Supraspinatus Tendinitis - Physiotherapy Protocol

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pres.layout = "LAYOUT_16x9";
pres.title = "Supraspinatus Tendinitis - Physiotherapy Protocol";
pres.author = "Orris Medical";

// ─── COLOR PALETTE ───────────────────────────────────────────────
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// ─── SLIDE 1: TITLE ──────────────────────────────────────────────
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  s.addText("Supraspinatus\nTendinitis", {
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// ─── SLIDE 2: ANATOMY & CLINICAL OVERVIEW ────────────────────────
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  const anatomyPoints = [
    "Part of the rotator cuff (SITS muscles)",
    "Runs under the coracoacromial arch",
    "Most vulnerable at 'critical zone' — 1 cm proximal to insertion on greater tuberosity",
    "Often co-exists with subacromial bursitis",
    "Impingement in the 60–120° painful arc",
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  const tests = [
    { name: "Hawkins-Kennedy", desc: "Arm/elbow at 90°, IR → pain = coracoacromial impingement" },
    { name: "Neer's Test", desc: "Forward flexion + IR → pain at 70–120°; tuberosity hits acromion" },
    { name: "Painful Arc", desc: "Abduction 60–120° reproduces anterolateral shoulder pain" },
    { name: "Empty Can (Jobe)", desc: "Resisted abduction at 90° in scapular plane, thumb down → pain/weakness" },
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// ─── SLIDE 3: 4-PHASE OVERVIEW ────────────────────────────────────
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    { num: "1", title: "Acute /\nPain Control", weeks: "Weeks 1–2", color: C.teal,    goals: ["Reduce pain & inflammation", "Protect tissue", "Maintain baseline ROM"] },
    { num: "2", title: "Early\nRecovery",    weeks: "Weeks 3–4", color: C.blue,    goals: ["Restore full ROM", "Scapular retraining", "Begin dynamic stabilization"] },
    { num: "3", title: "Progressive\nStrengthening", weeks: "Weeks 5–8", color: C.purple, goals: ["Isotonic RC strengthening", "Eccentric loading", "Scapular stabilizers"] },
    { num: "4", title: "Functional\nReturn",        weeks: "Weeks 9–12+", color: C.green, goals: ["Power & endurance", "Plyometrics / PNF", "Sport/work-specific activity"] },
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  s.addText("← 3–4 months total   (Surgery if no improvement after this period) →", {
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// ─── SLIDE 4: PHASE 1 ────────────────────────────────────────────
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  // Col 3: Strengthening
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  s.addText("💪  Isometric Strengthening", { x: 7.0, y: 0.95, w: 2.65, h: 0.38, fontSize: 11, bold: true, color: C.amber });
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  s.addText("✓  Progress when: Pain < 3/10 at rest | Pendulums and isometrics pain-free", {
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// ─── SLIDE 5: PHASE 2 ────────────────────────────────────────────
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  s.addText("PHASE 2  |  EARLY RECOVERY  |  Weeks 3–4", {
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  s.addText("⭐  Scapular Retraining (Priority)", { x: 0.45, y: 0.92, w: 4.3, h: 0.38, fontSize: 12, bold: true, color: C.accent });
  s.addText("Per Campbell's Orthopaedics: scapular retraining is central to relieving impingement", {
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  const scap = ["Isometric scapular retraction & depression", "Shoulder shrugs (elevation-depression)", "Seated rows (low-resistance band)", "Wall slides"];
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    { x: 0.45, y: 1.68, w: 4.3, h: 1.2, valign: "top", paraSpaceBefore: 5 });

  // Target muscles
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  s.addText("Target Muscles", { x: 0.45, y: 3.15, w: 4.3, h: 0.38, fontSize: 11, bold: true, color: C.blue });
  const musc = ["Serratus anterior", "Trapezius (lower > upper)", "Rhomboids", "Latissimus dorsi", "Levator scapulae"];
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    { x: 0.45, y: 3.55, w: 4.3, h: 1.6, valign: "top", paraSpaceBefore: 5 });

  // ROM right col
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  s.addText("🔄  ROM & Stretching", { x: 5.25, y: 0.92, w: 4.3, h: 0.38, fontSize: 11, bold: true, color: C.accent });
  const rom2 = ["Progress wand/L-bar: flexion, ER, IR", "Posterior capsule stretch (sleeper stretch)", "Aquatherapy to assist ROM if needed", "Correct posture: forward head, rounded shoulders", "Cryotherapy after exercise sessions"];
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    { x: 5.25, y: 1.35, w: 4.3, h: 1.6, valign: "top", paraSpaceBefore: 6 });

  // RC strengthening right col
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  const rc2 = ["Multi-angle submaximal isometrics", "Theraband IR/ER at 0° (arm at side)", "Scaption to 60–70° (pain-free only)", "Cross-friction massage: supraspinatus — arm in adduction + IR with forearm behind back"];
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  s.addText("✓  Progress when: Full pain-free ROM in all planes | MMT strength ≥ 70% of contralateral side", {
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// ─── SLIDE 6: PHASE 3 ────────────────────────────────────────────
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  s.addText("PHASE 3  |  PROGRESSIVE STRENGTHENING  |  Weeks 5–8", {
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  // RC isotonic
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  s.addText("RC Isotonic Exercises", { x: 0.45, y: 0.93, w: 2.7, h: 0.38, fontSize: 11, bold: true, color: "CE93D8" });
  const rc3 = ["Empty/Full can (scaption to 90°)", "ER with theraband (0° → 45° abd.)", "IR with theraband", "Prone horizontal abduction", "Prone extension", "Prone ER (elbow 90°, against gravity)", "Theraband rows", "Forward flexion to 90° (dumbbell)"];
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  // Eccentric loading
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  s.addText("⭐  Eccentric Loading", { x: 3.7, y: 0.93, w: 2.7, h: 0.38, fontSize: 11, bold: true, color: C.accent });
  const ecc = ["Eccentric ER: bilateral up, unilateral down", "Eccentric scaption (abduction): same principle", "Low resistance → slow pace initially", "Progress resistance and speed over time", "Key for tendon remodeling & collagen repair"];
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  // Scapular strengthening
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    { x: 3.7, y: 3.62, w: 2.7, h: 1.45, valign: "top", paraSpaceBefore: 5 });

  // Adjunct therapies
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  s.addText("ESWT (Shockwave)", { x: 6.95, y: 1.38, w: 2.6, h: 0.3, fontSize: 10.5, bold: true, color: C.amber });
  s.addText("Evidence supports for both calcific & non-calcific tendinopathy; reduces pain especially with exercise", {
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  s.addText("Dry Needling", { x: 6.95, y: 2.4, w: 2.6, h: 0.3, fontSize: 10.5, bold: true, color: C.amber });
  s.addText("Trigger point needling to supraspinatus/infraspinatus — BJSM 2026 NMA found this + exercise most effective for function", {
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  s.addText("PRP Injection", { x: 6.95, y: 3.45, w: 2.6, h: 0.3, fontSize: 10.5, bold: true, color: C.amber });
  s.addText("Comparable to exercise therapy alone in RCT; may supplement conservative program", {
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  s.addText("Percutaneous Electrolysis", { x: 6.95, y: 4.35, w: 2.6, h: 0.3, fontSize: 10.5, bold: true, color: C.amber });
  s.addText("Combined with exercise: greatest pain reduction (NMA 2026)", {
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  s.addText("✓  Progress when: Full ROM | MMT strength ≥ 90% contralateral | Pain-free during isotonic work", {
    x: 0.5, y: 5.28, w: 9, h: 0.28, fontSize: 9, color: C.white, valign: "middle"
  });
}

// ─── SLIDE 7: PHASE 4 ────────────────────────────────────────────
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  s.addText("PHASE 4  |  FUNCTIONAL RETURN  |  Weeks 9–12+", {
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  });

  // strength power
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  const str4 = ["Continue isotonic with increased resistance in all planes", "Resistance at 90° abduction, 90° ER/IR (throwing position)", "Plyometrics: medicine ball throws, wall throws, overhead tosses", "PNF diagonal patterns (D1, D2)", "Isokinetic strengthening if available", "Upper extremity ergometry for endurance"];
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  // NMC & sport specificity
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  s.addText("🎯  Neuromuscular & Sport-Specific", { x: 3.75, y: 0.93, w: 2.8, h: 0.38, fontSize: 11, bold: true, color: C.accent });
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    { x: 3.75, y: 1.36, w: 2.8, h: 3.7, valign: "top", paraSpaceBefore: 6 });

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    "Full pain-free ROM matching contralateral",
    "MMT strength ≥ 90% of contralateral",
    "No pain during sport-specific tasks",
    "Satisfactory DASH / ASES scores",
    "Confident proprioception & neuromuscular control",
  ];
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  s.addShape(pres.shapes.RECTANGLE, { x: 6.9, y: 4.3, w: 2.85, h: 0.93, fill: { color: "0D4010" }, line: { color: C.green, transparency: 50 } });
  s.addText("⚠️  Surgical Referral", { x: 7.0, y: 4.33, w: 2.65, h: 0.3, fontSize: 10, bold: true, color: "FF8A65" });
  s.addText("If no response after 3–4 months of conservative therapy → consider arthroscopic subacromial decompression", {
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  });

  s.addShape(pres.shapes.RECTANGLE, { x: 0.3, y: 5.28, w: 9.4, h: 0.28, fill: { color: C.green, transparency: 80 }, line: { color: C.green, transparency: 80 } });
  s.addText("✓  Goal: Return to full pre-injury sport or occupational activity without pain recurrence", {
    x: 0.5, y: 5.28, w: 9, h: 0.28, fontSize: 9, color: C.white, valign: "middle"
  });
}

// ─── SLIDE 8: EXERCISE SUMMARY TABLE ─────────────────────────────
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    ["Isometrics (IR/ER)",         "✓", "✓", "",  ""],
    ["Scapular isometrics",        "✓", "✓", "",  ""],
    ["Theraband IR/ER (0°)",       "",  "✓", "✓", ""],
    ["Scapular rows",              "",  "✓", "✓", "✓"],
    ["Sleeper stretch",            "",  "✓", "✓", "✓"],
    ["Empty/Full can",             "",  "",  "✓", "✓"],
    ["Eccentric ER & scaption",    "",  "",  "✓", "✓"],
    ["Serratus push-ups",          "",  "✓", "✓", "✓"],
    ["Prone horizontal abduction", "",  "",  "✓", "✓"],
    ["Prone ER & extension",       "",  "",  "✓", "✓"],
    ["Plyometrics / PNF",          "",  "",  "",  "✓"],
    ["Sport-specific drills",      "",  "",  "",  "✓"],
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  const colX = [0.3, 3.85, 5.25, 6.65, 8.05];
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      line: { color: C.white }
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    s.addText(h, {
      x: colX[ci], y: startY, w: colW[ci], h: 0.38,
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// ─── SLIDE 9: KEY EVIDENCE ────────────────────────────────────────
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  const papers = [
    {
      ref: "Lazzarini et al. — Br J Sports Med (2026)",
      type: "Systematic Review + Network Meta-Analysis",
      n: "89 RCTs  |  5,532 participants",
      finding: "Exercises targeting shoulder + scapular muscles may reduce pain (SMD -0.79) and improve function. Adding trigger point dry needling to combined exercise produced greatest functional improvement. Percutaneous electrolysis + combined exercise gave greatest pain relief.",
      color: C.amber
    },
    {
      ref: "Lazzarini et al. — Physical Therapy (2025)",
      type: "Systematic Review + Meta-Analysis",
      n: "RCTs comparing CSI vs. PT",
      finding: "Corticosteroid injections provide short-term benefit (3–12 weeks) but physiotherapist-led exercise interventions are comparable or superior at medium/long-term follow-up for rotator cuff tendinopathy.",
      color: C.accent
    },
    {
      ref: "Campbell's Operative Orthopaedics 15th Ed. (2026)",
      type: "Authoritative Textbook",
      n: "Clinical Practice Guideline",
      finding: "Scapular motor control and posterior scapular strengthening offloads the anterior supraspinatus and biceps tendon. Programs targeting serratus anterior, trapezius, rhomboids, latissimus dorsi are first-line. Surgery if failure after 3–4 months.",
      color: C.teal
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// ─── SLIDE 10: SUMMARY / CLOSING ─────────────────────────────────
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    { icon: "🎯", text: "Exercises targeting both shoulder AND scapular muscles = first-line physiotherapy (NMA 2026)" },
    { icon: "⭐", text: "Scapular retraining (serratus anterior, trapezius, rhomboids) is central to relieving impingement" },
    { icon: "📉", text: "Eccentric loading drives tendon remodeling — introduce by Phase 3" },
    { icon: "💉", text: "Corticosteroid injection: short-term benefit only; max 1–2 subacromial injections" },
    { icon: "⚡", text: "Dry needling + combined exercise = greatest functional improvement (BJSM 2026)" },
    { icon: "⏰", text: "3–4 months conservative therapy before surgical referral (arthroscopic decompression)" },
    { icon: "✅", text: "Return-to-sport: full ROM + MMT ≥ 90% contralateral + pain-free sport-specific activity" },
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// ─── WRITE FILE ───────────────────────────────────────────────────
pres.writeFile({ fileName: "/home/daytona/workspace/supraspinatus-ppt/Supraspinatus_Tendinitis_Physiotherapy_Protocol.pptx" })
  .then(() => console.log("✅ PPT created successfully"))
  .catch(err => { console.error("❌ Error:", err); process.exit(1); });