Student thesis: Doctoral ThesisDoctor of Philosophy


Rotator cuff (RC) tendinopathy is defined as pain and dysfunction of one or more of the RC tendons (supraspinatus, infraspinatus, subscapularis and teres minor). Inflammation has been associated with this condition. Graduated exercise is the main treatment for RC tendinopathy, and comparable outcomes to surgery, have been reported for the range of conditions associated with RC tendinopathy. However both non-surgical and surgical outcomes are frequently sub-optimal and new treatment methods to support current practice and improve outcomes are required.
A questionnaire investigation recruited 261 participants with shoulder pain from eight healthcare locations. Information was collected regarding beliefs and use of nutritional supplements. Supplement use was reported by 38% (100/261) respondents. Of those who were taking supplements, 82% (82/100) were taking them for shoulder pain. Fish oil supplements containing long-chain omega-3 polyunsaturated fatty acids (PUFAs) were the most popular dietary supplements.
Long-chain mega-3 PUFAs have been recommended for people with tendinopathy due to their potential to reduce inflammation. This investigation compared exercise and PUFAs to exercise and placebo supplements in the treatment of people with RC tendinopathy.
A double-blind placebo controlled randomized controlled trial was conducted in participants with RC tendinopathy recruited from hospital clinics. The active treatment group received nine opaque capsules of MaxEPA providing 1.53g eicosapentaenoic acid (EPA), 1.04g docosahexaenoic acid (DHA) and the placebo group received nine matching placebo capsules where the long-chain omega-3 fatty acids were replaced with oleic acid; all participants attended an eight week exercise programme. Participants were assessed, at pre-randomisation, eight weeks (primary outcome point), three months, six months and 12 months (secondary outcome point). Primary outcome was the Oxford Shoulder Score (OSS). Secondary outcomes included; the Shoulder Pain and Disability Index (SPADI), Patient Specific Functional Score, Euro Qol 5D-3L, Short Form 36, global rating of change and impairment measures. Analysis was by intention-to-treat. A total of 73 participants were randomized to treatment and data were available for the analysis of 36 in the PUFA supplement group versus 33 in the placebo. Both groups improved over the time course of the study. Plasma concentrations of EPA and DHA increased in the long-chain omega-3 PUFA supplemented group but not in the placebo, providing evidence that the participants took the supplements. There was no evidence of added benefit from long-chain omega-3 PUFA supplementation for the primary outcome change in OSS -0.23 (95% CI 3.89, 3.43) or in SPADI -1.68 (-12.64, 9.28) at two months. There was some evidence to suggest that SPADI was lower in the treatment group at three months. There was no difference in outcomes between groups at 12 months. Twelve participants undertook semi-structured face to face interviews to explore experiences, barriers, motivators and enablers to supplement use and exercise. The predominant enablers to exercise were found to be the perceived benefit from the exercises and extended follow up, with barriers being lack of suitable equipment and pain. The enablers to supplement taking were found to be the perceived benefit of the supplements and a systematic pill taking routine. Barriers were the size, taste and quantity of supplements, remembering to take them, and, lack of perceived benefit.
Date of Award2015
Original languageEnglish
Awarding Institution
  • King's College London
SupervisorMatt Morrissey (Supervisor) & Thomas Sanders (Supervisor)

Cite this