Kinematics Team FAQ: Supraspinatus Tear (Rotator Cuff Tear)
October 16thA shoulder can be perfectly manageable one day and surprisingly painful the next. Maybe you notice it while reaching for something above your head. Maybe it is only when you are lying in bed and happen to turn onto that side. There does not always have to be a big fall or obvious accident behind it either. A supraspinatus tear is one of the things we consider when these sorts of shoulder symptoms start getting in the way of normal movement.
Supraspinatus Tear Definition aka Rotator Cuff Tear. The rotator cuff is a group of four muscles that work around the shoulder joint. They sit underneath the larger muscles of the shoulder and connect, through their tendons, to the upper part of the arm bone. You can think of them as part of the system that helps the shoulder stay controlled while the arm moves.
The supraspinatus is one member of that group. Among other things, it helps with the early part of lifting your arm out to the side.
When the tendon is torn, some of its fibres have been disrupted. That damage can vary quite a bit. A partial tear affects only part of the tendon, while a full thickness tear extends through the tendon and may involve it pulling away from where it attaches to the bone.
The word “tear” can understandably make people think that surgery is inevitable. The size and type of tear, your symptoms and how well the shoulder responds to rehabilitation all matter. Smaller tears, in particular, can often be treated without surgery through a structured physiotherapy program.
Where will I feel pain with a supraspinatus tear?
The pain is usually felt along the outside of the upper arm, around the area where a t-shirt sleeve would sit. That can seem odd when you have been told the problem is in the shoulder. You might expect the pain to be right in the joint itself, but that is not necessarily how shoulder problems present.
For some people, it is a nagging ache that comes and goes during the day. Others notice it much more at night. Lying on the affected shoulder can be particularly uncomfortable, and simply rolling onto it in your sleep may be enough to wake you.
What movements will I struggle to perform if I have tear in my suprasinatus?
It is often the everyday stuff that exposes the problem. Washing your hair can become uncomfortable because the arm has to stay up for a while. Reaching into a high cupboard may hurt. So can getting an arm into a jacket, reaching behind your back or pulling a seatbelt across your body.
You may also notice that some parts of the lifting movement are worse than others. The shoulder can hurt as the arm travels upwards from your side, particularly around shoulder height and above, before becoming easier again as you get closer to full overhead movement. This pattern is commonly called a painful arc.
Heavier but otherwise ordinary tasks can cause trouble too. Lifting a full kettle, carrying a shopping bag on that side or reaching backwards in the car may all become noticeably harder.
Sleep is another common casualty. If putting pressure through the shoulder hurts, you may find yourself avoiding that side altogether.
Will I feel pain in any other regions of my body?
Shoulder pain has a habit of travelling a little. With a supraspinatus tear, symptoms can spread down the outside of the upper arm and sometimes reach as far as the elbow. It is less typical for the pain to continue into the hand or fingers. If you are experiencing symptoms that far down the arm, mention it during your assessment, as it may point towards another contributing issue.
The neck and the muscles sitting across the top of the shoulder can also become tight. When one part of the shoulder is not doing its usual share of the work, other muscles may start picking up the slack.
How does a supraspinatus tear happen?
There is not always a single moment you can blame. In some cases, there is. You might fall onto an outstretched hand, catch yourself when you stumble or try to lift something heavier than expected. The shoulder hurts immediately, and you can usually remember exactly what happened.
Other tears are much less dramatic. Tendons change over time, and they naturally become less resilient with age. Repeated loading can add to this, particularly when your work or sport involves a lot of overhead activity. Painters, tradespeople and swimmers, for example, can place considerable demands on the shoulder over the years.
Eventually, something quite unremarkable may be enough to bring the problem to your attention. Reaching for a seatbelt might do it. That does not necessarily mean the seatbelt movement caused all the damage. The tendon may already have been changing well before that particular movement made itself known.
What things should I try initially once I’ve supraspinatus tear?
Try not to fall into the trap of thinking that the shoulder needs complete rest. Some gentle movement is generally useful, provided you stay within a range that the shoulder can tolerate. Repeatedly forcing through sharp pain is another matter. The aim is to keep things moving without constantly winding the symptoms up.
If the shoulder is swollen or feels hot, an ice pack for fifteen to twenty minutes at a time may help make it more comfortable. Sleeping can sometimes be made easier by supporting the arm on a pillow rather than allowing it to hang unsupported.
You can also change the way you tackle certain jobs for a while. Keep heavier objects closer to your body instead of reaching out with them. If something needs to go overhead, use the other arm when you can. These adjustments do not mean you have to stop using the shoulder altogether.
What things should I try to avoid in the initial stages of a supraspinatus tear?
Heavy lifting is best reduced initially, particularly when you are holding the load overhead or with your arm stretched away from your body.
Throwing, sudden movements and exercises that place a lot of direct load through the shoulder, such as push ups, may also stir things up.
A sling can seem like an obvious solution because it takes the shoulder out of the equation. The problem is what happens if you stay in it for too long. Unless you have been specifically advised to use one, spending weeks keeping the arm still can lead to stiffness and reduced movement, which gives you something else to work on during recovery.
What type of exercises or movements do I need to control to rehab the supraspinatus?
Rehabilitation is not usually about finding one particular exercise and doing it over and over. What you need changes as the shoulder settles.
At the beginning, you are generally trying to regain comfortable movement without continually aggravating the tendon. Once that is going better, strengthening becomes a bigger part of the program. The rotator cuff needs attention, but so do the muscles around the shoulder blade. They help provide the control and stability the shoulder needs while you move your arm.
Eventually, the exercises should become more demanding. That might mean progressively heavier resistance or movements that resemble what you actually need to do outside the clinic. Someone who swims will have different demands from someone who lifts at work or spends their weekends under a barbell.
There is no sensible timetable that applies identically to everyone. How the shoulder responds to each stage matters. That is why an assessment is useful before jumping into a rehabilitation program you have found online.
What other considerations contribute to tear of supraspinatus?
The shoulder does not operate in isolation, so there are usually several things worth considering.
Your job, training and previous shoulder injuries can all influence how much demand is placed on the tendon. Repeated overhead work is an obvious example. Spending long stretches at a desk creates a different set of demands, but can still affect how the shoulder and surrounding muscles are being used.
Smoking and diabetes have also been associated with an increased risk of tendon tears and slower healing.
Then there is age. Tendons gradually lose some of their resilience as we get older, which helps explain why supraspinatus tears become more common after forty. In some people, there is no particular injury they can point to. The changes may have been developing quietly for quite some time.
What treatments can help relieve some pain or fast track my supraspinatus rehabilitation?
Before deciding what treatment you need, it helps to work out what the shoulder is actually tolerating.
A physiotherapy assessment looks at how you move, where symptoms appear and how much load the shoulder can currently handle. From there, treatment might include hands-on manual therapy, taping to help with discomfort, and exercises selected around your particular presentation rather than simply following a standard shoulder routine.
Sometimes rehabilitation alone is not enough, or the tear may be more significant. In those situations, further investigation can be useful. Imaging or referral to an orthopaedic specialist may be recommended so that options such as injections or surgery can be discussed if appropriate.
What are the expected timeframes of rehabilitating supraspinatus?
Recovery is difficult to put on a calendar because there is quite a bit of variation between people and between tears.
For smaller partial tears, symptoms may start improving within six to twelve weeks with physiotherapy. That is not necessarily the end of rehabilitation, though. Strength and the ability to tolerate heavier activity can continue developing for another three to six months.
Larger tears, particularly when surgery is required, generally involve a longer road back. Full activity may take around four to six months, while returning to overhead sport or heavy manual work can sometimes take closer to a year.
It can be frustrating when the shoulder feels better before it is ready for everything you want to do. Tendon tissue takes time to adapt to increasing loads, so trying to accelerate the process too aggressively can leave you taking a step backwards.
If your shoulder pain is affecting your sleep, making work difficult or stopping you from doing the activities you enjoy, it is worth having it assessed. You do not have to wait until the shoulder becomes unbearable before getting some answers.
Our physiotherapy team can assess what is happening, identify the factors that may be contributing to your symptoms and help you work out what the next stage of your rehabilitation should look like.
The information provided in this article is for general educational purposes only and should not be taken as a substitute for individual medical or physiotherapy advice.