Supraspinatus Tendon Injury: Tendinopathy, Tear and Rehab

Quick answer

Exercise first, even for many tears

The supraspinatus runs over the top of the shoulder and helps initiate lifting of the arm. Overload or wear leads to tendinopathy, and in some cases partial or full-thickness tears. Typical symptoms are pain at the top and side of the shoulder with overhead activity, night pain and weakness. MRI or ultrasound confirms the diagnosis. Most tendinopathies and many partial tears improve with an exercise-based rehabilitation over 8–12 weeks or more, with injections or surgery reserved for those who do not respond, or for acute traumatic or large full-thickness tears.

Important. Sudden shoulder weakness and inability to lift the arm after a fall or heavy lift, severe pain with deformity, a hot swollen joint with fever, or chest pain with shoulder pain need urgent assessment.

The supraspinatus and the rotator cuff

The rotator cuff is composed of four muscles: supraspinatus, infraspinatus, teres minor and subscapularis. Their tendons blend into a cuff around the head of the upper arm bone (humerus) and keep it centred in the shoulder socket during movement. The supraspinatus tendon passes under the acromion (the bony roof of the shoulder) and assists in initiating arm elevation. This position, along with a limited blood supply, makes it prone to overload and degeneration.

From tendinopathy to full tear

Tendinopathy: overload leads to tendon changes and pain without a tear; most common in people over 35 and in overhead workers and athletes.
Partial-thickness tear: some fibres are torn, but the tendon is still continuous.
Full-thickness tear: a complete tear through the tendon, from small to massive.
Acute traumatic tear: from a fall or lifting injury, with sudden pain and weakness.
Rotator cuff changes are common in people without symptoms: up to 30–50% of people over 60 have a tear on imaging, so findings must be interpreted in the clinical context.

Symptoms

Pain at the top or side of the shoulder, sometimes radiating to the upper arm.
Pain when lifting the arm between about 60° and 120° (“painful arc”) or reaching overhead or behind the back.
Night pain, particularly lying on the affected side.
Weakness when lifting or rotating the arm.
Clicking or catching sensations.
In acute tears, sudden pain with a pop and marked weakness.

How it is diagnosed

A clinician examines your shoulder, tests the strength of the cuff muscles and checks for impingement or neck problems. Ultrasound or MRI can show tendon degeneration or tears, and X-rays rule out other problems. Treatment decisions depend more on symptoms, function and age than on images alone. See tendinitis de hombro (Spanish).

Exercise-based rehabilitation

Phase 1 (settle pain, 1–3 weeks): pendulum exercises, gentle assisted range of movement, isometric external rotation and abduction with the arm at the side.
Phase 2 (strengthen, weeks 3–8): external and internal rotation with bands (3 × 12), scapular retraction and rows, side-lying external rotation with light weight, elevation in the scapular plane.
Phase 3 (load, weeks 8–16): progressive resistance for the cuff and deltoid, push-up plus, overhead pressing with light load, plyometric and sport-specific work as needed.
Throughout: keep pain within 3–4/10 during exercise and settling within 24 hours; maintain general shoulder and upper back strength and posture work.
Exercise-based programmes have similar results to surgery for many people with partial tears and tendinopathy, with fewer risks.

Pain management and daily habits

Modify, but do not eliminate, overhead and heavy tasks; avoid sleeping on the painful shoulder.
Use paracetamol or short courses of anti-inflammatories if suitable.
Keep the shoulder moving; avoid long periods in a sling.
Improve workstation ergonomics and posture.
Warm up before sport and build load gradually.
Stop smoking, which impairs tendon healing.

Injections and other treatments

A subacromial corticosteroid injection can provide short-term pain relief and help you take part in rehabilitation, but repeated injections may weaken the tendon and should be limited. Platelet-rich plasma and other biologic injections have uncertain evidence. Shockwave therapy may help calcific disease. Your doctor can advise on risks and benefits.

When surgery is considered

Repair is considered for acute traumatic full-thickness tears in younger or active people, large full-thickness tears with significant weakness, and for those who do not improve after several months of well-delivered non-surgical treatment. Arthroscopic repair techniques are common. Recovery involves a period in a sling and 4–6 months or more of rehabilitation. Not all repaired tendons heal, and outcomes depend on tear size, tissue quality, age and adherence to rehabilitation.

When to see a doctor

Sudden weakness or inability to lift the arm after an injury.
Severe pain not controlled by simple analgesia.
Night pain that persists beyond a few weeks.
No improvement after 6–8 weeks of exercise.
Numbness, tingling or neck pain with arm symptoms.
Any chest pain or breathlessness (emergency).

Three common situations

A painter with months of shoulder pain overhead: likely tendinopathy; start a graded exercise programme and adjust tasks.

A 55-year-old with a partial tear on MRI and moderate pain: a supervised exercise programme is a reasonable first step.

A fall on an outstretched arm followed by sudden weakness: seek urgent assessment for a traumatic tear.

Key points to remember

Supraspinatus injuries are common, and most improve with progressive exercise. Pain and imaging findings do not always match, so treat the person, not the scan. Consider injections or surgery when conservative care fails or after acute traumatic tears. Our physical therapy team can design a programme for your shoulder.

This guide is for general information and does not replace an assessment by your own doctor or physical therapist.

Questions about supraspinatus injuries

These answers are general information and do not replace an examination or individual medical advice.

What is the supraspinatus?

A rotator cuff muscle on top of the shoulder blade that helps start lifting the arm and stabilises the shoulder.

Can a torn supraspinatus heal without surgery?

Partial tears often improve with exercise; full tears do not heal spontaneously but many people function well without surgery.

How long does rehabilitation take?

Usually 8–12 weeks for tendinopathy; longer for tears or after surgery.

Is it normal to have a tear on MRI without pain?

Yes. Many older adults have tears without symptoms.

Should I rest the shoulder completely?

No. Relative rest and graded exercise are better than long-term immobilisation.

When is surgery recommended?

For acute traumatic tears, large full-thickness tears with weakness, or when conservative treatment fails.

Sources

This guide is for general information and does not replace medical advice. How a problem is diagnosed and treated depends on your examination and medical history. If you think you have an emergency, contact your local emergency services.