Supraspinatus Tendon: Injury, Symptoms and Treatment

Supraspinatus tendinitis: Tendinitis of the supraspinatus is the most common cause of shoulder pain. The supraspinatus is the most vulnerable muscle of the rotator cuff, and its tendon passes through a critical zone (the “Codman zone”) where it is subject to compression and hypovascularization. For more details, consult the guide on rotator cuff. For more details, consult the guide on Shoulder Pain at Night: Why It Gets Worse and How to Sleep.

Early diagnosis and a targeted rehabilitation program make the difference between rapid recovery and a chronic condition that can lead to adhesive capsulitis or complete tear.

What It Is and Why the Supraspinatus Is So Vulnerable

The supraspinatus is a rotator cuff muscle in the shoulder that initiates arm lifting; it’s vulnerable due to its location, repetitive use demands, and poor blood supply predisposing it to tears and inflammation. The supraspinatus originates from the supraspinous fossa of the scapula and inserts on the greater tuberosity of the humerus, passing through the narrow subacromial space. Its functions: initial abduction of the arm (first 15-20 degrees) and dynamic stabilization of the humeral head.

The “critical zone of Codman” (1 cm from the insertion) has reduced vascularization, which explains the vulnerability to tendinopathies. Prevalence: 5-10% of the adult population, increasing after age 40.

Causes

Mechanical (Extrinsic)

• Subacromial impingement: compression of the tendon between humerus and acromion during elevation
• Repetitive overhead movements (work, sports)
• Scapular dyskinesia
• Kyphotic posture (rounded shoulders) related to dorsalgia and cervicalgia

Degenerative (Intrinsic)

• Age-related tendon degeneration
• Hypovascularization of the critical zone
• Calcifications (evolution into calcific tendinitis)

Risk Factors

• Age >40 years, overhead sports, computer work (posture), smoking, diabetes
• Kinetic chain dysfunctions
• Weakness of scapular muscles

Symptoms

• Painful arc: pain between 60 and 120 degrees of abduction
• Nighttime pain: inability to sleep on the affected side
• Pain with overhead movements: reaching objects overhead, combing hair
• Weakness in abduction and external rotation

Clinical Tests

• Jobe test (empty can): pain/weakness with abduction and internally rotated arm
• Neer and Hawkins-Kennedy tests: signs of impingement
• In tendinitis the passive range of motion is preserved (unlike adhesive capsulitis)

Diagnosis

• Ultrasound: first-choice examination, evaluates thickening and tears
• X-ray: acromion morphology, calcifications
• MRI: gold standard for significant tendon lesions

Treatment

Acute Phase (1-2 weeks)

• Relative rest, ice, NSAIDs, avoid overhead movements

Physiotherapy

• Manual therapy: glenohumeral and scapulothoracic mobilizations
• Exercises: progressive program (detailed below)
• Instrumental therapies: laser, tecar therapy, shock waves (chronic forms)
• Postural re-education

Injections

• Subacromial corticosteroids (max 2-3 times)
• PRP (promising results in chronic forms)

Specific Exercises

Phase 1 — Mobility and Pain Control (Weeks 1-3)

Exercise 1: Codman Pendulum

Difficulty: Easy | Equipment: Table or stable chair | Duration: 2-3 minutes

Starting position:
Standing next to a table or stable chair. Lean forward at about 45-60 degrees, resting the hand of the healthy arm on the surface. The affected arm hangs freely, completely relaxed, without any muscle contraction.

Step-by-step execution:

1. Step 1: Shift body weight slightly to make the arm swing in small clockwise circles (10-15 circles), keeping the arm completely relaxed.
2. Step 2: Reverse direction and perform 10-15 counterclockwise circles.
3. Step 3: Continue with forward-backward oscillations (10-15) then lateral ones (10-15), using the arm’s weight to generate slight decompressive traction on the shoulder.

Sets and repetitions: 2-3 minutes of continuous oscillations — Repeat 4-5 times per day

Common mistakes to avoid:

• Contracting shoulder muscles to guide movement: the arm must swing passively
• Making circles too wide that cause knee pain in the supraspinatus tendon
• Standing too upright, reducing gravity’s decompressive effect

How to know you’re doing it correctly:
You feel a sensation of light decompression and relief in the subacromial space. The movement is fluid and painless. The arm swings freely with minimal effort.

Exercise 2: Passive mobilization supine

Difficulty: Easy | Equipment: Mat | Duration: 5 minutes

Starting position:
Lie supine on a mat, with knees bent for lumbar comfort. Grasp the wrist of the affected arm with the healthy arm’s hand. The affected arm is completely relaxed.

Step-by-step execution:

1. Step 1: With the healthy hand, slowly lift the affected arm upward, keeping the elbow straight. The affected arm should not generate any active force.
2. Step 2: Continue until reaching the point where you feel slight tension in the shoulder, without pain. Stop at that point.
3. Step 3: Hold the reached position for 15-20 seconds, breathing deeply. Slowly return the arm to the starting position.

Sets and repetitions: 10 repetitions — Repeat 2-3 times per day

Common mistakes to avoid:

• Actively contracting the affected arm to “help” the movement
• Lifting the arm too quickly, irritating the inflamed tendon
• Arching the back to compensate for lack of mobility

How to know you’re doing it correctly:
The movement is fluid and guided entirely by the healthy arm. You feel a stretching tension in the shoulder without acute pain. The supine position allows complete muscle relaxation.

Exercise 3: Isometric external rotation

Difficulty: Easy | Equipment: Wall | Duration: 5 minutes

Starting position:
Standing with the affected arm’s side toward the wall. Elbow bent at 90 degrees and close to the side. The back of the hand (or a small folded towel between hand and wall) is in contact with the wall.

Step-by-step execution:

1. Step 1: Push the back of the hand against the wall as if to rotate the forearm outward, without any visible movement occurring (isometric contraction).
2. Step 2: Maintain the push at about 30-50% of maximum force for 5-10 seconds, breathing normally.
3. Step 3: Slowly release the contraction and rest 5 seconds before the next repetition.

Sets and repetitions: 3 sets x 10 repetitions — 30-second pause between sets

Common mistakes to avoid:

• Pushing too hard, causing knee pain in the tendon
• Lifting the elbow away from the side during the push
• Holding breath during contraction

How to know you’re doing it correctly:
You feel slight muscle activation in the back of the shoulder without arm pain in the tendon. The elbow stays firmly at the side and no postural compensations occur.

Exercise 4: Isometric abduction

Difficulty: Easy | Equipment: Wall | Duration: 5 minutes

Starting position:
Standing with the affected arm’s side facing the wall. The arm is straight at the side, with the outer part of the arm (just above the elbow) in contact with the wall.

Step-by-step execution:

1. Step 1: Push the arm laterally against the wall as if to lift it to the side (abduction), without any visible movement occurring (isometric contraction).
2. Step 2: Maintain the push at about 30-50% of maximum force for 5-10 seconds. Breathe normally throughout the contraction.
3. Step 3: Slowly release the contraction and rest 5 seconds before the next repetition.

Sets and repetitions: 3 sets x 10 repetitions — 30-second pause between sets

Common mistakes to avoid:

• Pushing with excessive force, causing pain in the supraspinatus area
• Lifting the shoulder toward the ear (upper trapezius compensation)
• Tilting the trunk to the opposite side to increase the push

How to know you’re doing it correctly:
You feel muscle activation in the upper and lateral part of the shoulder (deltoid and supraspinatus) without acute pain. The shoulder stays low and posture remains correct throughout the contraction.

Phase 2 — Eccentric Strengthening (Weeks 3-8)

Exercise 5: External rotation with elastic (eccentric)

Difficulty: Intermediate | Equipment: Light-medium resistance elastic, door handle | Duration: 5 minutes

Starting position:
Attach an elastic to a closed door handle. Stand laterally, with the affected arm’s side opposite the door. Elbow bent at 90 degrees and close to the side. Grip the elastic with the affected arm’s hand.

Step-by-step execution:

1. Step 1: Rotate the forearm outward against the elastic resistance until maximum tolerable external rotation (about 2 seconds).
2. Step 2: From the maximum external rotation position, slowly return to the initial position controlling the elastic’s return. This eccentric phase must last at least 4 seconds.
3. Step 3: At the end of the eccentric phase, rest 2-3 seconds and repeat. Focus on slowness and control of the return phase.

Sets and repetitions: 3 sets x 12-15 repetitions — 45-second pause between sets

Common mistakes to avoid:

• Letting the elastic quickly return the arm to the initial position (losing the eccentric phase)
• Lifting the elbow away from the side during movement
• Using too resistant an elastic that prevents controlled execution

How to know you’re doing it correctly:
You feel intense but not painful muscle work in the back of the shoulder, especially during the slow return phase. The elbow stays firmly at the side throughout the movement.

Exercise 6: Eccentric full can

Difficulty: Intermediate | Equipment: Light dumbbell (0.5-1 kg) | Duration: 5 minutes

Starting position:
Standing with upright posture, feet shoulder-width apart. Grip a light dumbbell (0.5-1 kg) with the affected arm’s hand. The arm is at the side with thumb pointing up (“full can” position, as if holding a can upright).

Step-by-step execution:

1. Step 1: Lift the arm laterally and slightly forward (in the scapular plane, about 30 degrees ahead of the frontal plane) until reaching 70-80 degrees of elevation. Keep the thumb always pointing up. Ascent duration: about 2 seconds.
2. Step 2: Once maximum height is reached, begin a very slow and controlled descent. The descent (eccentric) phase must last at least 5 seconds.
3. Step 3: Once back to the starting position, rest 2-3 seconds and repeat. If pain occurs during execution, reduce the weight or height reached.

Sets and repetitions: 3 sets x 10 repetitions — 45-second pause between sets

Common mistakes to avoid:

• Rotating the thumb downward (“empty can” position) which increases compression on the supraspinatus
• Lifting the arm beyond 90 degrees, entering the impingement zone
• Descending too quickly, losing the benefit of eccentric work

How to know you’re doing it correctly:
You feel controlled muscle fatigue in the lateral and upper part of the shoulder during the slow descent. The movement is fluid and the thumb stays pointed toward the ceiling throughout execution.

Exercise 7: Scapular retraction with elastic

Difficulty: Intermediate | Equipment: Medium resistance elastic | Duration: 5 minutes

Starting position:
Standing with upright posture. Grip an elastic with both hands, arms extended forward at shoulder height, hands shoulder-width apart. The elastic is already slightly tense in the starting position.

Step-by-step execution:

1. Step 1: Keeping arms extended and at shoulder height, pull the elastic by opening arms laterally. The movement is guided by the scapulae, which come together (scapular retraction) and lower downward.
2. Step 2: Once maximum scapular retraction is reached (elastic almost touching the chest), hold the position for 2-3 seconds, feeling the contraction between the scapulae.
3. Step 3: Slowly return to the starting position, controlling the elastic’s return for 3-4 seconds.

Sets and repetitions: 3 sets x 12-15 repetitions — 30-second pause between sets

Common mistakes to avoid:

• Lifting shoulders toward ears during retraction (excessive upper trapezius activation)
• Bending elbows to make the movement easier
• Arching the lower back to compensate

How to know you’re doing it correctly:
You feel a firm contraction between the scapulae and in the middle back. Shoulders stay low throughout the movement. Posture visibly improves after execution.

Exercise 8: Wall push-up plus

Difficulty: Intermediate | Equipment: Wall | Duration: 5 minutes

Starting position:
Standing facing a wall, at arm’s distance. Hands placed on the wall at shoulder height, slightly wider than shoulders. Body aligned from head to feet.

Step-by-step execution:

1. Step 1: Bend elbows and approach the wall in a controlled manner, keeping the body aligned (like a classic push-up but in vertical position). Descend until the chest nearly touches the wall.
2. Step 2: Push with hands to return to the initial position with arms extended.
3. Step 3: Once full arm extension is reached, add the “plus”: push further with hands against the wall, protracting the scapulae forward (scapulae move away from each other). Hold the protraction 2-3 seconds, then release.

Sets and repetitions: 3 sets x 10-15 repetitions — 30-second pause between sets

Common mistakes to avoid:

• Forgetting the “plus” phase (scapular protraction), which is the most important part of the exercise
• Lowering the pelvis or arching the back during execution
• Performing the movement too quickly without controlling the protraction phase

How to know you’re doing it correctly:
You feel specific muscle work in the lateral chest area (serratus anterior) during the scapular protraction phase. The scapulae move visibly forward in the “plus” phase.

Phase 3 — Advanced Strengthening (Weeks 8+)

Exercise 9: Lateral elevation with dumbbell

Difficulty: Advanced | Equipment: 1-3 kg dumbbell | Duration: 5 minutes

Starting position:
Standing with upright posture, feet shoulder-width apart. Grip a dumbbell (1-3 kg, based on tolerance) with the affected arm’s hand. Arm at the side, thumb pointing up.

Step-by-step execution:

1. Step 1: Lift the arm laterally and slightly forward (in the scapular plane) up to 80-90 degrees, keeping the thumb pointing up. Ascent duration: 2-3 seconds.
2. Step 2: At the top, hold the position for 1-2 seconds, checking that the shoulder stays low (not lifted toward the ear).
3. Step 3: Descend slowly and controlledly to the initial position (3-4 seconds of eccentric phase).

Sets and repetitions: 3 sets x 10-12 repetitions — 45-second pause between sets

Common mistakes to avoid:

• Exceeding 90 degrees of elevation, increasing risk of subacromial impingement
• Rotating the thumb downward during ascent
• Swaying the trunk to give momentum to the dumbbell

How to know you’re doing it correctly:
You feel muscle fatigue in the deltoid and supraspinatus without acute pain in the range of motion. The arm rises and descends controlledly without trunk compensations. You can complete all the repetitions maintaining correct form.

Exercise 10: PNF diagonals with elastic

Difficulty: Advanced | Equipment: Medium resistance elastic | Duration: 5 minutes

Starting position:
Standing with upright posture. Secure the elastic low (under a foot or to a low support). Grip the elastic with the affected arm’s hand. Start with the hand positioned at the opposite lower side (arm crossing the body).

Step-by-step execution:

1. Step 1 — D2 flexion diagonal: Starting from the opposite side, move the arm diagonally up and outward, like drawing a sword, until bringing the hand high and laterally. The thumb rotates outward during ascent. 10 repetitions.
2. Step 2 — Controlled return: From the high position, return to the initial position slowly and controlledly (3-4 seconds of eccentric phase), following the same diagonal trajectory.
3. Step 3 — Reverse diagonal: Reverse the direction: start from high and outward and move the arm down and toward the opposite side. 10 repetitions. These diagonal movements reproduce functional patterns of daily life and sports.

Sets and repetitions: 3 sets x 10 repetitions per diagonal — 30-second pause between sets

Common mistakes to avoid:

• Performing the movement on a pure frontal or sagittal plane, losing the diagonal component
• Excessively rotating the trunk to compensate for lack of shoulder mobility
• Using too resistant an elastic that prevents completing the movement

How to know you’re doing it correctly:
The movement follows a fluid and natural diagonal trajectory, similar to daily gestures. You feel the muscle work of the entire rotator cuff and scapular musculature. The trunk stays stable and only the arm moves along the diagonal.

Healing Times

Prevention

• Warm-up before sports activities
• Regular rotator cuff strengthening with elastic
• Postural correction (avoid rounded shoulders)
• Scapular muscle strengthening
• Posterior capsule stretching

You might also be interested in: Lateral epicondylitis: symptoms, exercises and prevention

Frequently Asked Questions (

Read also: shoulder anatomy

FAQ)

Does supraspinatus tendinitis heal completely?

Yes, in most cases. Grades 1-2 have excellent prognosis with conservative treatment. The key is patience and consistency.

Can I exercise?

Avoid painful overhead exercises. You can continue activities that don’t involve the affected shoulder. Gradual reintroduction with your physical therapist.

Difference from adhesive capsulitis?

In tendinitis passive range is preserved with painful arc 60-120°. In capsulitis there’s limitation both active and passive, especially external rotation.

Do shock waves work?

Yes, in chronic and calcific forms. 3-5 sessions one week apart. Indicated after 3-4 months of conventional treatment without result.

Is nighttime pain typical?

Yes, it’s one of the most characteristic symptoms. Tips: sleep supine with pillow under arm, or on healthy side with pillow between arms. Ice 15 minutes before sleeping.

Can it depend on cervical problems?

Yes, cervicalgia can alter neuromuscular control of the shoulder. Evaluation should always include the cervical spine and entire kinetic chain.

For a broader overview of related conditions, see our complete guide to shoulder pain.

Scientific References

1. Lewis JS. Rotator cuff tendinopathy. Br J Sports Med. 2009;43(4):259-264.
2. Kuhn JE. Exercise in rotator cuff impingement. J Shoulder Elbow Surg. 2009;18(1):138-160.
3. Cools AM, et al. Rehabilitation of scapular muscle balance. Am J Sports Med. 2007;35(10):1744-1751.
4. Dong W, et al. Treatments for shoulder impingement syndrome. Medicine. 2015;94(10):e510.
5. Pieters L, et al. Conservative interventions for subacromial shoulder pain. J Orthop Sports Phys Ther. 2020;50(3):131-141.
6. Littlewood C, et al. Epidemiology of rotator cuff tendinopathy. Shoulder Elbow. 2013;5(4):256-265.
7. Rees JD, et al. Tendons — time to revisit inflammation. Br J Sports Med. 2014;48(21):1553-1557.
8. Neer CS II. Impingement lesions. Clin Orthop Relat Res. 1983;(173):70-77.
9. Diercks R, et al. Guideline for subacromial pain syndrome. Acta Orthop. 2014;85(3):314-322.
10. Saltychev M, et al. Conservative treatment or surgery for shoulder impingement. Disabil Rehabil. 2015;37(1):1-8.

Dr. Cosimo Pilotto — physical therapist | MyPhysioHelp.it

Related articles:

• Adhesive Capsulitis
• Rotator Cuff Syndrome
• Shoulder Dislocation
• Dorsalgia
• Cervicalgia and Kinetic Chain
• Kinetic Chain

Read Also

• Peroneal Tendinitis: Causes and Treatment
• Biceps Tendinitis at the Shoulder: Symptoms and Treatment
• Tendinitis: Complete Guide — Causes, Types and Prevention

Sources and Scientific References

1. Millar NL et al. (2021). Tendinopathy. Nat Rev Dis Primers. 7:1. DOI | PubMed
2. Swansen T et al. (2023). Postoperative Rehabilitation Following Rotator Cuff Repair. Phys Med Rehabil Clin N Am. 34:357-364. DOI | PubMed
3. Desmeules F et al. (2025). Rotator Cuff Tendinopathy Diagnosis, Nonsurgical Medical Care, and Rehabilitation: A Clinical Practice Guideline. J Orthop Sports Phys Ther. 55:235-274. DOI | PubMed
4. Lewis J (2016). Rotator cuff related shoulder pain: Assessment, management and uncertainties. Man Ther. 23:57-68. DOI | PubMed
5. Littlewood C et al. (2012). Exercise for rotator cuff tendinopathy: a systematic review. Physiotherapy. 98:101-9. DOI | PubMed

Frequently Asked Questions

What is supraspinatus tendinitis?

Supraspinatus tendinitis is the most common cause of shoulder pain, involving inflammation or degeneration of the supraspinatus tendon. This tendon is part of the rotator cuff and is particularly vulnerable due to its anatomy and reduced blood supply in a critical zone.

What are the common symptoms of supraspinatus tendinitis?

Typical symptoms include shoulder pain, especially at night or when sleeping on the affected side. You may also experience pain when raising your arm, particularly between 60 and 120 degrees of abduction, and weakness with overhead movements.

When should I consult a physical therapist for shoulder pain?

You should consult a physical therapist immediately if you experience shoulder pain, especially if it worsens at night or when raising your arm. Early diagnosis and intervention are crucial for effective treatment and to prevent the condition from becoming chronic.

How is supraspinatus tendinitis treated?

Treatment typically involves relative rest, ice, and avoiding repetitive overhead movements in the acute phase. Physiotherapy is vital, focusing on manual therapy, a progressive exercise program, and postural re-education to restore shoulder function and prevent chronic issues.

Can supraspinatus tendinitis heal completely?

Yes, with early diagnosis and a targeted rehabilitation program, complete recovery is often achievable. Promptly addressing the condition with appropriate physiotherapy is crucial to prevent chronicization and potential complications like adhesive capsulitis or a complete tendon tear.