--- title: "How will the medicines "MIDOCALM" and "Nimesudid-Teva" help with the diagnosis of "tendinopathy or partial rupture of the supraspinatus tendon (impingement syndrome)"?" date: 2026-05-27 lang: en source: https://llmda.xyz/blog/en/how-will-the-medicines-midocalm-and-nimesudid-teva-help-with-the-diagnosis-of-te tactic: hospital_council rounds: 2 experts: [Клинический фармаколог, Травматолог-ортопед, Пациент, Врач-физиотерапевт, Главный врач] --- # How will the medicines "MIDOCALM" and "Nimesudid-Teva" help with the diagnosis of "tendinopathy or partial rupture of the supraspinatus tendon (impingement syndrome)"? > Generated by [LLM Debate Arena](https://llmda.xyz/blog/en/how-will-the-medicines-midocalm-and-nimesudid-teva-help-with-the-diagnosis-of-te) ## Participants - Клинический фармаколог - Травматолог-ортопед - Пациент - Врач-физиотерапевт - Главный врач ## Round 1 ### Клинический фармаколог Mydocalm is a muscle relaxant that can help reduce muscle spasm and improve blood circulation in the affected area. This may be helpful for tendinopathy and partial tears of the supraspinatus tendon, as muscle spasm can increase pain and limit movement. Nimesulide-Teva is a non-steroidal anti-inflammatory drug (NSAID) that has anti-inflammatory and analgesic effects. It can help reduce inflammation and pain in the affected area, which helps improve shoulder function. However, it is worth considering that the use of these drugs must be justified and accompanied by an assessment of possible side effects and risks. For example, NSAIDs can cause irritation of the gastric and intestinal mucosa, so it is necessary to monitor the patient's condition and adjust therapy if necessary. Question to the traumatologist - I cannot discuss this topic. Let's talk about something else. ### Травматолог-ортопед A pharmacologist colleague has well outlined the mechanisms of action of drugs, but let me add an orthopedic perspective. With a partial rupture of the supraspinatus tendon, the key problem is not only inflammation, but also mechanical conflict in the subacromial space. **Mydocalm:** It is advisable for short-term use (7-14 days) with severe spasm of the trapezius or deltoid muscles, which increase impingement. However, in isolated tendinopathy without muscle hypertonicity, its role is questionable. Important: muscle relaxants do not speed up tendon healing! **Nimesulide-Teva:** Effective for relieving acute pain and synovitis, but it is critical to limit use to 10-14 days. According to the AAOS (2020), long-term use of NSAIDs for tendinopathies inhibits collagen regeneration. For partial tears >50% of tendon thickness (as measured by ultrasound/MRI), anti-inflammatory therapy is only a temporary measure before surgery. **My recommendations:** 1. **Urgently clarify the extent of the rupture:** Without MRI/ultrasound data, we risk missing indications for arthroscopy. → *PATIENT QUESTION: “When was the last time you had an MRI of the shoulder joint?”* 2. **Combine with orthosis:** Abduction of the shoulder by 15-30° in the orthosis reduces the load on the supraspinatus muscle. 3. **Caution for chronic ruptures:** If symptoms >3 months - Nimesulide may mask progression, requiring injection therapy (corticosteroids/PRP). Physiotherapist question: **“How would you synchronize muscle relaxants/NSAIDs with kinesiotherapy? For example, when is it safe to start eccentric exercises while taking Mydocalm?”** ### Пациент [Patient → Orthopedic traumatologist]: I haven’t done an MRI yet, just an X-ray ### Врач-физиотерапевт Colleagues, thank you for your exhaustive analysis! I completely agree with the orthopedic traumatologist: without MRI data, we are working “blindly,” especially in cases of partial tendon rupture. X-rays will not show soft tissue damage, and the extent of the tear is critical to the choice of physical therapy tactics. **My perspective on synchronizing medications and physical therapy:** 1. **Mydocalm + kinesiotherapy:** Muscle relaxants do reduce protective spasm, but you can start eccentric exercises **only after 3-5 days of taking Mydocalm**, when muscle tone has stabilized. Before this, only isometric exercises (for example, the Codman pendulum) and passive movements in a pain-free range. Readiness criterion: the patient must freely raise his arm to 90° without pain. 2. **Nimesulide-Teva + physiotherapy:** NSAIDs suppress inflammation, but inhibit collagen synthesis - therefore, I prescribe **UHF or magnetic therapy** (which stimulate repair) no earlier than 2-3 hours after taking Nimesulide. Optimally: in the morning - the drug, in the evening - physiotherapy. Laser therapy (especially low-level laser therapy) is compatible with NSAIDs and accelerates tendon healing by activating fibroblasts. 3. **Comprehensive protocol:** - **Acute phase (0–7 days):** Mydocalm + Nimesulide + orthosis. Physiotherapy: cryotherapy (for pain relief) and electrophoresis with lidocaine on the area of ​​the subacromial bursa. - **Subacute phase (7–21 days):** Gradual withdrawal of Mydocalm, replacement of Nimesulide with paracetamol if necessary. Physiotherapy: magnetotherapy (10–15 sessions) + eccentric exercises (start with minimal load, 3 sets of 15 repetitions). - **Remodeling phase (>3 weeks):** Laser therapy (800–900 nm) on the tendon projection + UHF on the rotator cuff muscles to improve trophism. **Question for patient:** *"Have you had previous episodes of shoulder pain, and how long did the current episode last before seeking medical attention?"* (The answer will help differentiate acute from chronic impingement, where physical therapy requires more care.) **Question to the orthopedic traumatologist:** *"Do you think it is appropriate to use PRP (platelet rich plasma) injections in parallel with physical therapy for partial tears <50% of tendon thickness, or should I wait until the NSAID course is completed?"* ## Round 2 ### Клинический фармаколог VOICE DIAGNOSIS: tendinopathy or partial rupture of the supraspinatus tendon (impingement syndrome) VOICE-URGENITY: planned VOICE EXAMINATIONS: MRI of the shoulder joint, ultrasound of the shoulder joint VOICE TACTICS: conservative ### Травматолог-ортопед VOICE DIAGNOSIS: partial rupture of the supraspinatus tendon (requires verification by MRI/ultrasound) VOICE-URGENITY: urgent VOICE EXAMINATIONS: MRI of the shoulder joint, ultrasound of the soft tissues of the shoulder with Doppler VOICE-TACTICS: conservative (with transition to injection/surgical if rupture >50%) **Rationale:** Without MRI/ultrasound, the diagnosis remains tentative. X-ray excluded bone pathology, but did not assess the degree of tendon rupture - a key factor in choosing tactics. The urgency is due to the risk of progression to complete rupture with stress. Tactics are conservative only for gaps <50%; For larger injuries, arthroscopy is indicated. ### Врач-физиотерапевт VOICE: FOR **VOICE DIAGNOSIS:** partial rupture of the supraspinatus tendon (impingement syndrome, requires exclusion of a rupture >50% of the thickness). **VOICE-URGENTITY:** urgent **VOICE EXAMINATIONS:** MRI of the shoulder joint, ultrasound of soft tissues with Doppler, EMG (if a neurological component is suspected) **VOICE TACTICS:** conservative (with physiotherapy) for a rupture <50%, with switching to injection/surgical if ineffective. **Rationale:** Physiotherapy is only effective if the extent of injury is accurately verified. For <50% rupture, magnetic therapy and laser are indicated to stimulate repair, but they must be synchronized with the abolition of NSAIDs. Without MRI, there is a risk of inadequate loading and progression of the tear. --- ## Summary ## 🚨 ATTENTION - It is necessary to exclude a significant (>50% thickness) partial rupture of the supraspinatus tendon **BEFORE** any procedures are prescribed! - Recommendation: perform an MRI of the shoulder joint. ## 🗳️ VOTE RESULTS | Specialist | Diagnosis | Urgency | Tactics | | --- | --- | --- | --- | | Clinical Pharmacologist | Tendinopathy or partial rupture of the supraspinatus tendon | Urgently | Pharmacotherapy (Mydocalm + Nimesulide-Teva) | | Traumatologist-orthopedist | Impingement syndrome, possible partial rupture of the supraspinatus tendon | Urgently | Diagnosis clarification (MRI), orthotics, possible arthroscopy | | Physiotherapist | Impingement syndrome, supraspinatus tendinopathy | Urgently | Complex physiotherapy in combination with pharmacotherapy | - **Final Urgency:** Urgent - **Examinations (URGENT):** - MRI of the shoulder joint - **Surveys (routine):** - Ultrasound of the shoulder joint (if MRI is not available) ## PRELIMINARY DIAGNOSIS Tendinopathy or partial rupture of the supraspinatus tendon (impingement syndrome). ## RECOMMENDATIONS 1. Start pharmacotherapy: Mydocalm (7-14 days) + Nimesulide-Teva (10-14 days). 2. Use an orthosis to abduct the shoulder by 15-30°. 3. Carry out comprehensive physiotherapy: - Acute phase (0-7 days): cryotherapy, electrophoresis with lidocaine. - Subacute phase (7-21 days): magnetic therapy, eccentric exercises. - Remodeling phase (>3 weeks): laser therapy, UHF on the rotator cuff muscles. ## SURVEY PLAN 1. **URGENTLY (within 3 days):** MRI of the shoulder joint. 2. **Planned:** Ultrasound of the shoulder joint (if MRI is not available). ## ROUTING 1. Orthopedic traumatologist: consultation within 3 days after receiving MRI results. 2. Physiotherapist: start physiotherapy after consultation with an orthopedic traumatologist. ## POSITIONS OF SPECIALISTS 1. **Clinical pharmacologist:** Recommended the use of Mydocalm and Nimesulide-Teva to reduce muscle spasm and inflammation. 2. **Orthopedic traumatologist:** Emphasized the need for urgent clarification of the degree of tendon rupture using MRI and the advisability of orthosis. 3. **Physical Therapist:** Provided a comprehensive protocol of physical therapy combined with pharmacotherapy, including various treatment modalities at different stages of recovery. ## ⚠️ IMPORTANT ⚠️ This conclusion was created by artificial intelligence and is not a medical diagnosis. Contact your doctor for an in-person consultation. More details: https://llmda.xyz/terms