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Increased supraspinatus tendon thickness following fatigue loading in rotator cuff tendinopathy: potential implications for exercise therapy
  1. Karen M McCreesh1,2,
  2. Helen Purtill2,3,
  3. Alan E Donnelly2,4,
  4. Jeremy S Lewis1,5,6
  1. 1 Department of Clinical Therapies, University of Limerick, Limerick, Ireland
  2. 2 Health Research Institute, University of Limerick, Limerick, Ireland
  3. 3 Department of Mathematics and Statistics, University of Limerick, Limerick, Ireland
  4. 4 Department of Physical Education and Sports Sciences, University of Limerick, Limerick, Ireland
  5. 5 Department of Musculoskeletal Services, Central London Community Healthcare NHS Trust, London, UK
  6. 6 Department of Allied Health Professions, School of Health and Social Work, University of Hertfordshire, Hatfield, UK
  1. Correspondence to Dr Karen M McCreesh; karen.mccreesh{at}


Background/aim Exercise imparts a load on tendon tissue that leads to changes in tendon properties. Studies suggest that loading immediately reduces tendon thickness, with a loss of this response in symptomatic tendinopathy. No studies investigating the response of tendon dimensions to load for the rotator cuff tendons exist. This study aimed to examine the short-term effect of loading on the thickness of the supraspinatus tendon and acromiohumeral distance those with and without rotator cuff tendinopathy.

Methods Participants were 20 painfree controls, and 23 people with painful rotator cuff tendinopathy. Supraspinatus tendon thickness and acromiohumeral distance were measured using ultrasound scans before, and at three time points after loading (1, 6 and 24 hours). Loading involved isokinetic eccentric and concentric external rotation and abduction.

Results There was a significant increase in supraspinatus tendon thickness in the pain group at 1 (7%, ∆=0.38, 95% CI 0.19 to 0.57) and 6 hours (11%, ∆=0.53, 95% CI 0.34 to 0.71), although only the 6 hours difference exceeded minimal detectable difference. In contrast, there was a small non-significant reduction in thickness in controls. The acromiohumeral distance reduced significantly in both groups at 1 hour (controls: ∆=0.64, 95% CI 0.38 to 0.90; pain: ∆=1.1, 95% CI 0.85 to 1.33), with a larger change from baseline in the pain group.

Conclusion Those diagnosed with painful supraspinatus tendinopathy demonstrated increased thickening with delayed return to baseline following loading. Rehabilitation professionals may need to take into account the impact of loading to fatigue when planning rehabilitation programmes.

  • shoulder
  • tendinopathy
  • exercise rehabilitation
  • eccentric
  • concentric

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  • Contributors KM, JSL and AD designed the study protocol, and received ethical approval. KM collected the data. KM and HP performed the statistical analysis. All authors read and approved the final manuscript.

  • Funding KM was supported by a Research Fellowship from the Health Research Board of Ireland to conduct this study.

  • Competing interests None declared.

  • Ethics approval The University of Limerick Faculty of Education and Health Sciences Ethics Committee(s) (Limerick, Ireland) approved this study. All participants gave written informed consent before data collection began.

  • Provenance and peer review Not commissioned; externally peer reviewed.