A Guide to Supraspinatus Tendon Tears (Rotator Cuff Injury)
An Overview of a Supraspinatus Tendon Tear
- Supraspinatus tendon tears are the most common tendon tear in the shoulder region.
- These tears can be painful.
- They usually present as a sharp pain at the outside or front of the shoulder, particularly with arm elevation (raising the arm to the side or front).
- Pain can also be brought on by laying on the side and a strong ache can persist after the injury has been irritated (this can cause difficulty sleeping).
- Supraspinatus tendon tears require specific rehabilitation of the rotator cuff and muscles that stabilize the shoulder blade.
- In some cases, surgery to repair the tendon is also required. Surgery may also involve orthopedic alteration of biomechanical factors around the shoulder joint in order to prevent further ongoing damage to the supraspinatus tendon.
This article discusses shoulder impingement, rotator cuff rehabilitation exercises, and surgical considerations relating to rotator cuff tears and the supraspinatus tendon in particular. There are several video examples to accompany the written explanation.
What Is the Supraspinatus Tendon?
The supraspinatus muscle is a relatively small but very important muscle. It plays a critical role in movements involving the shoulder joint, particularly arm elevation. It is located in the top portion of the back of the shoulder blade (the superior posterior portion above the spine of the scapula) known as the supraspinatus fossa.
The supraspinatus tendon runs from the muscle body through quite a narrow gap under the acromion. The acromion joins with the collar bone and attaches to the upper arm (humerus also not shown in this image). The acromion connects with the collar bone (clavicle) very close to the ball and socket (glenohumeral) joint of the shoulder.
The close proximity of the supraspinatus tendon to the acromion-clavicular arch is a common contributing factor in supraspinatus tears, particularly when the tendon becomes impinged between these bone structures with activities that require arm elevation.
What Does This Muscle Do?
In addition to arm elevation, the supraspinatus muscle is critical in pulling the head of the humerus (the ball part of the ball and socket joint) into the glenoid (socket).
Below is a brief video.
What Are the Factors That Lead to a Tear?
There are at least three important factors that contribute to supraspinatus tendon tears. Some can be altered with conservative rehabilitation exercises in order to prevent further tearing and ongoing pain, while others cannot be altered without surgery.
1. Age-Related Degeneration
- The supraspinatus tendon has a tendency to weaken with age and become prone to tendon tears.
- The majority of these tears occur amongst people over the age of 40 years.
- However, trauma (such as sporting injuries or motor vehicle accidents) can cause tears amongst people of any age.
2. Shoulder Girdle Structure
The individual shape of the bone structures (particularly the acromion) and soft tissues around the tendon will contribute to whether the tendon is able to move freely or become impinged between structures with arm elevation.
3. Biomechanics of Shoulder Movement
The supraspinatus is one of the four muscles that make up the rotator cuff group of muscles. The rotator cuff muscles are critical to the stability and optimal biomechanical movement at the shoulder joint.
If muscles of the rotator cuff are not providing adequate stability throughout the shoulder's range of motion, this can contribute to shoulder impingement and a break down of the supraspinatus tendon.
Who Is at Risk of a Tear?
- Many professions require repetitive or heavy overhead work (roof plasterer etc.).
- People doing repetitive work above shoulder height may find themselves at higher risk of a supraspinatus tear.
- Players involved in sports requiring fast throwing actions (baseball) or overhead hitting (volleyball, tennis) may also sustain a traumatic injury to their rotator cuff and the supraspinatus tendon in particular.
Physical Therapy Exercises
At approximately the 3:40 mark in the video above, there are a few exercises to help increase the range of the movement in the shoulder. Do not complete these exercises if they cause an increase in pain; instead, seek specific advice from an appropriately qualified professional such as a physical therapist or physician.
After a formal assessment, they will be able to prescribe a course of rehabilitative exercises or recommend surgery.
Physical therapy exercises for supraspinatus tendon tears usually have one of three purposes:
- Relieve pain
- Increase shoulder range of movement
- Strengthen rotator cuff muscles
Codman's Pendulum Exercise
Below is a pendulum exercise demonstration. Here are a few notes/tips before you begin:
- This exercise can be good for pain relief, and may also help increase the range of motion in the shoulder joint.
- You don't need to lean over as far as demonstrated in this video.
- For most people, it is usually preferable to lean on a bench or table rather than the seat of a chair. This will help minimize strain on the back.
Rotator Cuff Strengthening With a Theraband
Below is a demonstration of this exercise.
- Remember that you are not aiming for speed; slow stead controlled movement is best.
- You should not feel pain in the shoulder during the movement.
- As mentioned in the video, the aim of these resistance band exercises is not to increase your range of movement but to instead strengthen the rotator cuff muscles which will help protect the soft tissue structures around the shoulder in the long term.
- It is best to stick within the range of movement indicated on the video rather than try to rotate your arm too far out to the side and potentially aggravate already inflamed rotator cuff tendons.
When Is Surgery Needed?
In many cases, surgery is required. I could write another article regarding shoulder surgery for rotator cuff tears (perhaps another day!).
Tendon Is Completely Ruptured
If the tendon has been completely ruptured (no longer attached), then surgery will definitely be required with some level of urgency for the tendon to be successfully reattached.
Partial or Full-Thickness Tear
If there is a partial or full-thickness tear (but not a complete rupture) surgery may or may not be required and is best discussed with your orthopedic surgeon and/or physical therapist after appropriate imaging investigations have been undertaken.
When the supraspinatus tendon is torn but not completely ruptured, usually a period of conservative management with a physical therapy program will be trialed rather than rushing into surgery. Even if surgery is required, the physical therapy program can help strengthen the rotator cuff muscles before the surgery.
The postoperative recovery period following a surgical rotator cuff repair will take months and involve a specific program of range of motion and strengthening exercises that your surgeon will prescribe, often in conjunction with a physical therapist who will teach you exercises and monitor your progression.
Some surgeons will prescribe a slightly different post-operative rehabilitation program depending on the nature of the injury and precise surgery performed. Surgical repairs can be compromised when post-operative instructions are not followed, so if you have surgery make sure you know exactly what you should and should not do!
Below is a brief video.
This content is accurate and true to the best of the author’s knowledge and does not substitute for diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed health professional. Drugs, supplements, and natural remedies may have dangerous side effects. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.
© 2011 DrMikeM