Supraspinatus tendonitis is one of the most common causes of shoulder pain. It is a condition that struggles to heal on its own so almost always needs treatment. In this article, we will provide you with all the information you need to know about supraspinatus tendonitis and the quickest way to treat it.
What is supraspinatus tendonitis
The supraspinatus muscle is a soft tissue structure that is part of the rotator cuff muscles of the shoulder, which also include subscapularis, teres minor, and infraspinatus muscles. It attaches from the top of the scapular (posterior shoulder), then runs underneath the clavicle and acromioclavicular joint to attach at the top of the upper arm (humerus) on the greater tuberosity. Its function is to raise the arm outwards from the side, clinically known as ‘abduction.’ It also plays a small role in external rotation and resisting gravitational forces on the glenohumeral joint. When the tendon becomes inflamed or irritated, it is classed as suffering from tendonitis.
Symptoms of supraspinatus tendonitis
There are many different characteristics of the condition. A clinical presentation may involve a combination of the following symptoms:
- Pain when raising the arm forward, sideways, or above shoulder height.
- Repetitive activities that involve shoulder movement.
- Burning sensation in the shoulder.
- Weakness when lifting up an object or pushing a door open.
- Disrupted sleep due to the pain.
- Difficulty performing routine activities such as brushing hair or putting a jacket on.
- Referred pain into the upper arm.
Symptoms of other shoulder injuries can mimic the symptoms of supraspinatus tendon injuries. The most common is inflammation of the subacromial bursa, clinically known as bursitis.
What causes supraspinatus tendonitis
There are three main causes of supraspinatus tendinitis:
Repetitive activity: repetitive use of the shoulder joint can cause the supraspinatus tendon and other neighbouring rotator cuff tendons to become inflamed such as the biceps tendon.
Poor posture: if your shoulders are protracted forward from poor posture then your supraspinatus tendon can get blocked under a bony prominence called the acromion. It then suffers from continuous compression which leads to inflammation and irritation. The clinical name for this is subacromial supraspinatus impingement or shoulder impingement syndrome. There are three sites that the tendon can become impinged: under the acromion, on the glenoid rim, or under the coracoacromial ligament. The coracoacromial ligament attaches between the acromion and the coracoid process.
Direct blow: If you fall onto or hit your shoulder then it can directly inflame the supraspinatus tendon and affect shoulder function.
Ligament laxity: when the ligaments of the should are weak and lax, it causes the joint to become unstable. The rotator cuff tendons then have to work harder to stabilise it during movement, and as a result, can develop tendinitis.
- Tight shoulder muscles.
- Age – poor vascularity.
- A previous shoulder injury: tendinopathy, rotator cuff tears, bursitis.
A practitioner will start by manually assessing the shoulder joint and performing orthopedic movement tests. These tests will assess if a painful arc is present, which indicates shoulder impingement. The names of the main tests are Hawkins, Empty can, and Neer tests.
An ultrasound scan can be recommended if a tear of the supraspinatus tendon is suspected. An MRI scan (magnetic resonance imaging) can be performed if a more accurate analysis of the health of the supraspinatus is required which includes identifying the presence of calcific deposits. An x-ray cannot show tears or inflammation in the tendon.
Treatment for supraspinatus tendonitis
Tendons have a poor blood supply so they struggle to receive adequate levels of oxygen and nutrients to help with the healing process. Prolozone Therapy is a natural treatment that involves the injection of an activated form of oxygen and nutrients to help heal the tendon. It stimulates the production of collagen, which are the fibres that a tendon is made up of.
We have found at our clinic that massage into the supraspinatus muscle helps to enhance the effects of Prolozone Therapy into the tendon. It does this by helping to open up the subacromial space and release the tension in the area, which then helps to create a better environment for the inflammation to reduce.
A physiotherapist at a sports med clinic can prescribe strengthening exercises for the supraspinatus tendon to help take pressure away from the tendon and reduce the shoulder pain. Exercises may also help to open up the subacromial space and relieve the impingement.
Any medication for supraspinatus tendinopathy should be a last resort due to the side effects it can have. The most appropriate medication to temporarily reduce the inflammation and provide pain relief is non-steroidal anti-inflammatories (NSAIDs). It can’t help with the impingement.
If a tear is causing the tendon to become inflamed then an arthroscopy can be performed to repair it. If the supraspinatus tendonitis is being caused by compression, then an acromioplasty procedure can be performed. It is also known as a subacromial decompression to release the impingement.
Surgical treatment should always be a last resort and it is safer to first try Prolozone Therapy to repair the tear.
A treatment that involves the injection of anti-inflammatory medication into the supraspinatus tendon to help to reduce inflammation. This injection should be a last resort as many studies have shown it can weaken the fibres of a tendon.
- Sports massage into the rotator cuff muscles and trapezius muscle can help to prevent supraspinatus and other shoulder injuries.
- Regularly stretch your shoulder back to help prevent bad posture.
- Stretch your shoulder muscles before and after sporting activities.
- If you play a lot of racquet sports then it is advised to have regular physical therapy. It will also help to improve the range of motion in the shoulder joint.
Frequently asked questions
How long does supraspinatus tendonitis take to heal?
The poor blood supply and vascularity of tendons mean that is can take a long time for them to heal on there own. Without treatment, supraspinatus tendonitis can take up to 6 months to heal. Treatments such as Prolozone Therapy can significantly speed up the healing process. If you leave the tendonitis untreated then it runs the risk of turning into tendinosis.
Is supraspinatus tendonitis curable?
Supraspinatus is treatable and curable with the right treatment and advice.
How do you sleep with supraspinatus tendonitis?
The best position to sleep with supraspinatus is to lie flat on your back with your arm supported by a pillow.
Where is supraspinatus pain felt?
Supraspinatus pain is felt at the side of the shoulder in the middle section of the deltoid. In some cases, it can be felt further round the front of the shoulder.
Why does tendonitis hurt more at night?
Tendonitis hurts more at night because inflammation has a chance to build up. Movement in the day time helps to flush inflammation out of the tendon before it has a chance to build up and cause shoulder pain. Another reason may be due to the position of the shoulder when laying down as this can affect the blood flow to the tendon.
Why is supraspinatus most commonly injured?
The supraspinatus is most commonly injured because there are three different positions that it can become compressed. Overuse of the shoulder can cause the muscle and tendon to become inflamed.