What Is Tension Myositis Syndrome?

The supraspinalis muscle is covered by trapezius and deltoid muscles, and its tendons form the rotator cuff with the infraganglia, subscapularis, and small round muscles. The superior pectoralis muscle starts from the superior fossa of the scapula. The tendon passes under the coracoid ligament and the acromicular sac, and passes above the shoulder capsule, ending at the large humerus tubercle. Its shape is like a horseshoe shape. Its role is to fix and fix the humerus in the scapula. It cooperates with the deltoid muscles to abduct the upper limbs. It is easy to be injured due to frequent activities and the meeting point of the contraction of the shoulder muscles.

Supraspinatus tendinitis

The supraspinatus tendinitis is also called the supraspinatus syndrome, abduction syndrome. It refers to the degenerative changes of tendons caused by strains and minor trauma or cold, which are aseptic inflammations, with pain and dysfunction as the main clinical manifestations. Occurs in young and middle-aged workers, housewives, and athletes. Simple supraspinatus tendinitis has a slow onset, progressive pain on the outside of the shoulder, and severe shoulder pain with abduction of the upper arm at 60 ° to 120 ° (arc of pain). When the supraspinatus tendon was calcified, the X-ray film showed local calcification.

Anatomy and physiology of supinus tendinitis

The supraspinalis muscle is innervated by the superior scapular nerve, and an impenetrable compression point at the scapular notch is a weak point of the local anatomy of the human body. The supraspinalis muscle fibers are slender and large in span, and are easily damaged during exercise.

Attachment: The composition, function, starting and stopping point, innervation of "shoulder sleeve"

name	starting point	Stop	effect	N dominates
Supine muscle	Gangshangwo	Upper nodule	Upper arm abduction	N on shoulder
Subspinal muscle	Gangxia wo	Central nodule	Upper arm rotation	N on shoulder
Small round muscle	Gangxia wo	Lower nodule	Upper arm extension	Axillary N
Subscapularis	Subscapular fossa	Humerus nodules	Upper arm adduction	Subscapular N

Traditional Chinese Medicine Traumatology (Second Edition)

Etiology and pathology of supraspinatus tendinitis

The supraspinatus tendinitis belongs to the category of "biosis" in traditional Chinese medicine. It is caused by the effects of wind cold and dampness, strain, and trauma, which causes stagnation of qi and blood, obstruction of the veins, and pain when it does not pass. During the upper limb abduction and uplifting movement, the gap between the scapular fornix and the humeral head formed by the superior ganglia tendon, acromion and coracoid process is easily affected by the friction of the acromion coracoid process and the humeral head acromion coracoid process in the subscapular fornix space. Chronic strain on the supraspinatus tendon caused by intermittent impacts or pinching, or because the arm of the supinastus muscle is shorter, the work done in the upper limb abduction and lifting exercise is larger, and it is repeatedly affected with age for a long time. The degenerative changes of the tendon itself are due to the acromion bursa between the surface of the supraspinatus tendon and the acromion. Therefore, the tendonitis and acromion bursitis often coexist and affect each other. Occurs in supraspinatus tendinopathy.

The exact etiology and mechanism of the calcification of the supra-ganglion tendon is not clear. At present, clinical studies have concluded that the supra-ganglion tendon humerus nodule is within 1 cm of the proximal humeral nodule. The blood supply of this tendon is the worst in the avascular region, and it is also the area most affected by stress. "Dangerous area". When tendon degeneration and necrosis occurs in this "dangerous area", the local acidic environment during the repair of tendon fiber rupture can facilitate the precipitation of amorphous free calcium ions and form calcium salts deposited in the tendon fibers to cause calcification. Upper tendinitis, followed by a slow increase in calcium salt deposition, can cause irritation of the acromion bursa, showing symptoms of acromion bursal inflammation, and calcium deposition can develop to the surface of the tendon and even break into the acromion bursal.

Because the supraspinas tendon is susceptible to abrasion, impact, pinching, and other factors, the supraspinalis tendon degeneration and the earliest occurrence of muscle fiber breakage are the highest in the rotator cuff tendon group. The foundation is often partially torn. When the upper arm is abruptly retracted outside the booth once unprepared or a large calcium salt deposit infiltrates the superior tendon, it can cause most or complete rupture of the tendon.

The supra-ganglia tendon has suffered from frictional impact and pinching for a long time, which causes chronic cumulative strain and its degenerative changes of the tendon. It stimulates the bottom of the acromion and causes thickening and adhesion of the capsule wall.

Calcium salt deposition mainly occurs in degenerative tendon fibers, especially in the dangerous area that is subject to large stresses and is prone to degeneration. Initially, the lesion is located in the center of the tendon fiber, and there is degeneration and then calcium ion precipitation and deposition. The tissues surrounding the calcium salt deposits An inflammatory response occurs. For example, the calcium salt deposits are small and deeply buried in the center of the tendon. There is no clinical symptoms when the bursa is not stimulated, even if it is not noticed for several years. If the calcium salt deposits increase significantly, you can contact the bottom of the bursa. Shoulder and beak arch collide or be squeezed by the shoulder and beak arch and humerus head to produce pain. At this time, the edges of the calcium salt deposits are clear and the center is whitish but without tension. The base of the bursa can be thickened or even fluffy. Combination of tendon tissue, without acute symptoms at this stage, manifested as painful shoulder pain arc syndrome in the range of 60 ° 120 ° of upper limb abduction, if secondary trauma can manifest as subacute attack: bursal base and calcium salt deposits The swelling center is close to white or yellow. The density is as hard as a toothpaste. It contains hard grit-like substances. The long-term calcium deposits can be intertwined with tendon fibers. Acute attack: The large tension center in the calcium salt deposits is gray. The surrounding dark red or purple congested bursal bottom is close to the calcium salt deposits and the wall of the bursa is thin. If a small mouth is cut with a knife and milk-like liquid overflows, the calcium salt deposits can penetrate the bursal wall and enter the bursa. Milky in the bursa Rather than solid material body symptoms. The severity depends on the inflammatory response around the calcium salt deposits and the tension within itself. When the calcium salt deposits pierce by themselves, the pressure decreases and the pain is significantly reduced.

Clinical manifestations of supraspinatus tendinitis

1. Pain mainly at the acromion nodules, and can be radiated to the neck, shoulders and upper limbs. Pain is especially acute during shoulder abduction, so patients often avoid this action.

2. The shoulder joint is limited in movement. The main feature is that shoulder pain can cause significant pain when the shoulder is abducted to 60 ° 120 °. When it is larger or smaller than this range and other shoulder joint activities are not restricted. Pain, which is significantly different from biceps tendonitis and periarthritis.

3. Tenderness. Tenderness is often found at the large nodule of the superior part of the supraspinalis muscle, and it moves with the rotation of the humeral head. Local closure can make the pain disappear immediately, thereby helping diagnosis.

Diagnosis of supinus tendinitis

1. Occurs in middle-aged and young people with manual labor, housewives, and athletes. Generally, the onset is slow, and it is often caused by a history of minor trauma or cold, or work in a single posture.

2, acute phase or chronic shoulder pain author, severe shoulder pain, shoulder movement, exertion, especially in cold weather. The pain is usually on the outside of the shoulder, at the large nodule, and can radiate to the deltoid stop or fingers.

3. Limited shoulder movement and tenderness. When the shoulder joint is abducted to 60 ° ~ 120 °, it can cause obvious pain and limit movement. When it develops to the acute stage, it can have tenderness at the large nodule.

4. X-ray examination: Occasionally, calcification of the supraspinalis tendon and osteoporosis are a late change after tissue degeneration.

Differential diagnosis of supinus tendinitis

1. The pain arc around the shoulder joint inflammation is not limited to the middle range, but there is pain and local tenderness from the beginning of the movement to the entire range of motion.

2. Adhesive shoulder bursitis activity is different at the beginning. Pain occurs above 70 ° abduction, and pain is significantly worsened by super abduction.

3. Rupture of the rotator cuff is mostly caused by trauma such as throwing sports. Pain in the front of the shoulder is accompanied by tenderness near the large nodule or under the acromion. Active abduction is difficult. Actively maintain this limb position. Or 60 ° ~ 120 ° abduction positive pain arc sign.

Surgical tendonitis treatment

Manipulative treatment of supraspinatus tendinitis

Holding method First, use the holding method to pinch the neck, shoulders, and upper arms, loosening the tendons from top to bottom. Then focus on the neck and shoulders, rub the magic from top to bottom, to achieve the effect of Shujin active.

Rolling shoulders are applied outside the shoulders and behind the shoulders (soft), in conjunction with the abduction, adduction and rotation of the shoulder joints.

The patient in the shaking method is seated, the surgeon stands on the affected side, and grips the wrist from the front-up-back-down to make a circle from small to large, appropriate amount. During the big swing, the outreach should be between 90 ° and 120 ° as far as possible, and lift up slightly.

The patient is sitting in the diversion method. The operator holds both sides of the wrist with both hands and loosens the arm. During the downward traction movement, he shakes evenly with the arm 3-5 times.

Psoas tendinitis massage treatment

The first step is rubbing method: the patient takes a seated position, the patient's shoulders sag naturally and in a slightly retracted posture. The doctor stands on the affected side of the patient and uses the rubbing method to relax the supra-ganglion muscles to relax the blood and promote blood circulation. Or take the patient in a prone position, and the doctor stands on the affected side of the patient and relaxes the shoulder and back muscles with compression and rubbing.

The second step is the plucking method: the patient takes the sitting position, the doctor slightly stretches out the patient's shoulder joint, supports the upper elbow with one hand, and pulls the thumb with the thumb on the supraspinatus to relax the tendons and clear the adhesion. Or take the patient in a prone position, with both upper limbs of the patient relaxed behind, and the doctor flicks the superior ganglia muscles with their hands.

The third step is the rubbing method: the doctor stands behind the patient with two hands to relax the ganglia muscle, and then uses the rubbing method to relax the ganglia muscle.

The whole process takes about 15-20 minutes.

Supramuscular tendinitis medication

To relieve pain, oral anti-inflammatory analgesics such as indomethacin (25 mg each time, 3 to 4 times daily), piroxicam (indomethacin 20 mg each time, once daily), enteric-coated aspirin (each 0.3 to 0.9 grams, 3 times a day). When the pain is more serious, local closed injection of adrenocortical hormone can be applied. Commonly used hydrocortisone acetate 0.5 ~ 1ml, 1% procaine or lidocaine 2ml mixed injection, once a week, limited to 4 times.

Traditional Chinese medicine treatment of supraspinatus tendinitis

Tendonitis is commonly known as "pulsatile wind". In Chinese medicine, it belongs to the category of "strain." Patients will feel joints with different degrees of pain, numbness, stiffness, swelling and other symptoms. Usually, the morning stiffness of joints is most obvious after getting up, and the symptoms It does not alleviate significantly with frequent activities.

Essentials of daily preventive care for supraspinatus tendinitis

First, let the muscles rest or change sports

If you have tendinitis due to work, take a break for a few days to avoid pain. If the tendonitis is caused by exercise, you can change to another exercise.

Second, wear wrist or knee pads when exercising

Usually wear elastic sheaths such as wrist braces and knee pads, even if they provide a little support and warmth, they are helpful during and after exercise.

Third, for those diagnosed with supraspinatus tendinitis, you can directly use tendon cream and long-term treatment plans, including continuous strength training and muscle reeducation.

Fourth, pay attention to the daily working posture of using a computer

1. Keyboard: The elbow should be maintained at 90 degrees while typing, and the shoulders should naturally relax and hang down and rest on the armrest; the wrist should rest on the wrist rest board or other support design to avoid shoulder aches and wrist tendonitis.

2. Mouse: The mouse should be placed at the same height as the keyboard desktop, and as close to the body as possible. When moving the mouse, use the muscles of the upper arm and the forearm to move the mouse, not just the strength of the wrist to avoid wrist tendonitis; best Install elbow support.

3. For computer workers, rest 5-10 minutes per hour and do some simple office stretching exercises to avoid prolonged muscle contraction, causing muscle fatigue and pain or causing tendonitis.

Fifth, pay attention to the nutrition of daily diet

In the diet should be more B vitamins, eat more carrots and animal liver.

Attachment of supinus muscle tendinitis

Don't ignore any physical signals. You shouldn't tolerate sports unless you have permission from your doctor or physical therapist. If the pain is severe and you continue to labor your tendons, it may be torn. The result is the need for long periods of rest, surgery or even permanent injury.