Supraspinatus tendinopathy: shoulder pain when lifting your arm
Supraspinatus tendinopathy is the most common cause of shoulder pain. The supraspinatus is one of the rotator cuff tendons and runs through a narrow space under the acromion; when it is overloaded, it stops tolerating load and hurts when you lift your arm. Today the term "tendinopathy" is preferred over "tendinitis", because the problem is mainly one of tendon adaptation rather than just inflammation.
Typical symptoms
pain on the outside of the arm, below the shoulder;
pain when lifting the arm to the side or overhead, through an arc of movement;
pain when lying on the affected shoulder;
a feeling of weakness when lifting objects with the arm outstretched.
Why it happens
a rapid increase in overhead movements: swimming, tennis, padel, volleyball, the gym or work;
poor shoulder-blade control, which reduces the space the tendon passes through;
age-related tendon changes, from around 40;
sitting with rounded shoulders for many hours.
When to seek urgent help
sudden loss of strength to lift the arm after a fall, which may indicate a tear;
a warm, swollen shoulder with a fever.
Calcifications and similar causes
Some people have calcium deposits inside the tendon (calcific tendinopathy). They often cause no symptoms, but can trigger bouts of very intense pain, especially at night. Ultrasound identifies them and helps decide on treatment.
Other conditions cause similar pain and need different treatment: adhesive capsulitis ("frozen shoulder"), where the shoulder loses movement in all directions; acromioclavicular osteoarthritis, with pain at the top of the shoulder; and pain coming from the neck, which can radiate to the shoulder and arm. Find out more about neck pain.
How we diagnose it
At a pain medicine consultation, clinical tests locate the affected tendon and ultrasound shows the state of the supraspinatus and whether there is a partial or full tear. MRI is kept for cases that don't improve or when surgery is being considered.
Treatment
Physiotherapy with progressive loading: strengthening the rotator cuff and shoulder-blade muscles is the treatment with the strongest evidence.
Adjust load: temporarily reduce the overhead movements that hurt most, without immobilising the shoulder.
Ultrasound-guided procedures: when pain prevents rehabilitation, a precise injection gives a window of relief to do the exercises.
Movement analysis for athletes, to correct the movement that overloads the tendon.
See also the other causes of shoulder pain.
Exercises we often use
External rotation with a resistance band, with the elbow by your side.
Lateral raises to shoulder height, with a light, controlled load.
Shoulder-blade exercises: rows and exercises sliding the shoulder blade back and down.
Progression to overhead movements, when pain allows.
Mild pain during exercise is acceptable, as long as it doesn't increase the next day.
How to prevent it
Increase the volume of overhead training gradually.
Include rotator cuff and shoulder-blade exercises in your gym training.
When working at a computer, avoid sitting with rounded shoulders for long periods.
Frequently asked questions about supraspinatus tendinopathy
Should I use ice or heat?
Both can relieve pain for a while, but neither treats the tendon. What makes the difference is progressive exercise.
How long does recovery take?
Generally, from a few weeks to a few months of consistent exercise.
Does a partial tear need surgery?
In most cases, no. Many partial tears respond well to rehabilitation; surgery is considered for full tears in active people or when conservative treatment fails.
Can I keep swimming or playing padel?
Often yes, with adjustments to intensity and technique, while following the strengthening plan.
Dr. Miguel Reis e Silva
Doctor at Sport Lisboa e Benfica
Medical Director and Founder of Clínica Myalgia
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