What happens to the tendon
The supraspinatus tendon travels through the subacromial space, between the humeral head and the acromion, and is placed under high loads whenever the arm is abducted. Over time, and with repetitive use, this tendon may develop micro-trauma, degenerative changes and irritation, collectively referred to as supraspinatus tendinopathy or tendonitis. It often co-exists with subacromial pain, as the tendon and bursa are compressed in a relatively narrow space, especially when there is a sudden change in shoulder load due to new exercise, heavy work or prolonged overhead activities.
Typical symptoms include pain on arm elevation, a “painful arc” through part of the range, weakness or early fatigue when holding objects out in front or to the side, and sometimes night pain when lying on the affected shoulder. Diagnosis is based largely on clinical assessment and, when indicated, imaging to rule out other pathology and evaluate for partial- or full-thickness tears. Management is predominantly conservative, emphasising education, activity modification and a structured exercise programme aimed at restoring the tendon’s load tolerance rather than simply resting the shoulder.
