Supraspinatus Tendon Case Study

HPI: Ms. Smith presents to the office with bilateral shoulder stiffness and lateral elbow pain in right arm. The patient has been suffering shoulder stiffness for over 2 years. The symptom developed gradually after she started using her computer more at her work place; she had to hold her telephone between her shoulder and head while typing information on computer. The pain in right elbow stated about 8 months ago with gradual onset. The patient does not recall any trauma to the shoulder and elbow. She has been diagnosed as tennis

She said, she fell last night while playing volley ball. She landed on her right shoulder and heard a pop sound, too. She did not take any pain medicines. She applied icepack and felt burning pain. This was an interesting musculoskeletal assessment case. We assessed her right shoulder and compared with the left one. We found slight dislocation of the shoulder joint. She had good circulation in her right arm, no swelling noted in the right hand and the capillary refill was < 2 secs. Mary said, since she had burning pain, it could be a nerve injury, too. We also noted a slight swelling of her trapezius muscle on the right side. She complained of pain on palpation. Mary applied a sling to her right arm to keep it elevated. She may need an MRI to see the damage. Mary sent her to the urgent care. She told her that, since she heard the popped sound, the ER or Urgent care doctor can replace it. It will be a painful procedure, and she will need a strong pain medicine. She gave her the note for her teacher and asked her friend to drive her to the urgent

DOI: 9/18/2000. Patient is a 59-year-old female technician who sustained a work-related injury due to being jostled and jolted in the back of a golf cart which ran over a pothole. As per OMNI, she was diagnosed with post cervical protrusions, facet syndromes with headaches, lumbar facet syndrome and status post right shoulder repair/resection.

The patient wants to also update me as far as the arm pain he mentioned last time. He says his left arm is feeling better now. He is noticing that his right shoulder is hurting at times, especially in certain positons such as while he is sleeping and if he has his arm raised over his head while he is lying down. He had no specific injury or trauma. He is not aware of anything that makes it better or worse. He is not using any medication for it thus far. He would be interested in having

DOI: 9/30/2011. Patient is a 41-year-old male information technology computer support specialist who sustained injury while he was walking through a lobby when he slipped and fell. Per OMNI, he was initially diagnosed with lumbar intervertebral disc syndrome, myofasciitis and right arm strain. He underwent a right shoulder surgery on 07/16/13 and 12/22/15.

The patient notes that the injury happen when he was lifting some metal trash trays into a trash bin when he felt a sharp pain in his shoulders. Treatment history notes that the treatment to date has consisted of medications. Of note, the MRI done showed a large full thickness tear with retraction of the tendon. Physical examination of the left shoulder revealed that the range of motion has forward flexion of 0-175 degrees, external rotation of 0-40 degrees, and internal rotation to T12. There is positive Hawkins’ and Neer’s sign for impingement. There is weakness with abduction testing. Treatment plan notes recommendation, surgical intervention in the form of a left shoulder, subacromial decompression, rotator cuff repair surgery as necessary. A follow up of 2 to 3 weeks if surgery is authorized. As per medical summary and work status dated 6/14/16, it was noted that the patient has not improved significantly and would be needing surgery. The patient’s return to work date is 6/14/16 with no lifting over 10 pounds and no overhead reach. Follow up to clinic date is on

As per office notes dated 5/4/16, the patient is seen for bilateral elbow pain and bilateral wrist pain. She rates the pain as 3/10 with medication and 7/10 without medication. She is active for at least six hours a day and has energy to make plans. Her activity level has

Mr. Krupp had the repair to the torn bicep tendon on 6/30/17. He reported that he was given a cold compression device and that really helped with the pain. On 7/10/17 I met him at the MSU sport medicine clinic. We met with Dr. Supinanski. The sutures were removed to the left inner aspect of the arm. There are no signs of infection. Mr. Krupp said he has not taken any pain medications for days. Instructions are no lifting with the left hand of a pound or more. He will start physical therapy now. At the next appointment Dr. Scorfar will address the left shoulder. At this point, no repair to the left shoulder can be done, we need to let the bicep tendon heal

Per the IME report on 4/28/16 by Dr. Pierce Ferriter, the patient reports that he is actively treating with physical therapy and chiropractic treatment at a frequency of 3 to 4 times per week. The patient’s diagnoses include resolved lumbar strain, resolved cervical strain, resolved left shoulder strain and resolved right knee strain. There is no medical necessity for further physical therapy, orthopedic treatment of diagnostic testing based on examination.

Supraspinatus tendonitis typically occurs when there is an impingement of the supraspinatus muscle of the shoulder joint between the acromion as it passes by the acromion and humerus head. In response, the supraspinatus tendon and the contiguous peritendinous soft tissues become inflamed. The supraspinatus is a muscle located in the supraspinatus fossa of the scapula located in the shoulder and is largely affected by supraspinatus tendonitis. The supraspinatus allows for the abduction of the shoulder and its insertion is the greater tuberosity of the humerus. Tendonitis is the inflammation of a tendon and commonly occurs in the elbows, knees, and shoulders. Therefore, supraspinatus tendonitis is the inflammation of the supraspinatus. This condition is a very common inflammatory problem because it can be caused by the abduction of the arm, which is involved in many sports and activities.

Even with active assistance, the patient can only achieve approximately 140 degrees of forward elevation, 60 degrees of external rotation, and internal rotation barely to his upper sacrurn. He has 4/5 supraspinatus weakness and pain. Internal and external rotation strength seems to be normal. He has a nonspecifically painful Neer’s, Hawkins, and O’Brien’s test. His proximal biceps and acromioclavicular (AC) joint are both very tender to palpation.

Examination of the bilateral shoulder reveals tenderness to palpation about the anterior shoulders bilaterally. There is also restricted range of motion secondary to pain and her supraspinatus weakness and Hawkins’ impingement tests are both positive. In addition, Neer’s impingement and drop-arm tests are also positive.

12/31/15 Progress Report described that the patient has cervical spine, right shoulder, and right wrist pain. She rates her cervical spine at 8/10-scale level and frequent; right shoulder pain at 8/10-scale level; and bilateral wrist pain at 6/10-scale level. The pain is frequent and improved since last visit. Rest and medications make the pain better. Weather

DOI: 1/19/2015. Patient is a 44-year-old female machine operator who sustained injury while lifting pieces of cardboard into the machine when she felt pain to both sides of her shoulders and neck. Per OMNI, she was diagnosed with cervical and shoulder sprain/strain.

Rotator cuff tendons are prone to degeneration leading to swelling with sub-luxation due to continuous active and passive forces. Rotator cuff pathology includes tendinopathy, tendinosis and bursitis, as well as rotator cuff tears. Most common indication for rotator cuff tears include increasing age and traumatic shoulder injury. Clinical symptoms for rotator cuff injuries include shoulder pain, weakness and loss of range of motion. However, these symptoms are common in various diseases; differential diagnosis includes labral tears, glenohumeral ligament tears or sprains, coracoacromial and arcomioclavicular ligament tears and sprains, osteoarthritis, adhesive capsulitis, proximal peripheral neuropathies and cervical radiculopathy. Hence,