Supraspinatus Tendon RuptureShoulder Tendon Tear (Supraspinatus Tendon Tear)
Supraspinatus Tendon Rupture — Overview
Supraspinatus tendinopathy and partial/full-thickness tears develop within Codman's critical hypovascular zone beneath the coracoacromial arch, where extrinsic subacromial compression and intrinsic age/overuse collagen degeneration disrupt the glenohumeral deltoid–rotator cuff force couple.
A supraspinatus tendon tear (shoulder tendon tear) is fraying or tearing of the top tendon of your shoulder's rotator cuff, which keeps the ball of your arm centered in its socket when you lift your arm.
Primary Causes & Biomechanics
Key Points You Should Know
- •Extrinsic compression beneath a hooked acromion (Bigliani Type II/III), thickened coracoacromial ligament, or anterior scapular tilt
- •Intrinsic tendon degeneration in the hypovascular critical zone and repetitive overhead microtrauma
- •Loss of supraspinatus/infraspinatus humeral head depression allowing unopposed deltoid superior migration during elevation
- •Why Thumb-Up ('Full-Can') Protects the Tendon: Raising your arm with your thumb pointing up rotates the bone bump out from under the shoulder roof so the tendon never gets pinched!
- •Towel Roll Under the Elbow: Keeping a small rolled towel under your elbow during rotation exercises increases blood flow to the healing tendon.
- •Shoulder Blade First: Pulling your shoulder blades gently down and back opens the tunnel for your tendon.
Assessment Methods
1. Goniometric ROM & Postural / Kinematic Analysis
Active vs. passive shoulder abduction/scaption (identifying the 60°–120° Painful Arc and pseudoparalysis vs. capsular stiffness).
2. Special Clinical Provocation & Neurological/Functional Tests
Jobe's (Empty Can / Full Can) Test, Drop Arm Test (full-thickness tear), Neer & Hawkins-Kennedy Impingement Signs, and Scapular Assistance/Retraction tests.
3. Standardized Clinical Outcome Scales & Imaging Criteria
Constant-Murley Score, SPADI (Shoulder Pain and Disability Index), QuickDASH, and musculoskeletal ultrasound / shoulder MRI (Goutallier fatty infiltration grading).
1. Range of Motion & Posture Check
Your physiotherapist gently evaluates how comfortably and smoothly your supraspinatus tendon (critical hypovascular zone 1 cm medial to the greater tuberosity insertion) and subacromial space moves and checks your overall posture.
2. Muscle Strength & Functional Movement Check
Your muscle balance, walking or reaching comfort, and specific gentle movement tests are evaluated without triggering sharp pain.
3. Typical Symptoms & Daily Impact Review
Anterolateral shoulder pain radiating to the deltoid insertion (never below the elbow), classically worst between 60° and 120° of arm elevation (Painful Arc) and when lying on the affected shoulder at night.
Treatment Options & Phase-Based Protocol
✨ Enriched GIF Exercise & Precaution GuidePhase 1: Acute Symptom Modulation, Tissue Protection & Early Activation
- •Phase 1 Clinical Focus & Tissue Protection: Subacromial Decompression & Scapular Alignment Phase (Weeks 1–2): Relative overhead rest, cryotherapy/TENS, Codman's pendulum decompression, and scapular retraction/depression to elevate the acromial roof.
- •Pain, Edema & Neuromuscular Modulation: Targeted physical modalities, relative load management, and early protected mobility of the supraspinatus tendon (critical hypovascular zone 1 cm medial to the greater tuberosity insertion) and subacromial space without provoking mechanical or inflammatory irritation.
- •Proximal & Distal Kinetic Chain Maintenance: Maintain active mobility and circulation in adjacent joints while protecting the primary healing structures in Supraspinatus Tendon Tear.
Phase 2: Progressive Mobility, Motor Control & Targeted Strengthening
- •Phase 2 Progressive Mobilization & Motor Control: Humeral Head Depressor & Posterior Cuff Phase (Weeks 2–6): Supine wand-assisted flexion, towel-supported external rotation (infraspinatus/teres minor co-activation to depress the humeral head), and side-lying external rotation.
- •Biomechanical Alignment & Co-Contraction: Restore balanced agonist-antagonist force couples, joint centration, and multi-planar neuromuscular control across the supraspinatus tendon (critical hypovascular zone 1 cm medial to the greater tuberosity insertion) and subacromial space.
- •Myofascial Extensibility & Endurance: Address secondary compensatory tightness and build local muscular endurance within safe, symptom-free biomechanical parameters.
Phase 3: Functional Integration, Proprioception & Long-Term Prevention
- •Phase 3 Functional Integration & Long-Term Prevention: Scapular Plane Dynamic Strengthening Phase (Week 6–12): Scapular plane 'Full-Can' elevation (thumb up, 30° scaption)—never Empty-Can!—and closed-chain wall ball serratus anterior stabilization.
- •Proprioceptive Balance & Dynamic Loading: Progress to task-specific closed-chain, balance, and functional movement patterns tailored to daily life, occupational, or athletic demands.
- •Self-Management & Relapse Prophylaxis: Establish lifelong ergonomic habits, home exercise maintenance, and early warning-sign awareness to prevent recurrence.
Step 1: Calming Pain, Protecting the Area & Gentle Starter Motion
- •Why Thumb-Up ('Full-Can') Protects the Tendon: Raising your arm with your thumb pointing up rotates the bone bump out from under the shoulder roof so the tendon never gets pinched!
- •Calm Protection & Gentle Start: During the initial stage of Shoulder Tendon Tear, avoid painful overloading and perform the gentle, pain-free starter movements shown below to support circulation and comfort.
- •Respecting Your Body's Signals: Every movement should stay within a comfortable, non-painful zone—never force through sharp or radiating pain.
Step 2: Restoring Flexibility & Building Supporting Muscle Strength
- •Towel Roll Under the Elbow: Keeping a small rolled towel under your elbow during rotation exercises increases blood flow to the healing tendon.
- •Step-by-Step Flexibility & Support: As acute sensitivity settles, gradually build mobility and strengthen the supporting muscles around the joint at a steady, controlled pace.
- •Posture & Breathing Coordination: Keep your posture upright and breathe smoothly (never hold your breath!) during every repetition.
Step 3: Safe Daily Habits, Stamina & Preventing Recurrence
- •Shoulder Blade First: Pulling your shoulder blades gently down and back opens the tunnel for your tendon.
- •Confident Return to Daily Life: Integrate your stronger muscles and improved balance into walking, stairs, work, and recreational activities.
- •Preventing Future Flare-Ups: Continue your core protective habits and key maintenance exercises even after symptoms resolve.
Animated (GIF) Therapeutic Exercise Guide
Animated clinical exercise protocol with biomechanical angles, target muscle groups, and dosage parameters (Click image to enlarge)
Step-by-step animated exercise demonstrations you can safely perform at home (Click image to enlarge)
🔍 Enlarge1. Codman's Pendulum Glenohumeral Decompression Exercise
1. Bent-Over Gentle Arm Pendulum Swings
Trunk flexed forward 45°–60° with the sound hand supported on a table while the affected arm hangs completely relaxed like a plumb line. Momentum from gentle trunk sway creates passive glenohumeral distraction and synovial lubrication without rotator cuff firing. Specifically indicated in Supraspinatus Tendon Tear rehabilitation to optimize supraspinatus tendon (critical hypovascular zone 1 cm medial to the greater tuberosity insertion) and subacromial space biomechanics and neuromuscular control.
Lean forward supporting your healthy hand on a table and let your affected arm hang completely relaxed toward the floor. Gently sway your body to let the arm swing in small pain-free circles without using your shoulder muscles. Perform smoothly within a comfortable, pain-free range to support your Shoulder Tendon Tear recovery.
🔍 Enlarge2. Scapulothoracic Retraction & Depression (Middle/Lower Trapezius & Rhomboids)
2. Shoulder Blade Squeeze (Postural Alignment)
Adduction and depression of the scapulae via the middle/lower trapezius and rhomboids while inhibiting upper trapezius overactivity. Corrects anterior scapular tilt, widens the subacromial outlet, and unloads the anterior thoracic column. Specifically indicated in Supraspinatus Tendon Tear rehabilitation to optimize supraspinatus tendon (critical hypovascular zone 1 cm medial to the greater tuberosity insertion) and subacromial space biomechanics and neuromuscular control.
Sit or stand tall. Keep your shoulders relaxed away from your ears, gently draw your shoulder blades together and slightly downward toward your back pockets, hold for 5 seconds, and release. Perform smoothly within a comfortable, pain-free range to support your Shoulder Tendon Tear recovery.
🔍 Enlarge3. Towel-Supported Glenohumeral External Rotation (Infraspinatus & Teres Minor)
3. Outward Forearm Rotation with Rolled Towel Under Elbow
External rotation performed at 90° elbow flexion with a rolled towel placed between the elbow and trunk (20°–30° scaption). Enhances infraspinatus/teres minor recruitment while preventing superior humeral head migration and deltoid shear. Specifically indicated in Supraspinatus Tendon Tear rehabilitation to optimize supraspinatus tendon (critical hypovascular zone 1 cm medial to the greater tuberosity insertion) and subacromial space biomechanics and neuromuscular control.
Place a small rolled towel between your elbow and your side with your elbow bent at 90 degrees. Keeping your elbow pressed gently against the towel, rotate your forearm outward, hold for 3 seconds, and return slowly. Perform smoothly within a comfortable, pain-free range to support your Shoulder Tendon Tear recovery.
🔍 Enlarge4. Side-Lying Glenohumeral External Rotation (Isotonic Posterior Cuff)
4. Side-Lying Outward Arm Rotation
Isotonic external rotation against gravity in side-lying with a towel roll under the axilla. Elicits maximal isolated EMG activation of the infraspinatus and teres minor with minimal supraspinatus and deltoid overload. Specifically indicated in Supraspinatus Tendon Tear rehabilitation to optimize supraspinatus tendon (critical hypovascular zone 1 cm medial to the greater tuberosity insertion) and subacromial space biomechanics and neuromuscular control.
Lie on your uninjured side with a small towel under your top elbow, bent at 90 degrees. Slowly rotate your forearm upward toward the ceiling while keeping your elbow tucked at your side, pause, and lower slowly. Perform smoothly within a comfortable, pain-free range to support your Shoulder Tendon Tear recovery.
🔍 Enlarge5. Scapular Plane 'Full-Can' Elevation (30° Scaption, Thumb Up)
5. Thumb-Up Diagonal Arm Raise (Full-Can)
Active elevation in the scapular plane (30° anterior to the frontal plane) with external rotation (thumb pointing up) to shoulder height. Clears the greater tuberosity beneath the acromion and optimizes the deltoid-rotator cuff force couple. Specifically indicated in Supraspinatus Tendon Tear rehabilitation to optimize supraspinatus tendon (critical hypovascular zone 1 cm medial to the greater tuberosity insertion) and subacromial space biomechanics and neuromuscular control.
Stand tall with your thumb pointing upward like a 'thumbs-up' sign. Raise your arm slightly forward and to the side (at a 30-degree angle) up to shoulder height without shrugging your shoulder, then lower slowly. Perform smoothly within a comfortable, pain-free range to support your Shoulder Tendon Tear recovery.
🔍 Enlarge6. Closed-Chain Wall Ball Stabilization & Serratus Anterior Protraction
6. Wall Ball Circles & Shoulder Blade Control
Rhythmic stabilization and small circular perturbations with the hand pressing a soft ball against the wall at shoulder height. Stimulates glenohumeral joint mechanoreceptors, serratus anterior upward rotation, and rotator cuff co-contraction. Specifically indicated in Supraspinatus Tendon Tear rehabilitation to optimize supraspinatus tendon (critical hypovascular zone 1 cm medial to the greater tuberosity insertion) and subacromial space biomechanics and neuromuscular control.
Hold a small soft ball against the wall at chest or shoulder height with your elbow nearly straight. Gently press into the ball and trace small, controlled clockwise and counterclockwise circles. Perform smoothly within a comfortable, pain-free range to support your Shoulder Tendon Tear recovery.
Movements to Avoid & Strict Precautions
1. Overhead Lifting With the Thumb Pointing Down ('Empty Can' / Internal Rotation)
1. Lifting objects or weights with your thumb pointing down or elbows flared high
2. Sleeping Directly on the Painful Shoulder or With the Arm Tucked Under Your Head
2. Sleeping on the painful shoulder (sleep on your back or on the healthy side hugging a pillow under the painful arm)
3. Working With Arms Sustained Above Shoulder Height (>90°) During Acute Pain
3. Hanging curtains, painting ceilings, or reaching high shelves with an outstretched arm
4. Carrying Heavy Groceries With a Hanging Unsupported Arm
4. Carrying heavy buckets or bags that pull violently on the shoulder tendon
Supraspinatus Tendon Rupture — Video Guide
Click directly on any video to open and watch in a window, or review details via 📋 Summary & Options.
Condition Overview Video (1 Video)
Summary of pathophysiology, biomechanics, and clinical presentation
What the condition is, why it develops, and its basic mechanism
What Are Rotator Cuff & Supraspinatus Tendon Tears?
Supraspinatus tendinopathy and partial/full-thickness tears develop within Codman's critical hypovascular zone beneath the coracoacromial arch, where extrinsic subacromial compression and intrinsic age/overuse collagen degeneration disrupt the glenohumeral deltoid–rotator cuff force couple.
A supraspinatus tendon tear (shoulder tendon tear) is fraying or tearing of the top tendon of your shoulder's rotator cuff, which keeps the ball of your arm centered in its socket when you lift your arm.
Treatment and Exercise Videos
Phase-based physiotherapy protocols, mobilization, and therapeutic exercises
Step-by-step recovery and safe home exercise applications
Rotator Cuff (Supraspinatus) Tear Exercises | Non-Operative Physiotherapy Routine
Phase 1: Acute Symptom Modulation, Tissue Protection & Early Activation: Phase 1 Clinical Focus & Tissue Protection: Subacromial Decompression & Scapular Alignment Phase (Weeks 1–2): Relative overhead rest, cryotherapy/TENS, Codman's pendulum decompression, and scapular retraction/depression to elevate the acromial roof.
Step 1: Calming Pain, Protecting the Area & Gentle Starter Motion: Why Thumb-Up ('Full-Can') Protects the Tendon: Raising your arm with your thumb pointing up rotates the bone bump out from under the shoulder roof so the tendon never gets pinched!
3 Effective Rehabilitation Exercises for a Rotator Cuff Tear
Phase 2: Progressive Mobility, Motor Control & Targeted Strengthening: Phase 2 Progressive Mobilization & Motor Control: Humeral Head Depressor & Posterior Cuff Phase (Weeks 2–6): Supine wand-assisted flexion, towel-supported external rotation (infraspinatus/teres minor co-activation to depress the humeral head), and side-lying external rotation.
Step 2: Restoring Flexibility & Building Supporting Muscle Strength: Towel Roll Under the Elbow: Keeping a small rolled towel under your elbow during rotation exercises increases blood flow to the healing tendon.
Clinical Assessment, Goniometry & Special Test Videos
Displayed only in Healthcare Professional mode (hidden in Patient mode)
Supraspinatus (Jobe / Empty Can) Test — Clinical Assessment
Goniometric ROM & Postural / Kinematic Analysis: Active vs. passive shoulder abduction/scaption (identifying the 60°–120° Painful Arc and pseudoparalysis vs. capsular stiffness).
Drop Arm Test — Full-Thickness Rotator Cuff Tear Examination
Special Clinical Provocation & Neurological/Functional Tests: Jobe's (Empty Can / Full Can) Test, Drop Arm Test (full-thickness tear), Neer & Hawkins-Kennedy Impingement Signs, and Scapular Assistance/Retraction tests.
Hawkins-Kennedy Impingement Test — Subacromial Impingement Assessment
Standardized Clinical Outcome Scales & Imaging Criteria: Constant-Murley Score, SPADI (Shoulder Pain and Disability Index), QuickDASH, and musculoskeletal ultrasound / shoulder MRI (Goutallier fatty infiltration grading).