Supraspinatus Tendon – Tendinitis, Tendinosis and Tear

This article explains terms: the supraspinatus tendon, tendon inflammation (supraspinatus tendinitis), degeneration (tendinosis) and tear.

What Is Supraspinatus Tendon?

The supraspinatus tendon attaches the supraspinatus muscle, which arise from the shoulder blade, to the head of the arm bone at the shoulder joint.

Function of Supraspinatus Muscle

The supraspinatus muscle is part of the rotator cuff – a group of muscles that move the shoulder joint. It arises from the upper part of the spine of the scapula (upper in Latin = supra; from here the name supraspinatus). The supraspinatus muscle is responsible for moving the arm up and away from the body within a range 60 and 120 degrees. When supraspinatus is injured, pain appears in this range of arm motion. Pain begins midway when lifting the arm and disappears once the arm is completely lifted – this phenomenon is called the painful arc syndrome (Picture 1).

Supraspinatus tendinitis causing painful arc syndrome

Picture 1: Painful arc syndrome
(source: Wikipedia)

Being a part of the rotator cuff, the supraspinatus muscle also stabilizes the head of the arm bone (humerus) in the shoulder joint thereby preventing it from slipping upwards during shoulder movements.

Supraspinatus Tendinitis, Tendinosis and Tear – Mechanism and Symptoms

The supraspinatus tendon passes through a narrow tunnel below the scapular spine. A bony overgrowth (spur) or calcification of the ligament above this tunnel may hamper the smooth movement of the tendon. Constant friction on the tendon leads to inflammation known as supraspinatus tendinitis and causes pain during shoulder movements. This painful phase of the tendon injury may last for about a week or two and usually resolves spontaneously. However, persisting friction may result in tendon degeneration known as supraspinatus tendinosis. Tendinosis makes the tendon weak, but the patient often does not feel any pain and continues to use the shoulder. This may lead to a supraspinatus tendon tear. Even after a complete supraspinatus tendon tear, lifting the arm is still possible, since the function of the supraspinatus muscle is partly compensated by the other shoulder muscles. Therefore, a supraspinatus tear may not as obvious as other tendon tears, for example, Achilles tendon tear. A supraspinatus tear is insidious and may be missed altogether by the patient.

Diagnosis and Treatment

An orthopedist can recognize above mentioned disorders of the supraspinatus tendon from the upward slipping of the head of the arm bone, and the pain that typically occurs during the middle range of lifting the arm.

X-ray helps in the diagnosis of a narrow coraco-acromial arch and acromial spurs. An ultrasound can reveal tendon tears and tendinosis. MRI is the only investigation that can detect tendinitis.

Treatment of tendinitis is conservative and consists of cold compresses over the shoulder, analgesics and anti-inflammatory medications. A patient should avoid overhead arm movements within this time. Physical therapy should be started a week after starting medications and continued for a couple of months.

Treatment of tendinosis is by prolotherapy (proliferative therapy), in which certain substances that cause proliferation (growth) of the weakened tendon tissue are injected into the tendon. The procedure is also known as a non-surgical reconstruction of the tendon. At least two or three injections during the two weeks are required for best results. When prolotherapy is not available, steroid injections can be used, but these only limit the degeneration process and do not aid to active healing of the tendon.

Check the treatment of a torn rotator cuff.

Surgical or conservative treatment of a supraspinatus tendon injury at an early stage can result in the full resolution of symptoms. However, if treatment is delayed, permanent damage to the shoulder joint may occur, with the end-result being a stiff and weak shoulder joint.

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About Dr Gauresh (69 Articles)
An orthopedic surgeon trained in JJ Group of Hospitals and Grant Medical College. I have worked in this field for the past 3 years and have significant clinical experience to guide students and patients on any topic in orthopedics.
  • alexandra demetriou, OTR/L CHT

    Supraspinatus tendinitis is relatively common. I am a big advocate of functional exercises and natural anti inflammatories for dealing with this. I dont think that going for xray or MRI is necessary in early stages. Usually a good orthopedist can diagnosis this problem without spending extra healthcare dollars.

  • Dr Gauresh

    I agree its relatively common and that an MRI is not necessary but X-ray is important as it helps to rule out some important conditions. Though an orthopedist can diagnose it but he will surely ask for an x-ray atleast. This is the protocol that we usually follow.

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  • firefighter

    I have a full-thickness 11mm x 9mm tear of the supraspinatus found on MRI. I am a firefighter and triathlete. Is it necessary to have this surgically repaired or could it possibly be repaired through rehab or other means?

  • Dr Gauresh

    If you want to lead an active life then i suggest that you go ahead with a surgical repair. Its a quite significant tear and rehab and other means wouldnt give it much of support.

  • sopainful

    I have had 3 surgeries on L shoulder, 1 on R severe ligament laxity s/p MVC. Most recent was re-reconstuction (2007 repair failed) and ulnar nerve transposition in 10/09. I have a deep pit where supraspinatus muscle was. EMG confirmed NO RECRUITMENT, and fibrosis. My ortho thinks I have TOS & has shoved me off causing months of waiting. I think I have a detached supraspinatus tendon from the surgery, but they won’t even order an US or MRI. I am in pain & my arm is wasted. Thoughts?

  • Dr Gauresh

    The arm pain and wasting could be due to a detached supraspinatus. But are you able to do movements of the arm ?
    You should consult some other surgeon who would order a USG or MRI to diagnose the root of the problem.
    If the EMG is suggestive of fibrosis then it must have been because of the surgical trauma from your previous surgery.

  • sunil

    thanks for the wonderfull post, keep up the goodwork frm sunil shahani

  • Dr Gauresh

    Thanks for reading and appreciating.

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  • hmartelli28

    I am a 66 year old female with supraspinatus tendinosis and a 6x4MM superimposed partial thickness, humeral surface, supraspinatus tear extending to involve up to 50% of the tendon thickness. What should I do?

  • Dr Gauresh

    If the tear is severely affecting your daily activities then you should go for a surgical repair. But at your age healing is a bit slow so it could need months of physical therapy after the surgery. So do understand the pros and cons of each option before taking the decision.

  • Nearly There

    Within the above notes it states “Surgical or conservative treatment of a supraspinatus tendon injury at an early stage can result in the full resolution of symptoms. However, if treatment is delayed, permanent damage to the shoulder joint may occur, with the end-result being a stiff and weak shoulder joint.”

    I am 32 with full thickness tear to the left Supraspinatus and waiting for my op for 19 months now. It takes place next week. Whats the chances of any possible permanent damage due to waiting for the op for this period of time. Or does this refer to waiting for much longer periods?

  • Myriam Rodriguez

    I am 56 year old. I have pain in my left shoulder,for four months I take a multiple medicine for pain, and antiflamatories. an therapy too. In the MRI the impression , Supraspinatus tendinosis.. And the tendon appears thickened with intermediate signal.. What should I do..

  • Dr Gauresh

    If you have access to treatment options, like prolotherapy, then that would be the best option. As a second option, you can try out some physical therapy options, like local ultrasound therapy too. But do not depend on medications of pain and anti-inflammatory drugs for long.

  • jwong

    I had a right shoulder brachial plexus injury 11 months ago and recent ultrascan revealed a full thickness mid-posterior supraspinatus tendor tear of 1.4×0.7cm and which extends into the infraspinatus tendon. I don’t have pain, just weakness on the raising my arm upwards. Should I opt for surgery?

  • Dr Gauresh

    Well if you are within 35 years of age, then I would suggest surgery to go through the years of active life. If u are from the elderly age group then you can let it remain untouched with avoiding overhead activities as much as possible.

  • Dr Gauresh

    19 months is quite a long period too.. but it all depends on the kind of activity a person has during that period. Excessive overhead activity causes abnormal tracking of the rounded head of the arm bone, humerus, causing it to deform and become arthritic. Once that happens, surgery for just the supraspinatus tear is insufficient and would not cause complete resolution of symptoms.

  • Dr Gauresh

    Go for some advanced treatment modalities like prolotherapy if they are available to you. If not you can try some physical therapy. But please do not continue with pain pills for long as they are quite dangerous in the longer term.

  • jwong

    Thank you Dr Gauresh!

  • David

    I recently had an MRI on my left shoulder due to pain. Findings were:

    1: Full thickness SST tear with approx.
    1CM medial retractaion

    2: SST and IST tendnosis, bicep tenosynovitis

    3: AC joint, humeral head osteroarthosis

    Will I be able to heal this small tear using ultrasound treaments? I have ordered an FDA approved ultrasound wand to give myself home treatments. Or surgery the only option. Is the osteroarthosis bone spurs and should I have surgery to remove these.

    Thank you.

  • Dr Gauresh

    Bone spurs and related changes are commonly seen in advancing age and do not require treatment as such. I dont really expect a full thickness tear to resolve with using only ultrasound treatment. Surgery may be the only viable option in my opinion. However, if it gives you freedom from pain and helps you to regain useful movements of shoulder then it can be used to postpone the need for surgery.

  • Pamela

    MRI shoulder diagnosis code: 719.41 Supraspinatus Tendinosis, Findings state there is thickening of the supraspinatus tendon w/intermediate signal intensity consistent w/tendinosis.
    MRI cervical spine diagnosis code: 721.0, Findings state small osteophytes @ C3-4; Moderate to severe right foraminal stenosis, spondylosis & broad-based disc bulge noted @ C4-5; Small central disc protrusion w/o canal stenosis. Impression reads: Moderate to severe right foraminal stenosis @ C4-5 w/a large right sided osteophyte at that level. My question is this, I have the following symptoms that come & go. They may be in the same day, may not and do not occur every day. Numbness and or tingling in right fingers, shooting pain(similiar to an electrical shock) that runs down the top of my arm below the elbow(in a straight line)into top of hand & ends right between my pointer and middle finger. This sometimes causes an involuntary jerk of my arm, small but still involuntary. Aching in all of the right arm & hand, over into chest area & shoulder blade area. When I explain it to people I compare it tooth pain because the pain (that pain you get when the nerve in the tooth is irritated) & the aching are similiar, but you can’t go to the doctor & get it fixed like a tooth. Also, there has been a change in the feeling of my skin on the top part (above the elbow) of right arm. Could this be caused by the tendinosis? I ask because I am scheduled for ACDF Anterior Cervical Discectomy Fusion surgery on April 7th. Nov 2010 I started not being able to sleep on my right side and it has just progressively gotten worse. I barely get 2 hours of continous sleep at a time now and I have to sleep on the couch so I don’t accidently roll over onto my right side in my sleep. It’s just a mess!!! What do you think?