing 3
The American Academy of Family Physicians suggests avoiding overhead activities and those that reproduce pain 4
Cryotherapy, such as applying ice through a wet towel for 10-minute periods, provides acute pain relief, especially when used immediately after pain-provoking activities 4, 3
Eccentric strengthening exercises are the cornerstone of tendinopathy treatment and may reverse degenerative changes in the tendon structure, with optimal results seen after continuation for at least 3-6 months 3
The American Academy of Family Physicians recommends NSAIDs (oral) for short-term pain relief, though they do not alter long-term outcomes, and topical NSAIDs may provide pain relief with fewer systemic side effects than oral NSAIDs 3, 5

Therapeutic ultrasound may decrease pain and increase collagen synthesis, though evidence for consistent benefit is weak, and extracorporeal shock wave therapy (ESWT) is safe and potentially effective for pain relief 6, 7, 2
Corticosteroid injections may provide better acute pain relief than NSAIDs but do not improve long-term outcomes and should be used with caution as they may inhibit healing and reduce tendon strength 2, 3

Surgical management is considered if pain persists despite well-managed conservative treatment for 3-6 months, typically involving excision of abnormal tendon tissue and longitudinal tenotomies to release scarring and fibrosis, and is effective in carefully selected patients 1, 3

Misdiagnosis can occur, and proper diagnosis should be ensured through clinical tests (Hawkins' and Neer's tests) which are sensitive but not specific for supraspinatus impingement 1
Inadequate exercise progression, starting with too aggressive exercises, can worsen symptoms, and active rehabilitation with eccentric exercises should remain the foundation of treatment 3
Premature return to activities before adequate healing can lead to symptom recurrence 4
Delayed referral to surgical consultation if symptoms persist despite 3-6 months of appropriate conservative management should be avoided 1, 3