Overview

The supraspinatus is one of the four muscles that make up the rotator cuff in the shoulder. Located in the upper part of the scapula (shoulder blade), the supraspinatus runs beneath the acromion and attaches to the greater tubercle of the humerus (upper arm bone). It plays a crucial role in shoulder stabilization and is primarily responsible for initiating arm abduction (lifting the arm away from the body). The supraspinatus is frequently involved in shoulder injuries, especially in athletes and individuals performing repetitive overhead activities.

Causes

Supraspinatus problems are usually due to overuse, injury, or degenerative changes in the shoulder. Common causes include:

• Repetitive Overhead Movements: Sports like tennis, swimming, baseball, or occupations like painting and construction can strain the supraspinatus.
• Acute Trauma: A sudden fall on an outstretched arm or a direct blow can lead to a supraspinatus tear.
• Degenerative Changes: Age-related wear and tear, especially in people over 40, can weaken the tendon over time.
• Impingement Syndrome: Compression of the supraspinatus tendon under the acromion causes irritation and inflammation.
• Poor Posture: Rounded shoulders and poor biomechanics can increase stress on the rotator cuff.
• Calcific Tendinitis: Calcium deposits can form within the supraspinatus tendon, leading to pain and reduced mobility.

Symptoms

Supraspinatus issues often present with localized shoulder discomfort and functional limitations, including:

• Shoulder Pain: Aching or sharp pain in the upper shoulder, especially during lifting or overhead activities.
• Pain at Night: Increased discomfort while lying on the affected side, often disturbing sleep.
• Limited Range of Motion: Difficulty raising the arm, especially during the first 15 to 30 degrees of abduction.
• Weakness: Reduced strength when lifting objects or performing overhead tasks.
• Clicking or Popping Sounds: Audible sounds with shoulder movement, especially in cases of tendinitis or impingement.
• Stiffness: Shoulder stiffness and muscle tightness due to guarding or disuse.

Diagnosis

Diagnosis of supraspinatus injuries involves a combination of clinical examination and imaging techniques:

• Physical Examination: Specific shoulder tests like the empty can (Jobe’s test) and painful arc test help isolate supraspinatus involvement.
• Medical History: Assessment of activity level, occupation, and recent injuries to understand potential causes.
• Ultrasound: A dynamic imaging method to visualize tendon inflammation or tears.
• MRI (Magnetic Resonance Imaging): The gold standard for diagnosing rotator cuff tears, including partial or complete supraspinatus tears.
• X-rays: Useful to detect bony abnormalities, such as acromion shape or calcifications.

Treatment

Treatment depends on the severity of the injury and may range from conservative management to surgical repair:

Conservative Treatment

• Rest: Avoiding aggravating activities to allow healing.
• Ice Therapy: Applying ice packs to reduce inflammation and pain.
• Physical Therapy: Targeted exercises to restore range of motion, strengthen the rotator cuff, and improve shoulder mechanics.
• Anti-inflammatory Medications: NSAIDs like ibuprofen can reduce pain and inflammation.
• Corticosteroid Injections: For cases of persistent pain, injections may provide temporary relief.

Surgical Treatment

• Arthroscopic Repair: Minimally invasive surgery to repair torn supraspinatus tendons.
• Subacromial Decompression: Removal of bone spurs or acromion reshaping in cases of impingement.
• Open Surgical Repair: Reserved for large or complex tears when arthroscopy is not sufficient.

Prognosis

The prognosis for supraspinatus injuries is generally favorable with appropriate treatment. Mild cases respond well to conservative therapy within weeks to months. Physical therapy plays a crucial role in restoring function and preventing recurrence. Complete tendon tears may require surgery, and with proper rehabilitation, most patients regain satisfactory function. Early diagnosis and treatment improve outcomes, while delayed care may lead to chronic pain, weakness, or permanent shoulder dysfunction.

With adherence to rehabilitation and proper activity modification, individuals can often return to their usual activities and sports without long-term limitations.