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Supraspinatus friction massage
 A tendinosis/-itis of the supraspinatus is one of the most common tendinous problems in the shoulder ; it is 4-5 times more frequent than an infraspinatus lesion.
The clinical image can sometimes be confusing with that from the chronic subdeltoid bursitis. Accessory tests and procedures will be conclusive.
The treatment of choice for the supraspinatus is transverse friction massage in combination with mobilisation techniques.
(Part I, p43-44 ; Part II, p6-7)
Supraspinatus muscle lesion
Resisted abduction will be painful in the clinical examination
a) Variable pain
We think of a deltoid lesion (rare) or supraspinatus muscle.
Differentiation between both is possible by a resisted movement forwards and backwards with the arm held in 90° abduction : if any of these tests is positive, then the deltoid muscle is at fault.
(Make sure that the arm, with the elbow 90° bent, is well supported to exclude any activity of the supraspinatus muscle.)
* Supraspinatus muscle
Depending on the presence or not of a localizing sign, four sites have to be considered :
1. Painful arc = the lesion lies superficially at the tenoperiosteal junction.
2. Pain at full range on passive elevation = the lesion lies deeply at the tenoperiosteal junction.
3. Arc and elevation = the entire tenoperiosteal junction, superficially and deep.
4. No localizing sign = musculotendinous junction.
The fact that the lesion lies more superficial or deep is not important for treatment by deep friction but could be helpful for the application of infiltration.
Using palpation to find the precise localization of the lesion in the supraspinatus, is useless in the first three cases (both the structure and the site of the lesion are already known from the clinical image). Only in the fourth case is palpation for tenderness needed, and a local anaesthetic infiltration confirms the probable diagnosis.
Treatment :
* Tenoperiosteal junction (1-2-3) : infiltration and/or deep friction
* Musculotendinous junction (4) : deep friction.
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