Written By: Chloe Wilson BSc (Hons) Physiotherapy
Supraspinatus tendonitis is a common shoulder problem, also known as “Shoulder Impingement Syndrome” or “Painful Arc Syndrome”.
Shoulder impingement syndrome is the most common problem with one-in-five people having symptoms at some point in their lives.
Supraspinatus symptoms may come on suddenly after an injury, or build-up gradually on and off over years with no obvious cause.
The classic sign of supraspinatus tendonitis is a painful arc when moving the arm between 60-120 degrees of abduction as the tendon gets squashed against the bone in that range.
Symptoms of painful arc syndrome typically begin in middle-age, most frequently between the ages of 45-65.
Typically, supraspinatus tendonitis is an overuse injury caused by repetitive friction on the tendon, but it can be caused by a shoulder injury, instability or shoulder impingement.
Supraspinatus tendonitis is a common cause of shoulder pain. The shoulder joint is a ball a socket joint formed between the:
The shoulder is the most mobile joint in the whole body. Most joints get their stability from their bone structure but the shoulder sacrifices bony stability for mobility. Think how much more movement you can do with your arms than your legs. But the huge range of motion at the shoulder puts it at much greater risk of injury
To compensate, four muscles, known collectively as the “rotator cuff”, work together as the key dynamic stabilising muscles of the shoulder – supraspinatus, infraspinatus, teres minor and subscapularis.
The rotator cuff muscles arise from the scapula and their tendons attach to the head of humerus, underneath an arch formed by the acromion process - a bony projection at the top of the scapula that forms a joint with the clavicle aka collarbone.
Supraspinatus lies across the top of the shoulder blade. The supraspinatus tendon passes through a narrow channel between the acromion and the head of the humerus, known as the “sub acromial space”.
The subacromial space and is only around 7-14mm deep and is tightly packed with the:
The subacromial space is narrows considerably when the arm is raised around shoulder height, particularly when internally rotated (thumb pointing down). The space then opens back up once the arm is raised higher and externally rotated (thumb pointing up).
Supraspinatus tendonitis develops when there is repetitive friction on the tendon or it is repeatedly squashed or “impinged” in the subacromial space. This leads to inflammation and gradual degeneration of the tendon. In time, tears may also develop in the supraspinatus tendon leading to a partial or complete rotator cuff tear.
Common causes of painful arc syndrome include:
Supraspinatus Tendonitis may develop in isolation but it is often associated with other shoulder problems such as subacromial bursitis, shoulder impingement syndrome, biceps tendonitis and rotator cuff tears.
Mild supraspinatus tendonitis often goes unnoticed but what typically leads people to seek medical advice is shoulder and upper arm pain. Initially supraspinatus pain is usually only experienced with repetitive or sustained overhead or reaching activities. Over time, as the condition progresses, shoulder and arm pain at rest, weakness and stiffness can start to limit function.
Supraspinatus tendonitis symptoms may come on:
Common symptoms of painful arc syndrome include:
Suprapsinatus tendonitis can usually be diagnosed by your doctor or physical therapist by talking to you about your symptoms and examining your shoulder. If a partial or full thickness tear of the supraspinatus tendon is suspected, you may also be sent for an MRI or ultrasound scan.
Typical tests that are used to diagnose supraspinatus tendonitis are:
If no pain is reported with either of these tests, then supraspinatus tendonitis is most likely not the problem.
Less than one quarter of patients will require surgery for supraspinatus tendonitis, even if there is a full thickness tear in the tendon.
Transverse frictions are a specific type of connective tissue massage delivered transversely across the tendon fibres. When done correctly, deep transverse friction massage helps to reduce shoulder pain and inflammation, speed up healing of the damaged supraspinatus tendon and improve function by:
This helpful video from The Benjamin Institute shows the correct technique for deep transverse friction massage for suparaspinatus tendonitis.
A common misconception is that Deep Transverse Friction Massage is painful, but when done correctly this is not the case.
Gentle pressure is used initially across the supraspinatus tendon until the area becomes numb, known as the analgesic effect. At this point the depth of pressure is gradually increased without inducing pain. The length and frequency of treatment will depend on the stage of injury.
Transverse friction massage should only be carried out by a trained professional such as a physical therapist as success relies on a good knowledge of anatomy and structural organisation of the tissue so that they can be applied to the exact site of the supraspinatus tendonitis lesions, in the correct direction and at the right depth for the appropriate duration and frequency.
Anyone suffering from painful arc syndrome should see a physical therapist. They will fully assess your shoulder and identify anything which may be contributing to your shoulder problem. Physical therapy for supraspinatus tendonitis will tailored to what was found on examination and may include:
It is really important to avoid activities which bring on your shoulder pain to reduce the stress on the supraspinatus tendon and give it time to heal. Failure to do so increases the risk of progression to a supraspinatus tendon full thickness tear.
If your painful arc syndrome is linked to sport, seek expert advice on how to improve your technique to reduce the strain through the rotator cuff to prevent further irritation and supraspinatus tendon damage.
Painkillers and anti-inflammatories tablets or gels can help reduce pain and inflammation with painful arc syndrome.
Massaging a wet ice-cube over the tender area for 10 minutes can help reduce localised pain and inflammation.
An injection of steroid and local anaesthetic can help to reduce pain and inflammation and aid healing with supraspinatus tendonitis.
Steroid injections do temporarily weaken the tendon and can temporarily increase shoulder pain so it is important to take things easy for a few days and avoid any heavy lifting. You shouldn’t have more than 3 shoulder injections per year.
If symptoms of supraspinatus tendonitis have failed to resolve after 3-6 months of conservative treatment, then shoulder surgery may be recommended.
This tends to be when there are other pathologies alongside supraspinatus tendonitis such as subacromial bursitis, bone spurs and/or rotator cuff tears.
Subacromial decompression surgery is the most common option to open up the subacromial space and is combined with a rotator cuff repair if the supraspinatus tendon is torn. Learn More >
Whilst supraspinatus tendonitis is one of the most common shoulder complaints, there are a number of other conditions that present in a similar way or that often go hand in hand with painful arc syndrome. These include:
These shoulder conditions may occur alongside supraspinatus tendonitis or on their own.
Page Last Updated: 28/09/2021
Next Review Due: 28/09/2023