Supraspinatus Tendon Tear
Supraspinatus tendon tear - what you need to know
Supraspinatus tendon tears are the most common tendon tear in the shoulder region. Tears of the supraspinatus tendon can be painful. They usually present as a sharp pain at the outside or front of the shoulder, particularly with arm elevation (raising 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 page starts with a general overview of supraspinatus tendon tears and then 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.
Supraspinatus tendon - what is it?
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. The supraspinatus muscle body is located in the top portion of the back of the shoulder blade (superior posterior portion above the spine of the scapula) known as the supraspinatus fossa (top hollow part of the shoulder blade in the image on the right). This image is a left shoulder blade from the viewpoint of looking at it from behind (posterior view). The supraspinatus tendon runs from the muscle body through quite a narrow gap under the acromion (top left of shoulder blade in the image). Although not shown in this image, 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 (gleno-humeral) 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.
Action of the supraspinatus
In addition to arm elevation, the action of the supraspinatus muscle has important role in pulling the head of humerus (the ball part of the ball and socket joint) into the glenoid (socket). Here is a three second video of the action of the supraspinatus muscle.
Supraspinatus tendon tears - underlying causes
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.
These factors include:
1. Age related degeneration
The integrity of the supraspinatus tendon has a tendency to weaken with age and become prone to tendon tears. The majority of supraspinatus tendon 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 becomes 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 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 in the integrity of the supraspinatus tendon.
Traumatic causes of supraspinatus tendon tears
As mentioned above trauma is the cause of supraspinatus tendon tears in some cases. With the exception of motor vehicle accidents, this trauma usually occurs when the arm is elevated. 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.
Explanation of rotator cuff injuries and 3 exercises to increase shoulder range of motion
At approximately 3 minute 40 second mark in this video there are 3 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 (+ / - analgesic advice or possible recommendation for surgery if required).
Physical therapy exercises
Physical therapy exercises for supraspinatus tendon tears usually have one of three purposes:
1. Relieve pain
2. Increase shoulder range of movement
3. Strengthen rotator cuff muscles
Pendulum exercise (aka Codman's)
Here is a pendulum exercise demonstration. This exercise can be good for pain relief, and may also help increase the range of motion in the shoulder joint. It is noteworthy that 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 the strain through the back.
Rotator cuff strengthening with theraband
Here are some common but very useful exercises to strengthen the rotator cuff muscles. There are some links below for cheap resistance tubing if you need to get a hold of some. Remember as you complete these exercises you are not aiming for speed, slow stead controlled movement is best. You should also not be feeling pain in the shoulder during the movement. As mentioned in the video, the aim of these resistance band exercises are not to increase your range of movement but strengthen the rotator cuff muscles which will help protect the integrity of 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.
Surgery to repair a supraspinatus tendon tear and remove some bone to increase the space below the accromion
In many cases surgery is required. I could write a whole page on its own regarding shoulder surgery for rotator cuff tears (perhaps another day!). If the tendon has been completely ruptured (no longer attached) then surgery will definitely be required with some level of urgency if the tendon is to be successfully reattached. 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 trialled 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 post-operative recovery period following a surgical rotator cuff repair will take some 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 the exercises and monitor your progression. Some surgeons will prescribe slightly different post-operative rehabilitation program dependent 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!
- Arthroscopic subacromial decompression surgery information
This page has some good information about arthroscopic subacromial decompression surgery that can help increase the subacromial space and prevent damage from impingement of the supraspinatus tendon.
© 2011 DrMikeM