Bursal sided fraying of the supraspinatus is a specific shoulder condition that can cause discomfort and limit movement. This article explores its characteristics, development, diagnosis, and recovery approaches.
The Supraspinatus Tendon: Anatomy and Function
The supraspinatus tendon is a component of the shoulder’s rotator cuff, a group of four muscles and their tendons that surround the shoulder joint. This tendon is located in the supraspinous fossa of the shoulder blade, extending underneath the acromion and connecting to the upper humerus. It initiates arm abduction, lifting the arm away from the body, particularly in the first 0 to 15 degrees.
Beyond lifting the arm, the supraspinatus tendon also plays a role in providing stability to the shoulder joint. It helps keep the ball of the upper arm bone centered within the shallow socket of the shoulder blade, allowing for smooth and controlled movement. Directly above the supraspinatus tendon is the subacromial bursa, a fluid-filled sac. This bursa acts as a cushion, reducing friction between the tendon and the overlying acromion during shoulder motion.
Defining Bursal Sided Fraying
Bursal sided fraying of the supraspinatus refers to damage on the outer surface of the tendon, facing the subacromial bursa. Fraying describes a partial injury where tendon fibers degenerate or develop microscopic tears, but the tear does not extend completely through the tendon. This is distinct from articular sided tears, which occur on the inner surface closer to the joint.
Bursal sided fraying is often associated with mechanical stress or compression against the acromion. It represents a structural change where the tendon’s smooth surface becomes rough or shredded.
Recognizing the Causes and Symptoms
Bursal sided fraying can result from repetitive overhead activities. Occupations or sports involving repeated arm movements above shoulder level, such as painting, carpentry, swimming, or throwing, can gradually wear down the tendon. This stress can lead to the tendon rubbing against the acromion, known as subacromial impingement, causing inflammation and eventual fraying and tearing.
Age-related degeneration also plays a role, as tendon tissue naturally weakens and becomes more susceptible to injury. Less common, a sudden traumatic event, like a fall onto an outstretched arm or lifting something too heavy, can also cause or worsen fraying. Poor posture, variations in shoulder bone shape, and scapular movement issues can further increase risk.
Individuals with bursal sided fraying typically report shoulder pain, often localized to the outer aspect and sometimes radiating down the arm. This pain frequently worsens with overhead activities or specific movements. Night pain, particularly when lying on the affected shoulder, is also a common symptom. Other indications may include weakness when lifting or rotating the arm, limited range of motion, and occasionally a crackling or clicking sensation within the shoulder joint.
How Bursal Sided Fraying is Diagnosed
Diagnosis begins with a thorough physical examination by a healthcare professional. The doctor assesses the shoulder’s range of motion, strength, and identifies specific areas of pain or tenderness. They may perform tests like the Jobe’s test (Empty Can test), Hawkins-Kennedy test, or Drop-arm test, which help pinpoint supraspinatus tendon issues and potential impingement.
Imaging studies typically confirm the diagnosis and determine damage extent. Magnetic Resonance Imaging (MRI) is a primary imaging tool for evaluating suspected rotator cuff problems, providing detailed views of soft tissues like tendons and revealing fraying or tears. An MRI arthrogram, involving injecting dye into the shoulder before the scan, can enhance partial tear detection. Ultrasound is another imaging modality, offering high sensitivity and specificity for supraspinatus tendon injuries. Ultrasound allows for dynamic assessment, viewing the tendon in real-time as the shoulder moves, which can help identify impingement or how the tendon behaves during motion. X-rays may also be taken, primarily to rule out bone-related issues like fractures or arthritis, though they do not directly show soft tissue damage.
Treatment and Recovery Approaches
Treatment typically begins with conservative, non-surgical approaches, especially for less severe cases. Rest from aggravating activities is often recommended to allow the tendon to heal, along with applying ice to reduce inflammation and pain. Over-the-counter anti-inflammatory medications can also help manage discomfort.
Physical therapy is a key component of conservative treatment, focusing on exercises to restore flexibility, strengthen surrounding shoulder muscles, and improve overall shoulder mechanics. A physical therapist guides specific exercises to strengthen rotator cuff muscles, particularly the supraspinatus, and improve shoulder stability. The goal of physical therapy is to reduce pain, increase range of motion, and enhance shoulder function. Adherence to the prescribed rehabilitation program is important for successful recovery and preventing future injury.
If conservative treatments do not provide adequate relief after several months, surgical options may be considered. Arthroscopic surgery is a common procedure, where a small camera and instruments are inserted through tiny incisions. During surgery, a surgeon might perform debridement, smoothing or removing the frayed edges of the tendon. In some instances, if fraying is extensive or progresses to a partial tear, the surgeon may repair the tendon. Recovery timelines vary depending on injury severity and treatment approach, ranging from several weeks for conservative management to several months for surgical recovery.