Shoulder pain is a common issue, especially as we age, and one of the most frequent causes is a tear in the supraspinatus tendon—part of the rotator cuff. Here’s what every patient should know:
What Is the Supraspinatus Tendon?
The supraspinatus tendon connects one of your rotator cuff muscles to the top of the humerus (upper arm bone). This tendon plays a key role in lifting the arm and stabilizing the shoulder.
When it’s injured or torn, even small movements can become painful.
Risk Factors for Rotator Cuff Tears
Some people are more likely to develop rotator cuff tears due to a combination of lifestyle and medical factors. These include:
- Age over 60
- Male sex (accounts for 61.9% of tears)
- Smoking
- Diabetes
- High blood pressure (hypertension)
Why Is It So Painful?
Interestingly, the majority of pain-sensing nerve endings (nociceptors) in the rotator cuff are found specifically in the supraspinatus tendon—right at the point where it attaches to the humerus.
When the area becomes inflamed, certain chemicals like bradykinin and prostaglandins increase. These can make your nerves extra sensitive to movement or pressure, lowering your pain threshold—explaining why even a mild injury here can hurt significantly.
How Is a Tear Diagnosed?
Doctors often begin with a physical examination using a few reliable tests:
- Jobe’s Test (Empty Can Test): 88% sensitivity and 62% specificity
- Full Can Test: 70% sensitivity and 81% specificity
- External Rotation Lag Sign: Highly specific (98%) for infraspinatus tears
However, imaging is usually needed for a definitive diagnosis.
Ultrasound: A Powerful Diagnostic Tool
Ultrasound is a highly effective, safe, and cost-efficient way to diagnose rotator cuff injuries—especially supraspinatus tears.
What Ultrasound Can Reveal:
- Partial-thickness tears: Appear as dark (hypoechoic) or absent (anechoic) areas disrupting the tendon’s normal appearance.
- Full-thickness tears: Often show tendon volume loss and changes in the normal shape or texture.
- Cartilage Interface Sign: Specific for articular surface tears.
- Sagging Peribursal Fat Sign (SPFS): Most sensitive (88.4%) and specific (98%) for full-thickness tears.
Accuracy Compared to Other Imaging:
- Full-thickness tears:
- Ultrasound: 92.3% sensitivity / 94.4% specificity
- MRI: 94% specificity (67% sensitivity)
- Partial-thickness tears:
- Ultrasound: 66.7% sensitivity / 93.5% specificity
- MRI: Similar sensitivity (67%)
Why Choose Ultrasound Over MRI?
Ultrasound offers several practical advantages:
- More affordable and widely available
- Ideal for claustrophobic patients
- Safe for patients with pacemakers or other MRI-incompatible implants
- Great for dynamic assessments (real-time movement) and detecting foreign bodies
- Portable—can be done in clinic settings
Managing Partial-Thickness Supraspinatus Tears
Treatment usually starts with conservative (non-surgical) methods:
- Avoid painful movements
- Gentle joint mobilization may help regain motion and ease pain
- Supervised exercise programs are more effective than passive techniques
- Gradual strengthening of scapular stabilizers and rotator cuff
- Focus on neuromuscular coordination and core stability to restore proper shoulder mechanics
What to Expect Long Term
- Short to mid-term outcomes with conservative care are usually good for pain and function.
- Long-term results (beyond 6 years) may be less satisfying without surgical intervention, especially if the tear progresses.
Why Monitoring Is Crucial
Without treatment, rotator cuff tears can worsen over time, potentially leading to:
- Muscle wasting (atrophy)
- Fatty infiltration (steatosis)
- Traumatic arthritis
If a tear becomes irreparable, surgical options may no longer be effective. That’s why regular follow-up—especially with ultrasound—is so important for patients choosing non-operative management.
Final Thoughts
Ultrasound plays a vital role in the early diagnosis and monitoring of supraspinatus tendon injuries. It provides a safe, accessible, and reliable tool for guiding treatment decisions and avoiding complications.
If you’re experiencing persistent shoulder pain or suspect a rotator cuff injury, speak to your healthcare provider about the benefits of musculoskeletal ultrasound.
