Treatment Options

Corticosteroid Injections


There has been no substantial evidence to suggest that the use of corticosteroids is effective in the repair of supraspinatus tendinopathy, however a single injection into the subacromial space may decrease pain symptoms and allow for a rehabilitation program to commence (Brukner & Kahn, 2006). NSAIDs have a similar role in the treatment of supraspinatus tendinopathy.


Nitric Oxide Therapy


Murrell (2007) has identified nitric oxide (NO) therapy, administered via a patch, as a possible treatment for supraspinatus tendinopathy. NO is important for the volume of collagen synthesis during tendon healing. In some animal models it has been found that NO enzymes are inhibited and causes a reduced healing capacity. Murrell (2007) found that the application of a NO patch enhanced the healing capacity of the tendon; therefore improving the ability to recover from a tendinopathy. Participants in the NO group had decreased pain, increased range of motion in abduction, flexion and external rotation of shoulder and increased power in abduction and external rotation.


Topical glyceryl trinitrate (GTN) application via transdermal patches causes the production of NO. Paoloni, Appleyard, Nelson and Murrell (2005) compared the use of topical GTN with a placebo patch. The study showed that a significant reduction in pain scores with activity, at night and at rest for patients receiving topical GTN. The topical GTn group also demonstrated an increase in range of motion fro internal rotation and abduction and an increase in force produced for the supraspinatus manual muscle test. These results were still effective six months post treatment. Therefore GTN transdermal patches may be a useful tool in the conservative management of supraspinatus tendinopathies.




Hyperthermia has been introduced as a possible therapy in the treatment of supraspinatus tendinopathy. Hyperthermia therapy acts to raise the therapeutic temperature of the muscle and tendon several centimetres beneath the skin (Giombini, Cesare, Safran, Ciatti and Maffulli (2006). Giombini et al., found that hyperthermia therapy was effective in the short term management of a supraspinatus tendinopathy when compared with convetional therapeutic unltrasound and exercise. However further research is needed into the benefits for this therapy in the short term and more specifically in the long term.


Electrotherapeutic Modalities

There is insufficient evidence to support the use of ultrasound, laser and magnetic field therapy in the treatment of supraspinatus tendinopathies (Brukner & Kahn, 2006).


Extracorporeal Shock Wave Therapy

Speed et al. (2002) studied the effect of extracorporeal shock wave therapy on 74 patients with chronic non-calcific rotator cuff tendinopathies. There were 2 groups: those treated with the shock wave therapy and a control (sham treatment) group. After two months of treatment both groups had improvements in the shoulder pain they reported, but there was no significant difference found between the two groups. Therefore extracorporeal shock wave therapy demonstrated no added benefit in the treatment.


Gerdesmeyer et al. (2003) looked at extracorporeal shock wave therapy in 144 patients with calcific rotator cuff tendinopathies. There were three groups:  treatment with high-energy extracorporeal shock wave therapy, low-energy extracorporeal shock wave therapy and sham treatment. There were two treatments given two weeks apart. After six months there were improvements in shoulder function, self-rated pain and size of calification in the high and low-energy extracorporeal shock wave therapy groups. The high-energy extracorporeal shock wave therapy treatment group also had greater improvements than the low-energy group.


Haake, Deike, Thon and Schmitt (2002) also looked at extracorporeal shock wave therapy in people with calcific rotator cuff tendinopathies and found significant improvements in shoulder function when compared to control group. Therefore extracorporeal shock wave therapy seems to be beneficial for people with a calcific tendinopathy, but its benefit is questionable in people with non-calcific tendinopathies.


It is thought that the repeated shock wave that is delivered to the affected area promotes new blood flow; therefore promoting the tissue healing process (Wikipedia, 2009).