Just above your shoulder blade, there’s a small but vital muscle called the supraspinatus. It’s a key player in the group of muscles and tendons known as the rotator cuff, which keeps your shoulder stable and allows it to move. A tear in this muscle causes intense pain and limits your arm’s movement, making everyday tasks like brushing your hair or putting on a jacket a challenge.

Supraspinatus tears happen suddenly from an injury, like falling or lifting something heavy. They can also develop gradually, especially in people over 40, as the tendon wears down over time. If you’re experiencing shoulder pain, weakness, or limited movement, you might have a supraspinatus tear.

Anatomy of Supraspinatus

You will find the supraspinatus muscle at the top of your shoulder. It starts on the top part of your scapula (shoulder blade) and inserts on your humerus (upper arm).

The supraspinatus muscle acts is part of the rotator cuff, a group of muscles and tendons that provide stability and allow your shoulder to move in various directions. It helps lift your arm and plays a crucial role in the smooth functioning of your shoulder joint.

What have you lost?

Imagine trying to reach for a book on the top shelf or putting on your coat without the supraspinatus muscle. The supraspinatus muscle is essential for lifting your arm sideways and turning it, working closely with the other rotator cuff muscles to control and execute these movements. It helps stabilize your shoulder joint, reducing the impact of sudden movements or external forces that could cause injury.

Your shoulder is supported by the rotator cuff, a group of four muscles including the supraspinatus. These muscles work together to stabilize your shoulder and allow a wide range of movements. When your supraspinatus muscle is torn, this whole support system is disrupted. The other muscles and tendons have to work harder to compensate, leading to increased strain and potential further injury.

I have a Supraspinatus muscle tear. How did it happen?

Imagine you’re reaching up to grab something heavy from a shelf. Suddenly, you feel a sharp pain in your shoulder. This could be the first sign of a supraspinatus muscle tear.

A muscle is basically like a bundle of thin ropes (fibres) grouped together in a bunch to form a thicker rope. These “bunches” can tear in different ways, all presenting a bit differently from each other. Picking up a heavy object, changing the direction of a movement too quickly, or a sudden stretch can overload and tear these structures. The fibres can tear from top to bottom, across, or in between the fibres. A large tear in any of these dimensions will be extremely painful and debilitating.

The most common grading we use is partial or full thickness tears. With a partial thickness tear, the muscle hasn’t torn all the way through. so the muscle is still attached to the bone, but is thinner and weaker. Full thickness tears, as the name suggests, go deeper into the muscle.

Causes of Supraspinatus tears

Overuse

Repetitive overhead activities like painting, swimming, or playing sports such as tennis or baseball can strain the supraspinatus tendon over time, leading to tears.

Age-related wear

As we age, our soft tissue loses elasticity and muscles become more prone to injury. The supraspinatus muscle is no exception, and tears are more common in people over the age of 40.

Trauma

A sudden fall onto an outstretched arm or a direct blow to your shoulder can cause an acute tear in the supraspinatus muscle.

Lifting

Heavy lifting or awkward movements can put too much stress on the supraspinatus muscle, leading to tears.

Symptoms of Supraspinatus muscle tears

Mild

  • Discomfort when reaching for objects overhead
  • Mild pain when lifting items from a high shelf
  • Difficulty brushing or combing hair
  • Minor ache when getting dressed
  • Difficulty reaching into the backseat of a car
  • Discomfort when carrying a light bag on the sore side
  • Mild pain when pushing open a heavy door
  • Difficulty buckling a seatbelt
  • Some pain when tucking in a shirt or fastening a bra
  • Minor discomfort when stretching your arm out to the side
  • Mild discomfort when turning a steering wheel with the affected arm
  • Slight pain when trying to sleep on the affected side
  • Pain goes away when you rest
  • Slight discomfort when using a computer mouse for extended periods
  • Cramping of muscles around your shoulder

Moderate

  • Noticeable pain when lifting your arm above shoulder level
  • Difficulty putting on a coat or shirt
  • Significant discomfort when trying to sleep on the affected side
  • Noticeable weakness when lifting objects
  • Pain when trying to throw a ball with any force
  • Difficulty and pain when reaching out to grab something from a distance
  • Moderate pain when pushing or pulling open heavy doors
  • Discomfort when carrying groceries or a moderately heavy bag on the affected side
  • Pain when trying to do overhead activities such as hanging curtains or changing light bulbs
  • Difficulty washing or combing your hair without experiencing pain
  • Noticeable pain when trying to scratch your back or zip up a dress
  • Discomfort when reaching across your body such as to grab a seatbelt
  • Increased pain when lifting a child or pet
  • Moderate difficulty when vacuuming, sweeping, or doing other household chores
  • Pain when playing sports that involve overhead arm movements like tennis or volleyball
  • Moderate discomfort when trying to do simple exercises like arm raises or shoulder stretches
  • Sleeping on the affected side is nearly impossible due to constant pain
  • Sharp pain when turning a steering wheel especially during sharp turns
  • Reaching for items in the backseat of a car is severely painful
  • Significant pain and weakness when pushing up from a lying or sitting position
  • Using a computer mouse or typing for extended periods becomes very painful
  • Moderate pain and weakness make moderate exercises like push-ups or light weightlifting impossible

Serious

  • Intense pain when attempting to lift your arm even slightly

  • Inability to put on a shirt or jacket without significant discomfort
  • Severe pain when trying to reach behind your back for any reason
  • Constant pain when lying on the affected side, disrupting sleep
  • Marked weakness of your arm, making it difficult to lift even light objects
  • Excruciating pain when attempting to throw or catch a ball
  • Severe pain when reaching out for objects
  • Intense discomfort when pushing or pulling open doors
  • Inability to carry a bag or groceries without significant pain
  • Overhead activities become nearly impossible due to pain and weakness
  • Severe pain and difficulty when washing or styling your hair
  • Extreme discomfort when scratching your back
  • Severe pain when reaching across your body such as to buckle a seatbelt
  • Intense pain when lifting a child or pet
  • Household chores like vacuuming or sweeping become very painful
  • Sports involving overhead arm movements are out of the question
  • Pain and difficulty with basic exercises like arm raises or shoulder stretches
  • Sleeping on the affected side is nearly impossible due to constant pain
  • Sharp pain when turning a steering wheel especially during tight turns
  • Reaching for items in the backseat of a car is severely painful
  • Significant pain and weakness when pushing up from a lying or sitting position
  • Gardening activities like digging or heavy lifting are out of the question
  • Using a computer mouse or typing for extended periods becomes very painful
  • Severe pain and weakness make moderate exercises like push-ups or light weightlifting impossible

Tests that you can do to see if you have a torn Supraspinatus muscle

  • Lift your arm to the side at shoulder level, keeping your elbow straight.
  • Point your thumb down, like you’re pouring out a can.
  • Try to lift your arm as if pushing against something.
  • Pain or weakness may mean you have a supraspinatus tear.

  • Lift your arm in front of you, keeping your elbow straight.
  • Try to raise your arm as high as you can.
  • Pain or difficulty reaching full height could mean a supraspinatus tear.

  • Keeping your elbow straight, slowly lift your arm to the side and up over your head.
  • Pay attention to any pain you feel.
  • Pain in this range may suggest a problem with your supraspinatus.

How severe is my shoulder muscle tear?

Mild (Grade I – Minor Tear)

For a mild or Grade I supraspinatus muscle tear, you’ll experience a mild ache or tenderness on the top of your shoulder, especially when lifting your arm overhead or reaching behind your back. While movement is generally not limited, activities like putting on a coat or brushing your hair will be uncomfortable. This grade of injury represents a minor tear in the supraspinatus muscle, typically not causing significant impairment in daily activities.

Moderate (Grade II – Partial Tear)

In cases of a moderate or Grade II supraspinatus muscle tear, the pain and discomfort become more severe compared to a mild tear. You will notice these symptoms when lifting your arm or sleeping on the affected side. Activities that involve raising your arm, such as throwing a ball or reaching for high shelves, elicit a sharp pain or a sense of weakness in the shoulder. This indicates a larger tear in the supraspinatus muscle, but not a complete rupture.

Severe (Grade III – Full Thickness Tear)

If you have a Grade III supraspinatus muscle tear, you will have severe and constant pain, interfering with your day to day activities and sleep. You will notice significant weakness of your arm, making it difficult to lift the arm or carry objects. This grade represents a full thickness tear of the supraspinatus muscle, with significant pain and disability.

Diagnosis

Physiotherapy diagnosis

Our team of expert physiotherapists use a detailed approach to diagnose supraspinatus muscle tears. Our goal is to accurately identify the source of your shoulder pain and create a personalized treatment plan for you.

We’ll carefully check your shoulder for any tender spots, swelling, or warmth. During our assessment, we evaluate your shoulder movements to check the flexibility of your muscles and test muscle strength around your shoulder. There are specific tests we use to diagnose shoulder injuries, and get to the root cause of your problem.

After these steps, we’ll discuss with you the best way to treat your shoulder pain. Our aim is to help you recover and get back to your daily activities without pain.

X-rays

This type of imaging is great for looking at bones, but it doesn’t show soft tissue like muscles and tendons. X-rays are not very useful when diagnosing supraspinatus muscle tears.

Diagnostic ultrasound

An ultrasound is a valuable tool for diagnosing a torn supraspinatus muscle. It can show the presence and extent of a tear, as well as any inflammation or swelling around the tendon.

If you need an ultrasound, your physio will refer you.

MRI

An MRI (Magnetic Resonance Imaging) is an advanced imaging technique that is often used by surgeons to diagnose a supraspinatus muscle tear. It can show the exact location and size of the tear, as well as any associated injuries such as damage to other rotator cuff tendons or the shoulder joint.

If your physiotherapist suspects damage to the deeper structures of your shoulder, you will be referred to the right specialist.

Why is the pain not going away?

Improper Healing and Ongoing Pain

If your supraspinatus muscle doesn’t heal properly, you will keep feeling pain. This happens if the muscle keeps getting hurt or doesn’t heal fully, leading to ongoing inflammation. Over time, this inflammation causes scar tissue to form, making your shoulder stiff and sore.

Other Problems and Weak Muscles

You might also have other shoulder issues, like pinched nerves or arthritis. These can come up if the muscles around your shoulder weren’t strong enough to keep it stable, putting you at risk for more shoulder pain.

Not Getting the Right Treatment

Maybe the first treatment you got didn’t really tackle the main problem or how serious your injury was. Not getting the right care can slow down your recovery. Plus, there might be other health issues you’re dealing with, like diabetes, weak bones, or rheumatoid arthritis, that can affect how well your shoulder heals.

What NOT to do

  • Continuous use of anti-inflammatory medication, as they are thought to delay healing

  • Manage the pain by only taking pain medication or muscle relaxants. You are only masking the symptoms of something more serious

  • Stretch through the pain

  • Walk, run, jog through the pain

  • Do not ignore back pain that gets worse (it could be an sign of a deeper problem)

  • Leave it untreated, if you are uncertain of the diagnosis, rather call us and be safe

What you SHOULD do

  • Rest as needed

  • Avoid activities that is flaring up your pain, like sitting for long hours or bending

  • Make a list of movement or activities that brings on your pain and rank them

  • Make an appointment to confirm the diagnosis and determine how severe the tissue damage is.

  • Finish your treatment and rehabilitation programme for better long-term results

Making it worse

  • Carrying heavy bags

  • Hanging washing

  • Picking up your child

  • Stretching through pain

  • Lifting weights

  • Reaching over your head

  • Throwing

  • Playing tennis or Padel

  • Reaching to the back seat of your car

Problems we see when patients come to us with shoulder pain

Using a Shoulder Brace

A brace is useful in the first couple of days, for pain relief, but shouldn’t be used for longer than a week without a proper diagnosis. Otherwise, your shoulder joint gets stiff and muscles keep getting weaker, leading to even more problems than you started with.

Loading too soon

Even if your shoulder starts to feel better, don’t rush back into heavy lifting or sports. Muscles need time to heal completely. If you push too hard too soon, you will hurt it again. We’ll help you figure out when it’s safe to get back to your normal activities.

Using medication to hide the pain

Pain medicine can help you feel better, but it doesn’t solve the problem. Using too much for too long will hide more serious damage.

Not getting the Right Diagnosis

It’s important to know exactly what’s wrong with your shoulder before you start treating it at home. What works for one person might not be right for you. Make sure you know what’s going on with your shoulder before trying out exercises or remedies you find online.

Physiotherapy treatment

We know that recovering from a supraspinatus muscle tear is challenging. We’re here to help you with a treatment plan that will guide you through your recovery. This plan will include various techniques to reduce pain and inflammation, and improve the strength and mobility of your shoulder.

Physiotherapy treatment includes modalities like soft tissue mobilization and joint mobilization to ease your pain, and improve your range of motion. Other techniques like dry needling and electrotherapy can also be used to treat pain and stimulate healing. Strapping is used to deload and protect the injured area, so we can get you moving as soon as possible to promote healing.

A crucial part of treatment is activity modification, to reduce stress on the healing structures. Education about how to modify you activities will be part of your rehabilitation program, as well as therapeutic exercises, designed to improve control and strengthen the muscles around your shoulder.

Our goal is to help you return to your daily life and exercise routine as quickly and safely as possible while minimizing the risk of re-injury to your supraspinatus muscle.

Phases of rehabilitation

1st Phase: Acute Phase (week 1)

During the acute phase, the primary goals are to reduce pain and inflammation, and to protect the tear from further injury. Treatment includes relative rest, and gentle range of movement exercises. A sling may be used to immobilize your shoulder and provide support. Functional abilities are limited during this phase, with the arm mainly used for essential activities to avoid strain on the injured muscle.

2nd Phase: Early Recovery Phase (weeks 2-3)

The early recovery phase focuses on increasing range of motion and preventing stiffness in your shoulder joint. Treatment involves a gradual increase in passive and active-assisted range of motion exercises, along with isometric exercises to maintain the activation of your rotator cuff muscles without causing further strain. Functional abilities improve, allowing for light activities, but overhead movements are still limited.

3rd Phase: Intermediate Recovery Phase (weeks 3-4)

In the intermediate recovery phase, the goals are to improve the strength and endurance of your rotator cuff and scapular stabilizers. Treatment includes progressive resistance exercises using bands or light weights, scapular stabilization exercises, and the continuation of range of movement exercises. Functional abilities expand to include moderate activities with minimal discomfort, such as lifting light objects and performing daily tasks.

4th Phase: Advanced Recovery Phase (weeks 4-6)

The advanced recovery phase aims to restore full strength and endurance to your shoulder and improve functional use of your arm. Treatment consists of advanced strengthening exercises, including resistance bands and light dumbbell exercises, as well as functional exercises that mimic daily or work-related activities. Functional abilities improve, allowing for most daily activities and a return to work, depending on the job’s physical demands.

5th Phase: Return to Activity Phase (weeks 6-10)

During the return to activity phase, the focus is on a gradual return to sport or recreational activities while maintaining shoulder strength and flexibility. Treatment includes sport-specific or activity-specific exercises and continued strength and flexibility exercises. Functional abilities improve to allow a return to recreational activities or sports with modifications as needed, along with continued improvement in strength and endurance.

6th Phase: Final medical clearance tests )+ week 12)

This last phase aims to maintain shoulder strength, flexibility, and function and prevent re-injury. Treatment involves a regular exercise routine that includes rotator cuff strengthening, flexibility exercises, and activity-specific exercises. Functional abilities include a full return to daily, work, and recreational activities, with an ongoing exercise program to maintain shoulder health.

Healing time

Recovery time for a supraspinatus muscle tear depends on the extent of the damage. In general terms, healing takes about 4-6 weeks, but recovery can be a much longer road. For grade II tears this process can take 3-6 months whereas a full thickness tear can take up to a year.

You will see your physiotherapist twice a week for the first two weeks and then once a week thereafter. Once your pain is under control, you will need treatment every second week to continue strengthening and endurance exercises. When you enter this conditioning phase of treatment, your physiotherapist will see you once every 4 weeks to monitor your progress and adjust your exercise program as necessary.

Other forms of treatment

Pain Medications: These can help ease your symptoms, but they also hide how bad your injury is if you haven’t gotten the right diagnosis yet. Medication can be useful resource during in your recovery, but you should use it carefully and as advised.

Corticosteroid Injections: The relief from injections is only temporary and this medication weakens the ligaments and tendons around your shoulder.

Ice and Heat Therapy: These are useful home remedies for pain management, but should only be applied alongside a proper treatment plan.

Biokineticist: A biokineticist can help guide your rehabilitation and conditioning once healing has taken place.

Chiropractor: Forceful techniques like adjustments to your shoulder joint after a tear can actually do more damage to your already injured muscle.

Sling or Brace: Using a sling or brace at the start of your injury may give your arm the rest it needs, but you should still get a diagnosis and have a plan to start moving and using your arm on your own again.

Is surgery an option?

Surgery for a supraspinatus muscle tear is considered with full thickness tears , but only if non-surgical treatments haven’t been effective. One example of unsuccessful non-surgical management will be significant loss of shoulder joint stability or persistent pain that keeps your from using the arm in day to day activities.

After the surgery, your shoulder will need time to heal and a gradual return to movement and activities. Your physiotherapist is an expert at treating post-operative shoulder conditions and guiding the rehabilitation process.

What else could it be?

  • Shoulder Impingement Syndrome: When the tendons of the rotator cuff become pinched in your shoulder with overhead movements.
  • Adhesive Capsulitis (Frozen Shoulder): Involves a gradual onset of stiffness and severe pain that affects your entire shoulder.
  • Calcific Tendonitis: Caused by calcium deposits in the tendons of the shoulder, resulting in sharp pain.
  • Shoulder Dislocation: When the ball of the shoulder joint comes out of its socket, causing intense pain and almost complete inability to move your shoulder.
  • Shoulder Bursitis: Inflammation and swelling of the bursa in your shoulder joint, causing pain with almost any movement, not just overhead.

Also known as

  • Supraspinatus tear

  • Rotator cuff tear
  • Torn shoulder muscle
  • Pulled shoulder muscle
  • Supraspinatus muscle rupture
  • Rotator cuff injury
  • Shoulder tendon tear
  • Supraspinatus strain