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.

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  • 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.

  • Pingback: Rotator Cuff Impingement Syndrome | Current Health Articles 2009()

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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?

    • 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.

  • 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.

    • 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

    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.

  • 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?

  • thomas

    found out on july 2013 evidence of a high grade tear involving the suparspinatus tendon, involving greater than 90% of the tendon fibers. no evidence of retraction. its been over a year since it happened can it still be repaired at 60 years old?????????????????

    • Hi Thomas. We cannot with any certainty comment on your case. Your orthopedic surgeon needs to assess your case and discuss it with you. However, the prognosis is not as good in patients older than 60 years, especially if they are smokers, have very large tears, where there are other contributing conditions and where it is a degenerative tear as compared to an acute tear. The procedure of choice to repair the tear can also play a role in determining the outcome. Your orthopedist will discuss all these factors with you.

  • Makaila

    Hi I have pain in my left scapular area and the ultrasound show 8mm tear in the muscle. My question is how long this take to heal

    • Hi Makaila. An 8mm tear usually does not require surgery. It depends on how the tear occurred and what treatment is being currently done. If you are older and a tear occurred due to wearing down of the tendon then these cases are a bit more complicated as compared to a tear that occurred with an acute injury in younger people. It also depends on how well you are resting the shoulder, how often you are having physical therapy and doing strengthening exercises if it has been advised at this point. Individual variation in a person’s healing ability is another factors. As you can see it is difficult to say for sure but can range from several weeks to a few months.

  • ma

    Hi, I have shoulder injury end of January, and now doctor send me to MRI, here is the result,

    Both the subscapularis and supraspinatus tendons are bulbous and inhomogeneous with tendinosis tendinopathy.
    Fluid in the subacromial / subdeltoid bursa , representing bursitis.
    Hypertrophic acromioclavicular joint changes and laterally down -sloping type II acromial configuration extends to about the underlying supraspinatus with compromise of the subacromial space.
    Trace fluid of the long head of the biceps tendon sheath and trace fluid at the rotator interval capsule of the glenohumeral joint.
    My question is, do I need surgery??
    Thank you!

    • Hi Ma. It really depends on multiple factors like your age, severity of symptoms and so on. We are not allowed to provide any advice on the next step in management (be it on whether surgery is needed or which medication you should use) as part of our comment policy. Please do understand that we are only here to guide you with your symptoms, not reach a diagnosis from your medical reports or determine the treatment. You need to speak to you doctor about your case as he/she is more familiar with it.

      • ma

        Thank you so much for the answer! I (52y. old and activ person )just would like to know, in similar cases the ortho doc does surgery, or is another way to help patient? I feel now chronic pain and have already swollen arm, and I I have numbness is my hand and I don’t feel my fingers. And the problem is I can’t take still painkiller because of my problem with heart and paradox reaction of some analgetica. Thank you in advice!!!

        • Given the heart condition and so on coupled with the information you provided, surgery would not usually be considered. Intensive physical therapy over a long period of time, anti-inflammatory drugs and so on would be the better options.

          • ma

            Thank you very much!!!

  • Beatrix Horman

    Hi, I had a shoulder injury 3 years ago. Already had two surgeries and the initial pain is still there, getting worse. My last contrast MRI shows a SLAP tear, 1st degree, Rotator cuff tendinosis and intermediate to high grade partial articular sided tear of the infraspinatus. I’m not able to use my arm and the pain keeps getting worse. Looking for treatment options, not finding much with my web searches.

  • venkatesh

    Hi.. i have right shoulder pain .doctor told me to take X-ray .it is normal than blood test .It is also normal then i went for MRI .It shows T2WI and PD hyperintense signal noted intrasubstance of supraspinnatous tendon of insertion site-suggestive of partial intrasubstance tear of supraspinatus tendon. do i need surgery??
    Thanking you

    • Satya Sunkara

      Hi Venkatesh,
      I was diagnosed with same problem as you have described. Currently I am on pain and anti inflammatory drugs for a week. what was your treatment regimen? How is your condition now.

  • Hi Joseph. You need to consult with the doctor/specialist who requested the MRI for him/her to explain the results to you. We do not intervene in the diagnosis or treatment stage between patient or practitioner as this affects the practitioner’s ability to diagnose or manage the condition. With that said, the term edema refers to swelling, often due to inflammation, and tendons are bands of connective tissue that attach a muscle to a bone. The supraspinatus muscle runs in the upper back and shoulder. Your doctor will guide you further.

  • Jacob

    Good evening, hope you can give an opinion on this PLEASE, I beg you. I am based in New Zealand & I am felling very disillusioned about what to do. I am getting conflicting advice from different Dr’s here about what i should do. I am a 34 year old male. I have received my MRI report and it reads; The right shoulder scan demonstrates a relatively large partial thickness articular surface tear of the anterior aspect of the footprint of the supraspinatus tear 5 x 8 x 3 mm with a few intact bursal surface fibres present. Mild right subacromial subdeltoid bursitis. If you had a patient like this would you recommend surgery or conservative treatment like physio etc.? I would appreciate any feedback on this matter please 🙂 I don’t suffer a lot of pain, only for certain overhead movements & throwing a ball hard will i experience some loss of power & some pain. I may have had this injury for a while too and I am not sure if parts of my muscle may have atrophied. I can forward you my MRI report too if you would like to see it, but it is basically what I mentioned here in this email. I would appreciate any feedback or opinion.

    I wonder what the future holds for rotator cuff tendon surgery when you consider that with ACL treatments there is new of treating the ACL treatments more effectively. Have a look at this youtube video ..This new surgery — bridge-enhanced ACL repair (BEAR) — uses a special protein-enriched sponge to encourage the torn ends of an ACL to reconnect and heal. Please let me know what you think about my partial thickness report? Thank you 🙂