A muscle is surrounded by an outer sheath that allows it to move smoothly over the surrounding tissues as it contracts. Inside the outer sheath are bundles of muscle fibers known as fascicles, which are further made of myofibrils. These myofibrils are composed of millions of microscopic units called sarcomeres that are responsible for muscle contraction.
In the sarcomere, muscle proteins called myosins pull against thin ropes of a protein (called actin) when they are stimulated by nerves. When this occurs, the sarcomeres shorten, resulting in a contraction. When the myosin proteins relax, the sarcomeres lengthen back to their original position and so does the muscle. Overall, the combination of muscle contraction and relaxation is coordinated through the nervous system. This is what allows athletes to run, kick, throw, and even walk and breathe.
The supraspinatus is a muscle that is located at the top of the shoulder. It is one of the four muscles of the rotator cuff and helps with arm abduction (raising the arms up and away from the body). The supraspinatus tendon is often the tendon that is injured in a rotator cuff injury although not always.
It typically starts with tendinitis. Supraspinatus ruptures often occur gradually, though many are associated with sports injuries, falls on your shoulder, or an added injury due to shoulder dislocation in elderly adults. If you have ever been diagnosed with bursitis, it may be possible the supraspinatus tendon is the real source of your pain, not the shoulder bursa. In this case, the pain does not usually resolve with prescribed medications.
Causes & Symptoms
Supraspinatus tendon injuries can lead to more injuries. As soon as one area of the tissue is damaged, other areas can get torn or strained as well. It is entirely possible to be suffering from a supraspinatus tear injury, strained rotator cuff muscle, and also develop a bone spur in your affected shoulder. A supraspinatus tear in the tendon or muscle could also lead to impingement syndrome (this is where your tendon or bursa gets caught between the bones in your shoulder).
If you’ve suffered a traumatic sudden injury to your shoulder, you may have heard a sudden popping sound or felt a tearing sensation in your shoulder. Swelling around your shoulder will occur within a few hours after the injury or in the following days. If the injury is severe enough, you may also have some bruising on your shoulder.
Immediate, intense, pain will also follow, especially when you attempt to raise, lower, or rotate your damaged arm. If your tear is big enough, you might feel weakness (or instability) in your shoulder. Over time this weakness will turn into a limited range of motion and inability to raise, lower, or rotate your arm, which can result in pain. After experiencing a supraspinatus tear / rupture, your injury would also be interfering with your sleep, causing pain and forcing you to wake up several times to adjust your sleeping position.
Degenerative supraspinatus ruptures are subtle with pain that increases over time. You may also notice swelling after exercise or regular daily activities. If you do have pain, you may experience something called trigger point pain in your shoulder and possibly feel weakness or instability.
Trigger point pain is pain that comes from a specific spot in your supraspinatus muscle that has become a hypersensitive area. These trigger points, or hypersensitive areas of pain, are known to be a source of continuous pain and lack of blood flow within the tissue. In addition, pain can increase with certain activities, like raising your arm to reach for something off a high shelf, getting dressed, or reaching behind your back.
Generally, tendon tears / ruptures are classified according to the extent of the injury. Therefore, here are three different grades as seen below:
- Grade 1 – The muscle / tendons have been stretched or pulled slightly, yet there is no pain experienced during exercises and weight-bearing activities. Mild tenderness and swelling may occur. Fortunately, there isn’t any mechanical instability.
- Grade 2 – The muscle / tendon has been overstretched and slightly torn, moderate swelling with bruising occurs, some functional loss, and there is mild to moderate instability to the torn tendon.
- Grade 3 – The muscle / tendon is partially or completely ruptured, severe swelling with bruising occurs, complete functional loss (unable to weight bear), and there is moderate to severe instability.
Who gets a Supraspinatus Rupture?
Overall, anyone can injure their supraspinatus muscle, though shoulder tendon tears happen most often from sudden or traumatic accidents and overuse or repetitive stress.
A fall, lifting, or pulling an object that is too heavy, accident or injury during a sporting event may all cause sudden trauma to the supraspinatus tendon. Athletes that play sports where they repeatedly use their arms in raised and lowered positions (such as baseball players, swimmers, tennis players, and football players) are commonly affected by supraspinatus ruptures.
It is more likely for a younger adult to get a torn supraspinatus tendon through an accident or sudden traumatic event. In comparison, overuse and repetitive movement injuries can affect everyone due to degeneration of their supraspinatus over time.
As we age, our tissue ages too – the tissue in our supraspinatus begins to thin and break down. Any repetitive or frequent movement can place stress on your shoulder over the years. Your shoulder can also suffer degenerative changes such as arthritis, osteoarthritis, and / or cartilage thinning on the ends of the bones.
How does it affect you? How serious is it?
If your supraspinatus rupture requires further surgical treatment, there can be a slight percentage of developing complications. Most patients report improved shoulder strength and reduced pain after a supraspinatus surgery, but a tiny portion of shoulder surgery patients experience complications. Some possible surgical complications include:
- Generally, surgery involving anesthesia, which includes supraspinatus surgery, poses a slight risk of stroke, heart attack, pneumonia, or blood clot.
- Damage to adjacent nerves and blood vessels. Studies have shown that some patients going through shoulder surgery experience nerve damage.
- Infection in the supraspinatus muscle or even in the entire shoulder. Fortunately, there is a low chance of experiencing an infection when undergoing surgical treatment.
While supraspinatus surgeries can have positive, lasting results, not all surgical repairs heal. When a supraspinatus repair is unsuccessful, a patient experiences postoperative pain and / or shoulder stiffness.
Recommended Treatment & Rehabilitation
The recommended way to diagnose a supraspinatus rupture is with a doctor for a further physical examination of your shoulder. Range of motion tests will be done to see how much movement has been lost in the shoulder. Your doctor may also consider any past shoulder injuries or joint stiffness that you may have had in the past. This will greatly help your doctor to determine if you have an even more complex injury in your shoulder and rule out any other supraspinatus muscle injuries that are present (if any).
A large set of range of motion and strength tests will be performed by your doctor, including the drop arm test. He or she will measure the number of degrees your arm can move when rotating. In the drop arm test, your doctor will ask you to put your arm out to the side and up towards your head. They will then ask you to move your arm back slowly to see if your arm will drop quickly on its own because of a rupture. In addition, your doctor may order imaging tests to rule out other conditions. X-rays will provide an image of the overall bone structure of your shoulder.
It is helpful in identifying abnormal bone shapes, fractures, arthritis, osteoarthritis, bone spurs, or loose bones and bone abnormalities that can mimic a rupture. Other particular tests like a bone scan, magnetic resonance imaging (MRI), or blood tests can be done if an X-ray fails to rule out other conditions. These tests will also rule out any infections of the bone or tissue and help to determine if you’re suffering from other injuries, such as arthritis or osteoarthritis.
Physiotherapy can be very successful in treating supraspinatus tears. Therefore, you’ll be able to work with a physiotherapist to help devise a treatment program that is specific to your condition and goals. This treatment program may include the following:
Your physiotherapist will help you indent and avoid painful movements to allow the torn tendon to heal. Ice, massage, or moist heat may be applied for pain management. Therapeutic modalities, such as electrical stimulation (TENS) may be applied.
Posture education is an important role in rehabilitating your ruptured tendon. Your physiotherapist may recommend adjustments to your workstation and work habits. He or she will also instruct you in ideal sitting, standing, and sleeping positions to help alleviate symptoms. Your therapist may suggest different ways to perform currently painful activities and show you movements to avoid while the shoulder is in a painful condition.
You will learn exercises and stretches to help your shoulder and shoulder blade move properly, so you can return to reaching and lifting without pain.
As your symptoms improve, your physiotherapist will help you return to your previous level of function, which may include household chores, job duties, and sports-related activities. Functional training can include working or lifting a glass into a cupboard or throwing a ball using proper shoulder mechanics.
Your physiotherapist may use certain manual techniques, such as gentle joint movements, soft-tissue massage, and shoulder stretches, to get your shoulder moving again with your shoulder blade.
Performing the perfect exercise for shoulder pain is an important key to your recovery. Therefore, here are some exercises for you to try:
Bend over at the waist and let the arm-hand down passively. Using your body to initiate movement, swing the arm gently forward and backward and in a circular motion. Perform this pendulum exercise for several minutes, then repeat 3-5 times a day.
Isometric shoulder external rotation
Standing in a doorway with your elbow bent at a 90-degree angle and the back of your wrist pressing against the door frame, try to press your hand outward into the door frame. Hold this position for about 5 seconds, then repeat the exercise 3 times a day.
Isometric shoulder internal rotation
Standing in a doorway with your elbow bent at a 90-degree angle and the front of your wrist pressing against the door frame, try to press your palm into the door frame. Hold for 5 seconds, then do 3 more sets of 10 repetitions a day.
Stand with your arms at your sides and with your elbows straight. Slowly raise your arms to eye level. As you raise your arms, they should be spread apart so that they are only slightly in front of your body (at about a 30-degree angle to the front of your body). Point your thumbs toward the ceiling. Hold this stretch for 2 seconds and lower your arms slowly before repeating the exercise with 3 sets of 10 repetitions.
Side-lying external rotation
Lie on one side with your top arm at your side and your elbow bent to 90 degrees. Keep your elbow against your side, raise your forearm and hold for 2 seconds. Slowly lower your arm, then do 3 more sets of 10 repetitions.
Alternative & Homeopathic Treatment
There are different ways for you to alleviate your supraspinatus pain. The key to this process is understanding that some movements and exercises can be very helpful, while others can harm your shoulder. Here are some homeopathic treatments to help relieve your torn supraspinatus tendon:
Applying ice reduces blood flow, which will decrease inflammation and swelling, and alleviate pain in the process; cold therapy is recommended immediately after pain strikes, and ice packs should be applied for 15-20 minutes, up to 5 times a day.
Applying heat to a painful shoulder increases blood flow and brings in oxygen and nutrients to the area, which will accelerate the healing process and alleviate pain; this is recommended a few days after the onset of pain and can be accomplished with an added hot shower directly on the shoulder or a hot pack applied to the affected area for 15-20 minutes a day.
Some patients with a torn shoulder tendon can experience relief with pain medications that do not require a prescription, particularly non-steroidal anti-inflammatory drugs (NSAIDs) like aspirin, ibuprofen, and naproxen; NSAIDs may alleviate pain by reducing inflammation.
Sleeping on your bad shoulder can make matters much worse, so it is recommended to try to sleep on your back or the side of your body that is unaffected by shoulder pain to avoid worsening the problem.
Gently massaging your shoulder will help alleviate stress and tension in the surrounding muscles, while also improving blood circulation and reducing swelling in the process, all of which can reduce your pain levels.