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Supraspinatus Tear

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Original Editor - Brecht Haex

Top Contributors - Leana Louw, Kim Jackson, Mats Vandervelde, Brecht Haex, Fasuba Ayobami, Muhammad Arslan, Vidya Acharya, Naomi O'Reilly, Wendy Walker, Saimat Lachinova, Habibu Salisu Badamasi, Simisola Ajeyalemi, Wout Van Hees, Joao Costa, Shreya Pavaskar, Anthony Mertens, Wanda van Niekerk, Alexandra Stead and Rachael Lowe

Description

Supraspinatus muscle (highlighted in green) - posterior view
Supraspinatus muscle (highlighted in green) - posterior view

A supraspinatus tear refers to a partial- or full-thickness disruption of the supraspinatus tendon, which forms part of the rotator cuff of the shoulder.[1] It may occur following acute trauma or develop gradually due to repetitive loading and degenerative changes.[2] Quite often, the tear occurs in the tendon or as an avulsion from the greater tuberosity.[3] Although the supraspinatus tendon is commonly affected in isolation, tears may also involve one or more of the other rotator cuff tendons.[4][5]

Image: Supraspinatus muscle (highlighted in green) - posterior view[6]

Clinical Relevant Anatomy

The shoulder joint is made up of three bones: the humerus, scapula and clavicle. The head of the humerus and the glenoid of the scapula form a ball-and-socket joint[7]. The supraspinatus muscle is located on the back of the shoulder, forming part of the rotator cuff.[8] The rotator cuff consists of supraspinatus, infraspinatus, subscapularis and teres minor.[9] The rotator cuff covers the head of the humerus and keeps it in place and these muscles help to lift and rotate the arm.[10]

The supraspinatus tendon passes beneath the acromion and attaches to the greater tubercle of the humerus.[11][12] It contributes to shoulder abduction and helps maintain glenohumeral stability during arm movement.[13] Injury to this tendon may cause pain during arm elevation, weakness during resisted abduction and difficulty performing overhead activities.[14] Larger tears may result in substantial weakness and impaired active shoulder elevation.[15]

Chronic or larger supraspinatus tears may also be associated with tendon retraction, muscle atrophy and fatty infiltration.[16] These changes can influence the potential for tendon repair and the choice of treatment.[17] Clinical assessment should therefore consider not only the presence of a tear but also its size, functional effects and associated muscle changes.[18]

Visit the shoulder for more detailed information.

Supraspinatus

Origin: Supraspinous fossa of the scapula.[19]

Insertion: Superior facet of the greater tuberosity of the humerus.[12]

Innervation: Suprascapular nerve (C5–C6).[20]

Function:

  • Assists in abduction of the arm at the glenohumeral joint.[21]
  • Contributes to dynamic stabilisation of the glenohumeral joint by helping to maintain the humeral head within the glenoid cavity.[22]
  • Works synergistically with the other rotator cuff muscles to control humeral head movement during shoulder motion.[23]

[7][24][25]

Epidemiology

The aetiology of supraspinatus tears is multifactorial, consisting of age-related degeneration, microtrauma, and macrotrauma.[26] It mostly affects the dominant arm with about 50% of people in their 80s experiencing this condition.[27][28] Injury and degeneration are the two main causes of rotator cuff tears.[29] Rotator cuff tears are associated with older patients, those with a history of trauma and mostly affect the dominant arm.[30]

Supraspinatus tears are among the most frequently reported tendon injuries of the rotator cuff, with their occurrence increasing with age.[31] A prospective study conducted in Brazil by Yazigi Junior et al. (2018), involving 80 patients with shoulder pain, identified partial-thickness supraspinatus tears in 38.75% and full-thickness tears in 16.2% of participants.[32] This study also reported that supraspinatus tears were more frequently identified in patients over 40 years of age (68.4%) compared with those aged 40 years or younger (21.7%). These findings demonstrate the association between increasing age and supraspinatus tendon pathology, although the results represent a symptomatic clinical population rather than the general population.

A 2021 meta-analysis by Zhao et al. included nine observational studies from eight countries: Japan, the United States, Argentina, Italy, Switzerland, Brazil, India and South Korea. Among the 3,240 participants included, 687 (21.2%) were classified as having supraspinatus tears.[33] Furthermore, a 2025 study conducted in India found that the supraspinatus tendon accounted for 85.9% of all identified rotator cuff tears, including partial- and full-thickness tears.[34] These findings highlight the frequent involvement of the supraspinatus tendon in rotator cuff pathology, although the reported percentages reflect different study populations and should not be interpreted as general population prevalence estimates.

In the Brazilian study, supraspinatus tears were identified in 49% of male participants and 65.5% of female participants with shoulder pain.[32] However, the meta-analysis by Zhao et al., which included studies from eight countries, identified male sex as a risk factor for supraspinatus tears.[33] The difference between these findings may reflect variations in study populations, participant characteristics and sampling methods. Therefore, further population-based research is required to establish the prevalence of supraspinatus tears across different age groups and between males and females.

Aetiology

The aetiology of supraspinatus tears is multifactorial, involving several intrinsic and extrinsic factors that contribute to tendon degeneration and injury.[35] The following are the main causes associated with the development of supraspinatus tears:

Age-related degeneration: Progressive changes in tendon structure, collagen organisation and tissue elasticity reduce the tendon's ability to tolerate mechanical stress, increasing susceptibility to tears, particularly in older adults.[36][37]

Repetitive mechanical loading: Repeated shoulder movements, particularly overhead activities, can expose the supraspinatus tendon to excessive mechanical stress, contributing to microtrauma and progressive tendon deterioration.[38]

Reduced tendon vascularity: Relatively limited blood supply in certain regions of the supraspinatus tendon may contribute to impaired tissue repair and increased susceptibility to degenerative changes.[39]

Extrinsic mechanical compression: Anatomical variations and changes in the subacromial structures may contribute to mechanical compression of the supraspinatus tendon during shoulder movement.[40]

Acute trauma: Sudden excessive loading or traumatic injury may cause partial- or full-thickness tears, particularly when the tendon is subjected to forces beyond its capacity.[41][38]

Mechanism of Injury

Supraspinatus tears can develop through acute traumatic injury or repetitive mechanical loading, which may lead to progressive tendon damage. The mechanisms of injury include:

1. Acute traumatic tears

Acute traumatic tears occur when a sudden excessive tensile force is applied to the supraspinatus tendon, exceeding its mechanical capacity and resulting in partial- or full-thickness disruption.[38] Common mechanisms include:[42]

  • Falling onto an outstretched arm or directly onto the shoulder.
  • Sudden forceful lifting or pulling.
  • Shoulder dislocation, particularly following traumatic injury.
  • Direct impact or high-energy trauma involving the shoulder.

2. Repetitive loading and progressive tendon failure

Repeated loading of the supraspinatus tendon, particularly during activities involving shoulder elevation and overhead movements, can produce cumulative microdamage.[43] When the rate of damage exceeds the tendon's capacity for repair, progressive structural deterioration may occur, eventually resulting in a partial- or full-thickness tear.[38] This mechanism is commonly associated with:[44]

  • Repetitive overhead activities during occupational or sporting tasks.
  • Repeated shoulder elevation and abduction under load.
  • Prolonged or excessive mechanical loading without adequate recovery.
  • Progressive deterioration of tendon integrity, which may increase susceptibility to rupture during relatively low-force activities.

A pre-existing degenerative tendon may also sustain an acute tear following a relatively minor traumatic event, resulting in an acute-on-chronic injury.[45]

Risk Factors

Following are risk factors of supraspinatus tear:[33]

  • Individuals over 40 years of age have an increased likelihood of developing supraspinatus tendon tears, with prevalence increasing further with advancing age.[30][46]
  • Supraspinatus tears have been reported more frequently in males than females, with male sex identified as a potential risk factor.[30][47]
  • Smoking
  • Genetics
  • Hypercholesterolemia
  • Body mass index
  • Height
  • Repetitive stress/lifting
  • History of trauma
  • Lack of blood supply
  • Bony spurs
  • Overhead activities and other people who do overhead work: Tennis players, Baseball pitchers, Painters, Carpenters, and Plumbers.
  • Traumatic injury e.g. fall (more common cause in younger individuals)[7]

Clinical presentation

Supraspinatus tears are classified as partial-thickness or full-thickness tears.[48] They may be symptomatic or asymptomatic, depending on factors such as tear size, location and associated tendon and muscle changes.[49]

Partial thickness:

  • Involve incomplete disruption of the supraspinatus tendon fibres, with some fibres remaining intact.[2]
  • May involve the articular surface, bursal surface or the internal substance of the tendon.[50]
  • Can increase in size and potentially progress to full-thickness tears.[51][52]

Full thickness:

  • Involve disruption across the entire thickness of the supraspinatus tendon and muscle fibres, from the articular to the bursal surface.[53]
  • May involve partial or complete detachment of the tendon from its insertion on the greater tuberosity.[54]
  • Larger tears may be associated with tendon retraction, supraspinatus muscle atrophy and fatty infiltration.[55]

Signs and Symptoms

Patients normally present with:[7][28][56]

  • Pain/worsening pain (in cases where tears are progressing), the most common symptoms are:
  • Pain when lifting and lowering your arm or with specific movement
  • Pain at rest
  • Pain at night, predominantly when you lie on the affected shoulder
  • Traumatic tears: Sudden, intense pain often accompanied by a snapping sensation and immediate weakness in the upper arm
  • Located anterolaterally and superiorly
  • Referred to the level of the deltoid insertion with full-thickness tears
  • Repetitive strain tear: Starts off mild and only when lifting your arm; over time the pain can become more noticeable at rest
  • Aggravated in overhead or forward-flexed position
  • Limited range of motion
  • Reduced forward elevation, external rotation and abduction
  • Struggle with activities like reaching behind back, combing hair and overhead activities
  • Stiffness
  • Weakness when rotating or lifting your arm
  • Crepitus, Clicking, and Instability

Differential Diagnosis

The following conditions may present with symptoms similar to those of a supraspinatus tear and should be considered during clinical assessment:[57][58] Shoulder joint and surrounding structures:

Cervical and neurological conditions:

Disorders affecting the cervical spine, nerve roots or peripheral nerves may produce referred shoulder pain, sensory disturbances or muscle weakness, which can mimic the clinical presentation of a supraspinatus tear.[59] These conditions should be considered during differential diagnosis, particularly when symptoms extend beyond the shoulder or are accompanied by neurological signs.[60] Following conditions should be considered:

Referred pain:

Cardiac conditions may cause referred shoulder pain due to the convergence of visceral and somatic sensory pathways within the central nervous system.[61] This pain may be perceived in the shoulder or upper limb rather than being localised to the chest, and should be considered when assessing unexplained shoulder pain, particularly when accompanied by other cardiac symptoms.[62] Following conditions should be considered:

  • Angina pectoris
  • Myocardial infarction

Diagnostic Procedures

Physical Examination

Subjective interview:

  • Onset: Spontaneous or after injury
  • Duration of pain
  • Pain provocation/aggravating factors
  • Night rest
  • Same problems in the past?
  • Activity limitations
  • Localize pain
  • Past medical history
  • Recreational or sport activities (possible overhead activities)

Observation:

  • Any atrophy present

Range of motion:

  • Expect reductions in flexion, abduction and external rotation
  • If passive abduction range is more than active range, it is an indication of a rotator cuff tear

Muscle power:

  • Test supraspinatus by resisting abduction at 90° and internal rotation
  • Scapular movement may be affected

Palpation:

  • Forearm behind back to palpate rotator cuff just anterior and below the acromion
    • Muscle atrophy present
    • Tenderness

Special tests:

  • Drop-arm test: Active shoulder abduction to 90°, then return [63]
    • Positive: Dropping the arm down with pain indicates a positive test

Drop Arm Test video provided by Clinically Relevant


  • Jobe/supraspinatus/empty can test: Resist shoulder abduction and internal rotation[63]
    • Positive: Pain/weakness

Empty Can Test video provided by Clinically Relevant

  • Full can test: Resisted shoulder abduction in external rotation
    • Positive: Pain/weakness

Full Can Test video provided by Clinically Relevant

  • Subacromial grind test: Patient standing and examiner standing facing the patient, the examiner grasps the patient's flexed elbow. The shoulder is passively abducted in the scapular plane to 90°. The examiner's other hand is placed over the patient's shoulder overlying the anterior acromion and greater tuberosity. The examiner passively internally and externally rotates the shoulder detecting the presence of palpable crepitus.
    • Positive: Palpable crepitus.[64]

[65][12]

Special Investigations

X-rays

  • Excluding sclerosis and osteophyte formation on the acromion
  • X-rays measure the size of the subacromial space
  • Unable to see the tendon
Supraspinatus tear as seen in radiographics

MRI

  • MRI Scan shows partial or full tears in the tendons of the rotator cuff, inflammation to weak structures and cracks in the capsule

CT Scan

  • CT scan is able to localize tendon when patient positioned with forearm behind the back

Ultrasound

Outcome Measures

Medical Management

Conservative Management

Indications:[27][28]

  • Older (>70 years) patients with a chronic tear
  • Patients with irreparable tears with irreversible changes
  • Patients of any age with small (<1 cm) full-thickness tears
    • As a result of the slow rate of progression of these tears
  • Patients without a full-thickness tear

Management includes:[66]

NSAID's:

  • Ibuprofen

Corticosteroid injections:

  • Eliminate pain for a period of time, making physiotherapy management easier
  • Tendon tissue can be weakened by these injections (which would have an adverse effect on the outcome of a possible surgery)
  • Limited to 2 injections
  • Physiotherapy (see Physiotherapy management below)

Surgical Management

Indications:[27][28][67]

  • Failed conservative management
  • Larger symptomatic full-thickness tears (1-1,5cm) as a result of the high rate of progression. Should be considered for earlier surgical repair in younger patients if the tear is repairable and the muscle degeneration is limited
  • Acute large tears (>1 cm-1.5 cm) or
  • Young patients with full-thickness tears who have a significant risk for the development of irreparable rotator cuff changes
  • Complete tear with significant pain and dysfunction after 6 months of treatment
  • Repeated dislocations

Rotator cuff repair

Most repairs are done arthroscopically[67]. Severity (partial vs full-thickness) will determine the approach.

  • Partial repair: The tendon and surrounding bone will be smoothed to avoid further damage and therefore allowing the tendon to heal mostly on its own[68]
  • Complete tear: Tear in middle of tendon: Suture the two parts of the tendon back together. Tear close or on its point of attachment on the head of the humerus: Attach the tendon back to its original place by an anchor (sometimes two). This anchor actually consists of a small screw that is bored into the head of the humerus with on the back surgical wires which hold the tendon in place[69].

Physiotherapy Management

Physiotherapy management depends on the extent of the tear, and plays in important role in both conservative management as well as post-surgical rehabilitation. More details can also be obtained from the rotator cuff page.

Conservative Management

Physiotherapy goals:

  • Improve pain together with NSAID’s (2-6 weeks)
  • Cryotherapy (only in first 48 hours)
  • Massage
  • Improve circulation (to control inflammation and speed up the healing process)
  • Improve range of motion:
    • Stretching (careful with timing, as stretching of acute injury may aggravate the tear):[70] 
      • Crossover arm stretch: 12 seconds, 5 times a day; 5-6days/week 

Kristian Berg. Prescriptive stretching; Human Kinetics [71]

  • Door stretch: 5 x 30 seconds (5 second rest in between)
  • Passive/Active range of motion:[72]
    • Pendulum exercises: Forward and back, side-to-side, circular motion. 2 sets of 10 a day, 5-6days/week
    • Symptom limited active-assisted range of motion exercises

Kristian Berg. Prescriptive stretching; Human Kinetics [71]

  • Increase strength:[73][74]
    • Rotator cuff (especially supraspinatus) strengthening to improve muscle control and strength
    • Prone Horizontal Abduction progress by using resistance bands
    • Prone Row with External Rotation
  • Regain function of affected upper limb (up to 3 months)
  • Home exercise programme

Clinical Bottom Line

A supraspinatus tear can occur due to trauma or repeated micro-trauma and present as a partial or full-thickness tear.[7] Most of the time, the tear occurs in the tendon or as an avulsion from the greater tuberosity[3]. The tear can be partial or full-thickness. Pain, loss of range of motion and weakness is the 3 most common symptoms.[7][28][56] Supraspinatus tears can be managed conservatively, with NSAID's and physiotherapy, as well as surgically to repair the tear.

References

  1. ↑ Bedi A, Bishop J, Keener J, Lansdown DA, Levy O, MacDonald P, Maffulli N, Oh JH, Sabesan VJ, Sanchez-Sotelo J, Williams III RJ. Rotator cuff tears. Nature reviews Disease primers. 2024 Feb 8;10(1):8.
  2. ↑ 2.0 2.1 Sripathi P, Agrawal DK. Rotator cuff injury: pathogenesis, biomechanics, and repair. Journal of orthopaedics and sports medicine. 2024 Oct 22;6(4):231.
  3. ↑ 3.0 3.1 Benazzo F, Marullo M, Pietrobono L. Supraspinatus rupture at the musculotendinous junction in a young woman. Journal of Orthopaedics and Traumatology 2014;15(3):231-4.
  4. ↑ Yubran AP, Pesquera LC, Juan ELS, Saralegui FI, Canga AC, Camara AC, et al. Rotator cuff tear patterns: MRI appearance and its surgical relevance. Insights Imaging. 2024;15(1):61. doi:10.1186/s13244-024-01607-w.
  5. ↑ Mall NA, Lee AS, Chahal J, Sherman SL, Romeo AA, Verma NN, et al. An evidenced-based examination of the epidemiology and outcomes of traumatic rotator cuff tears. Arthroscopy. 2013;29(2):366-76.
  6. ↑ Supraspinatus muscle (highlighted in green) - posterior view image - © Kenhub https://www.kenhub.com/en/library/anatomy/supraspinatus-muscle
  7. ↑ 7.0 7.1 7.2 7.3 7.4 7.5 7.6 American Academy of Orthopedic Surgeons, Ortho Info. Rotator cuff tears, http://orthoinfo.aaos.org/topic.cfm?topic=a00064 (accessed 29/08/2018).
  8. ↑ Kadi, R., Milants, A., & Shahabpour, M. (2017). Shoulder Anatomy and Normal Variants. Journal of the Belgian Society of Radiology, 101(Suppl 2), 3. https://doi.org/10.5334/jbr-btr.1467
  9. ↑ Akhtar A, Richards J, Monga P. The biomechanics of the rotator cuff in health and disease: a narrative review. J Clin Orthop Trauma. 2021;18:150–156.
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  12. ↑ 12.0 12.1 12.2 Sahu D, Phadnis A. Revisiting the rotator cuff footprint. J Clin Orthop Trauma. 2021;21:101514. Cite error: Invalid <ref> tag; name ":5" defined multiple times with different content
  13. ↑ Yanagawa T, Goodwin CJ, Shelburne KB, Giphart JE, Torry MR, Pandy MG. Contributions of the individual muscles of the shoulder to glenohumeral joint stability during abduction. J Biomech Eng. 2008;130(2):021024.
  14. ↑ Edwards P, Ebert J, Joss B, Bhabra G, Ackland T, Wang A. Exercise rehabilitation in the non-operative management of rotator cuff tears: a review of the literature. Int J Sports Phys Ther. 2016;11(2):279–301.
  15. ↑ Sheth MM, Shah AA. Massive and irreparable rotator cuff tears: a review of current definitions and concepts. Orthop J Sports Med. 2023;11(5):23259671231154452.
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  17. ↑ Jensen AR, Taylor AJ, Sanchez-Sotelo J. Factors influencing the reparability and healing rates of rotator cuff tears. Curr Rev Musculoskelet Med. 2020;13(5):572–583.
  18. ↑ Hsu KL, Kuan FC, Velasquez Garcia A, Hong CK, Chen Y, Shih CA, Su WR. Factors associated with reparability of rotator cuff tears: a systematic review and meta-analysis. J Shoulder Elbow Surg. 2024;33(9):e465–e477.
  19. ↑ Saran S, Shirodkar K, Gavvala SN, Evans S, Iyengar KP, Jevalle DG, et al. Supraspinous fossa: anatomy and pathology. Indian J Radiol Imaging. 2025;35(1):139–147.
  20. ↑ Montané-Blanchart M, Miguel-Pérez M, Rodero-de-Lamo L, Möller I, Pérez-Bellmunt A, Martinoli C. Variations in the course and diameter of the suprascapular nerve: anatomical study. Int J Environ Res Public Health. 2022;19(12):7065.
  21. ↑ Lee ECS, Roach NT, Clouthier AL, Bicknell RT, Bey MJ, Young NM, et al. Three-dimensional scapular morphology is associated with rotator cuff tears and alters the abduction moment arm of the supraspinatus. Clin Biomech (Bristol). 2020;78:105091.
  22. ↑ Akhtar A, Richards J, Monga P. The biomechanics of the rotator cuff in health and disease—a narrative review. J Clin Orthop Trauma. 2021;18:150–156.
  23. ↑ Williamson PM, Hanna P, Momenzadeh K, Lechtig A, Okajima S, Ramappa AJ, et al. Effect of rotator cuff muscle activation on glenohumeral kinematics: a cadaveric study. J Biomech. 2020;105:109798.
  24. ↑ Schünke M, Schulte E, Schumacher U, Voll M, Wesker K. Prometheus: Algemene anatomie en bewegingsapparaat, 2010. p600.
  25. ↑ Physioworks, Rotator Cuff Tear.http://physioworks.com.au/injuries-conditions-1/rotator-cuff-tears (accessed 29/08/2018).
  26. ↑ Lawrence RL, Soliman SB, Dalbøge A, Lohse K, Bey MJ. Investigating the multifactorial etiology of supraspinatus tendon tears. J Orthop Res. 2024;42(3):578–587.
  27. ↑ 27.0 27.1 27.2 Tashjian RZ. Epidemiology, natural history and indications for treatment of rotator cuff tears. Clinics in Sports Medicine 2012:31(4):589-604.
  28. ↑ 28.0 28.1 28.2 28.3 28.4 Yamamoto A, Takagishi K, Osawa T, Yanagawa T, Nakajima D, Shitara H, Kobayashi T. Prevalence and risk factors of a rotator cuff tear in the general population. Journal of shoulder and elbow surgery 2010:19(1):116-20.
  29. ↑ Abdelwahab A, Ahuja N, Iyengar KP, Jain VK, Bakti N, Singh B. Traumatic rotator cuff tears: current concepts in diagnosis and management. J Clin Orthop Trauma. 2021;18:51–55.
  30. ↑ 30.0 30.1 30.2 Zhao J, Luo M, Liang G, Pan J, Han Y, Zeng L, et al. What factors are associated with symptomatic rotator cuff tears: a meta-analysis. Clin Orthop Relat Res. 2022;480(1):96–105.
  31. ↑ Teunis MT, Lubberts BB, Reilly BB. A systematic review and pooled analysis of the prevalence of rotator cuff disease with increasing age. Journal of shoulder and elbow surgery. 2014 Dec 1;23(12):1913-21.
  32. ↑ 32.0 32.1 Yazigi JA, Nicolao FA, Matsunaga FT, Archetti N, Matsumoto MH, Tamaoki MJ. Sensitivity and specificity of ultrasonography in diagnosing supraspinatus lesions: a prospective accuracy diagnostic study. Sao Paulo Medical Journal. 2018 Aug 13;136(04):292-7.
  33. ↑ 33.0 33.1 33.2 Zhao J, Luo M, Liang G, Wu M, Pan J, Zeng LF, Yang W, Liu J. Risk factors for supraspinatus tears: a meta-analysis of observational studies. Orthopaedic journal of sports medicine. 2021 Oct 5;9(10):23259671211042826.
  34. ↑ Tankala J, Parameswaran A, Yadav VK, Nori M, Eachempati KK, Apsingi S. Asymptomatic rotator cuff tears among the indian population: prevalence, risk factors, and tear characteristics. Indian Journal of Orthopaedics. 2025 Jun;59(6):800-6.
  35. ↑ Lawrence RL, Soliman SB, Dalbøge A, Lohse K, Bey MJ. Investigating the multifactorial etiology of supraspinatus tendon tears. Journal of Orthopaedic Research®. 2024 Mar;42(3):578-87.
  36. ↑ Sercek M, Emekli E. MRI-based rotator cuff muscle morphometry across isolated supraspinatus tendon tear severity. Skeletal radiology. 2026 Sep 25:1-1.
  37. ↑ Kwan KY, Ng KW, Rao Y, Zhu C, Qi S, Tuan RS, Ker DF, Wang DM. Effect of aging on tendon biology, biomechanics and implications for treatment approaches. International Journal of Molecular Sciences. 2023 Oct 14;24(20):15183.
  38. ↑ 38.0 38.1 38.2 38.3 Griffith KM, Hammer LC, Iannuzzi NP, Takatani KC, Hsu JE, Cotton JD, Gee AO, Gardner RJ, Lack WD. Review of human supraspinatus tendon mechanics. Part I: fatigue damage accumulation and failure. Journal of Shoulder and Elbow Surgery. 2022 Dec 1;31(12):2671-7.
  39. ↑ Hegedus EJ, Cook C, Brennan M, Wyland D, Garrison JC, Driesner D. Vascularity and tendon pathology in the rotator cuff: a review of literature and implications for rehabilitation and surgery. British journal of sports medicine. 2010 Sep;44(12):838-47.
  40. ↑ Spargoli G. Supraspinatus tendon pathomechanics: a current concepts review. International journal of sports physical therapy. 2018 Dec;13(6):1083.
  41. ↑ Abdelwahab A, Ahuja N, Iyengar KP, Jain VK, Bakti N, Singh B. Traumatic rotator cuff tears-current concepts in diagnosis and management. Journal of clinical orthopaedics and trauma. 2021 Jul 1;18:51-5.
  42. ↑ Nyffeler, R. W., Schenk, N., & Bissig, P. (2021). Can a simple fall cause a rotator cuff tear? Literature review and biomechanical considerations. International orthopaedics, 45(6), 1573–1582. https://doi.org/10.1007/s00264-021-05012-6
  43. ↑ Griffith MK, Hammer ML, Iannuzzi MN, Takatani MK, Hsu MJ, Cotton PJ, Gee MA, Lack MW. Review of human supraspinatus tendon mechanics. Part II: tendon healing response and characterization of tendon health. Journal of Shoulder and Elbow Surgery. 2022 Dec 1;31(12):2678-82.
  44. ↑ Seitz AL, McClure PW, Finucane S, Boardman III ND, Michener LA. Mechanisms of rotator cuff tendinopathy: intrinsic, extrinsic, or both?. Clinical biomechanics. 2011 Jan 1;26(1):1-2.
  45. ↑ Pogorzelski J, Erber B, Themessl A, Rupp MC, Feucht MJ, Imhoff AB, et al. Definition of the terms "acute" and "traumatic" in rotator cuff injuries: a systematic review and call for standardization in nomenclature. Arch Orthop Trauma Surg. 2021;141(1):75–91.
  46. ↑ Eustace, S. K., Murphy, A. N., Hurley, D. J., Abul, A. H. A., & Kavanagh, E. (2023). MRI findings in atraumatic shoulder pain-patterns of disease correlated with age and gender. Irish journal of medical science, 192(2), 847–852. https://doi.org/10.1007/s11845-022-03012-y
  47. ↑ Haveri S, Patil KS, Uppin RB, Patil S, Putti BB. A cross-sectional study on novel risk factors associated with supraspinatus tendon tear. Indian J Orthop. 2021;55(2):457-63.
  48. ↑ Wang S, Tang K, Chen J, Jiang J, Dong Y. Ultrasound accuracy in classifying full-thickness supraspinatus tear patterns: an arthroscopic correlation study. British Journal of Radiology. 2026 May;99(1181):951-8.
  49. ↑ Ueda Y, Tanaka H, Tomita K, Tachibana T, Inui H, Nobuhara K, Umehara J, Ichihashi N. Comparison of shoulder muscle strength, cross-sectional area, acromiohumeral distance, and thickness of the supraspinatus tendon between symptomatic and asymptomatic patients with rotator cuff tears. Journal of shoulder and elbow surgery. 2020 Oct 1;29(10):2043-50.
  50. ↑ Serpi F, Albano D, Rapisarda S, Chianca V, Sconfienza LM, Messina C. Shoulder ultrasound: current concepts and future perspectives. Journal of Ultrasonography. 2021 Jun 7;21(85):154-61.
  51. ↑ Frandsen JJ, Quinlan NJ, Smith KM, Lu CC, Chalmers PN, Tashjian RZ. Symptomatic rotator cuff tear progression: Conservatively treated full‐and partial‐thickness tears continue to progress. Arthroscopy, Sports Medicine, and Rehabilitation. 2022 Jun;4(3):e1091-6.
  52. ↑ Garcia MJ, Caro D, Hammerle MV, Villarreal JB, DeAngelis JP, Ramappa AJ, Nazarian A. Disparities in rotator cuff tear progression definitions and rates: a systematic review. JBJS Open Access. 2024 Oct 22;9(4):e24-00097.
  53. ↑ Llopis E, Perez A, Cerezal L. Rotator cuff. Musculoskeletal diseases. 2021 Apr 13;2024:11-8.
  54. ↑ Thompson SM, Prinold JA, Hill AM, Reilly P, Emery RJ, Bull AM. The influence of full-thickness supraspinatus tears on abduction moments: the importance of the central tendon. Shoulder & Elbow. 2019 May;11(1_suppl):19-25.
  55. ↑ Belzer MM, Ramsey MD, Opel MD, Berkson MM, Gundle MK, Nagy MM, Boucher MR, McCarron MJ. MRI-based 3-dimensional volumetric assessment of fatty infiltration and muscle atrophy in rotator cuff tears. Journal of shoulder and elbow surgery. 2022 Jun 1;31(6):1272-81.
  56. ↑ 56.0 56.1 Mayo Clinic Rotator cuff injury. http://www.mayoclinic.org/diseases-conditions/rotator-cuff-injury/symptoms-causes/dxc-20126923 (accessed 30/08/2018).
  57. ↑ Medscape. Supraspinatus tendonitis: Differential diagnoses, http://emedicine.medscape.com/article/93095-differential (Accessed 20/03/2015).
  58. ↑ Medscape. Rotator cuff injury: Differential diagnoses, http://emedicine.medscape.com/article/92814-differential, (Accessed 25/03/2015).
  59. ↑ Shim JY, Shin MH. Conditions Mimicking Cervical Radiculopathy–Key Shoulder Disorders and Diagnostic Insights: A Review Article. The Nerve. 2025 Apr 24;11(1):1-9.
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  62. ↑ Knuuti J, Wijns W, Saraste A, Capodanno D, Barbato E, Funck-Brentano C, et al. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes. Eur Heart J. 2020;41(3):407-77.
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  64. ↑ Sawalha S, Fischer J. The accuracy of “subacromial grind test” in diagnosis of supraspinatus rotator cuff tears. International journal of shoulder surgery 2015;9(2):43-46.
  65. ↑ Walters J, editor. Orthopaedics - A guide for practitioners. 4th Edition. Cape Town: University of Cape Town, 2010.
  66. ↑ Björkenheim JM, Paavolainen P, Ahovuo J, Slätis P. Surgical repair of the rotator cuff and surrounding tissues. Factors influencing the results. Clinical orthopaedics and related research 1988;(236):148-53.
  67. ↑ 67.0 67.1 Millar NL, Wu X, Tantau R, Silverstone E, Murrell GA. Open versus two forms of arthroscopic rotator cuff repair. Clinical orthopaedics and related research 2009;467(4):966-78.
  68. ↑ American Academy of Orthopedic Surgeons. Rotator Cuff Tears: Surgical Treatment Options. https://orthoinfo.aaos.org/en/treatment/rotator-cuff-tears-surgical-treatment-options/ (accessed 30/08/2018).
  69. ↑ Akpınar S, Uysal M, Pourbagher MA, Ozalay M, Cesur N, Hersekli MA. Prospective evaluation of the functional and anatomical results of arthroscopic repair in small and medium-sized full-thickness tears of the supraspinatus tendon. Acta orthopaedica et traumatologica turcica 2011;45(4):248-53.
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  73. ↑ Physioroom. Exercises to Strengthen the Rotator Cuff Muscles in the Shoulder.http://www.physioroom.com/experts/asktheexperts/answers/qa_mb_20050225.php (accessed 31/08/2018).
  74. ↑ Heers G, Anders S, Werther M, Lerch K, Hedtmann A, Grifka J. Efficacy of home exercises for symptomatic rotator cuff tears in correlation to the size of the defect. Sportverletzung Sportschaden: Organ der Gesellschaft fur Orthopadisch-Traumatologische Sportmedizin 2005;19(1):22-7.
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