The shoulder: Acute rupture of the infraspinatus tendon

Palpation of the tender distal remnant of the ruptured tendon (on the greater tuberosity).
The needle is thrust in vertically in the centre of the tender area.
Infiltration of about +/- 0.1 cc of the liquid.
The needle is partly withdrawn and re-inserted in a slightly different direction and another 0.1 cc of the fluid is injected.
The procedure is repeated about ten times (each time +/- 0.1 cc is injected).
It is important to infiltrate the tendinous structer and not the gap. For this reason a typical tendinous resistance must be felt during the whole procedure.

Follow up:
One infiltration of 10 mg triamcinole is usually sufficient to abolish the painful
arc and to restore full and painless passive movement.
The patient should be encouraged to use the arm normally.
Further treatment consists of functional exercises.
Emphasis should be given to stabilising and strengthening of the shoulder girdle
(levator scapulae and latissimus dorsi) and proprioceptive exercises for the other cuff muscles.
Patients must also be instructed to move the arm regularly into full
passive lateral rotation (with the use of the other arm or by twisting the
trunk to the opposite direction while stabilizing the forearm against a fixed
object) in order to prevent isolated anterior contraction of the capsule.