A supraspinatus tendon tear is a common injury affecting the shoulder joint. This tear is a specific type of rotator cuff injury and a major cause of shoulder pain and functional limitation. The condition involves damage to the tendon of the supraspinatus muscle, a structure located deep within the shoulder. Understanding the injury, its causes, and treatment options is essential for recovery and restoring shoulder function.
The Supraspinatus: Anatomy and Function
The supraspinatus is one of four muscles that make up the rotator cuff, a group responsible for stabilizing and moving the shoulder. This muscle originates from the supraspinous fossa, a depression on the back of the shoulder blade (scapula). Its tendon passes through the narrow subacromial space, situated beneath the bony acromion process at the top of the shoulder.
The tendon inserts onto the greater tubercle of the humerus (the upper arm bone). The primary action of the supraspinatus is to initiate shoulder abduction, which is the movement of lifting the arm away from the side of the body. It is active during the first 15 degrees of this motion and works with other rotator cuff muscles to keep the humerus centered in the shoulder socket, providing joint stabilization.
Tears are categorized by severity, which guides treatment. A partial-thickness tear involves damage to only a portion of the tendon’s fibers, leaving the tendon largely attached to the bone. A full-thickness tear involves a complete disruption, creating a hole in the tendon or fully detaching it from the humerus.
How the Injury Occurs and Common Symptoms
Supraspinatus tears occur through two primary mechanisms: acute trauma or chronic degeneration. An acute tear results from a sudden, forceful event, such as falling onto an outstretched arm, a direct blow to the shoulder, or lifting a heavy object with a jerking motion. These traumatic tears often cause immediate pain and weakness.
Degenerative tears are more common and develop slowly due to wear and tear, aging, repetitive overhead activities, or shoulder impingement. As tendons age, they lose elasticity and become more susceptible to damage, making chronic tears prevalent in older individuals. Repetitive motions in certain sports or occupations cause microtrauma that gradually weakens the tendon until a tear occurs.
The primary symptoms of a supraspinatus tear are pain and weakness in the shoulder. Patients often experience pain when lifting or lowering the arm, especially when reaching overhead. Persistent night pain that disrupts sleep is a common complaint, particularly when lying on the affected side.
The injury causes noticeable weakness, making it difficult to lift the arm away from the body against gravity. In chronic cases, the shoulder may feel stiff, and a clicking or popping sensation may occur during movement. Pain may radiate down the side of the arm, limiting daily tasks like dressing or reaching.
Diagnostic Procedures and Imaging
Diagnosis begins with a thorough physical examination and detailed history of the injury and symptoms. The doctor performs specific maneuvers to assess the shoulder’s range of motion, strength, and pain. These include tests designed to isolate the supraspinatus muscle, such as the “Empty Can” test, which can demonstrate weakness related to the tear.
Imaging studies confirm the diagnosis and determine the tear’s characteristics. X-rays are typically the first step, used primarily to rule out bone conditions like fractures or arthritis and identify bone spurs causing impingement. Since X-rays do not show soft tissues, Magnetic Resonance Imaging (MRI) is often used for comprehensive soft tissue visualization.
MRI provides detailed images of the tendon, showing the location, size, and degree of retraction of the tear. Ultrasound is an alternative imaging method that allows dynamic evaluation of the tendon during movement. Both MRI and ultrasound are essential for determining if the tear is partial or full-thickness, which directly impacts treatment planning.
Conservative and Surgical Treatment Options
Treatment depends on the tear’s size, the patient’s age, activity level, and symptom duration. For most partial-thickness tears and smaller degenerative full-thickness tears, conservative treatment is recommended. This non-surgical management begins with rest and activity modification to protect the shoulder.
Nonsteroidal anti-inflammatory drugs (NSAIDs) help manage pain and reduce inflammation. If pain is severe, a corticosteroid injection may be administered beneath the acromion to provide temporary relief. This conservative phase uses physical therapy to reduce symptoms and restore function before considering surgery.
Surgery is necessary for most full-thickness tears, especially those from acute trauma or those failing conservative management after three to six months. The goal is to reattach the torn tendon back to the head of the humerus. Most repairs are performed arthroscopically, a minimally invasive technique using small incisions and a camera, which results in a quicker initial recovery.
For very large or complex tears, an open repair or a mini-open technique may be required for secure reattachment. The choice between surgical and non-surgical treatment is made after weighing the tear’s severity against the patient’s lifestyle and recovery goals.
Rehabilitation and Expected Recovery Time
Following any treatment, a structured physical therapy (PT) program is fundamental to regaining full shoulder function. Rehabilitation focuses on a phased approach: protecting the healing tendon, restoring range of motion, and rebuilding strength. After surgery, the shoulder is immobilized in a sling for four to six weeks to allow the tendon to heal to the bone.
During the first phase, a physical therapist guides the patient through passive range of motion exercises, moving the arm without muscle activation to protect the repair. Active movement and strengthening exercises begin later, usually around three to four months post-surgery. Full recovery is a lengthy process, taking approximately four to six months for smaller tears and up to 12 months for massive tears. Adherence to the PT regimen is essential for restoring full strength and mobility.