Supraspinatus shoulder pain (A pain in the arc)

Jason Bianchi Osteopath Kinesis Clinic
Jason Bianchi
Associate Osteopaths
Date Posted
January 26, 2022

What is the supraspinatus?

The supraspinatus is a muscle which sits within the top of the shoulder blade (Supraspinous fossa). It is one of the rotator cuff muscles (supporting muscles of the shoulder) which carries out movement of the arm to the side (known as abduction) The supraspinatus is responsible for providing stability by securing the head of the humerus against the glenoid fossa (shoulder joint). Along with the deltoid muscle, supraspinatus abducts the arm and initiates movement for the first 20° before the deltoid muscle assists the movement to 90°.

So why is this muscle involved with shoulder pain?

The supraspinatus runs across the shoulder blade (scapula) and inserts in the top, outside region of the arm (humerus) The supraspinatus tendon runs in between two bony regions, the acromion (edge of the scapula) and the head of the glenoid (head of the humerus). When the arm is abducted, the space between these bones compress, reducing the amount of space the supraspinatus muscle tendon has to move. When there is an injury or a positional compromise of the shoulder, this can reduce the space even further causing further stress on the tendon.

Pain in the arc

When the arm is lifted out to the side of the body (abduction). Initially the patient may not experience any discomfort before 45°. As the arm is raised between 45°–120°, the supraspinatus tendon is under more compression between the acromion and the humerus. As the arm is raised to 180°, the arm will feel more comfortable, as the palm of the hand turns inwards (External rotation of the humerus). This is due to the bony landmark that sticks out of the humerus the (greater tuberosity) moving away from the supraspinatus tendon and allowing more space for the tendon to move through the subacromial space.

Testing for shoulder impingement

The ‘painful arc’ is one of the tests carried out to assess whether there is pain as the arm is raised into abduction. The test is positive if pain is experienced between 45°-120°. There are a number of additional tests that can be carried out to investigate the shoulder pain, which may include the Hawkins, Neer and Jobe test.

Other contributing factors to shoulder pain

Within the subacromial space, there are a number of surrounding structures, that can be contributing to shoulder pain. This may include involvement of the bursae. Bursae are fluid filled sacs that are responsible for reducing frictions between moving parts in your body., There are six bursae around the shoulder. One of the bursae above the supraspinatus is called the subacromial bursa. The bursa sits under the acromion and above the supraspinatus tendon. As the tendon is pressed between the bone landmarks the tendon also squashes the bursa. Repeated movement of raising the arm can further irritate both the tendon and bursa It can lead to secondary conditions, such as a sub acromial bursitis (Inflammation of the burse sac). At this stage, pain can then be further increased and movement then limited. The supraspinatus is also responsible for maintaining position of the glenohumeral joint. If the supraspinatus is injured, the other rotator cuff muscles will have to take the slack of maintain joint stability. This can lead to the rotator cuff muscle being worked harder, causing fatigue and long term could cause problems for the other rotator cuff muscles.

What’s posture got to do with it?

Sedentary lifestyle such as desk work can be a contributing factor to poor posture. Given the amount of time sitting at a desk in front of a computer can be anything up to eight hours. Throughout the day our posture can gradually become slumped in our lower back, which in turn drops the shoulders forwards to counter balance our body weight. This causes the shoulder blades to draw forwards (protraction). Over time this affects the muscles, both in the front of the chest and around the shoulders and neck. With the shoulders maintaining more of a protracted position, this can lead to the misalignment of the shoulders. This means that each time the arm is abducted, it’s more likely to cause irritation and over time cause increased wear and tear and even inflammation.

Treatment:

As well as considering the Supraspinatus itself, it is important to also consider associated structures and tissues, including mobility of the thoracic spine and neck. These areas can also be contributing to shoulder problems. If the thoracic spine is forward positioned (kyphosis) this can change the position of your shoulders blades which can lead to further compromise of the supraspinatus muscle. Improving movement through the thoracic spine can help to maintain better posture allowing the chest to push forwards and shoulder blades to retract. This can help the supraspinatus tendon to run freely between the acromion and glenoid head.

Osteopathy can help with shoulder pain by improving the quality of the supraspinatus muscle through soft tissue manipulation, as well as looking at improve joint mobility or the shoulder complex and surrounding areas, such as the thoracic spine. This can include gentle articulations of the thoracic spine and or spinal manipulation to encourage movement of the thoracic joints. Other treatment modalities may include Laser Therapy treatment, which is an effective way to treat the inflammation of the tendon and the bursa. Other treatments that are effective include the Graston Technique, which is an instrument assisted soft tissue technique (IAST) that works by breaking down restrictions and scar tissue that can form. The Graston Technique can help to improve and restore movement and soft tissue quality.

Exercise

As well as treatment, strengthening the muscles in the back and shoulders can help with pulling back the scapulae. As well as strengthening muscles, stretching the chest muscles (pectorals) and improving mobility in the thoracic spine can further help with aligning the shoulders.

If you are suffering with shoulder pain, contact Kinesis clinic to arrange an appointment with our OSTEOPATH JASON BIANCHI.

Osteopath Reviews

Keeping people active and pain free in Guildford
Jason treated a debilitating back injury that had left me in pain for more than a year. Prior to this, I had seen every specialist going and nothing seemed to be working, I had almost given up hope that it would ever get better. I am so glad that I came here on recommendation, as I am now almost completely pain free and can manage any twinges at home with the exercises provided.Jason was very well informed and knowledgeable, able to explain everything very clearly and talked me through treatment and what to expect every step of the way. He used a mixture of laser therapy, dry needling and manipulation and sent follow up exercises, amending my treatment plan as time went on - a completely tailored service that was adapted to my personal recovery. I felt in completely safe hands and couldn’t believe that finally, after such a long time I was seeing progress.If you’re considering seeking treatment and have tried lots of different avenues to no avail, I highly recommend giving this a try, I’m so glad that I did. The difference it has made to my day to day life is unbelievable, and I’m extremely grateful!
Lily Csombor
Lily Csombor
1717479382
Five years ago I had spinal surgery following a fracture. Whilst relatively successful giving a better range of movement initially, by year three years post op intense pain had returned. I could not walk very far and only with the support of a cane.On recommendation, I booked an appointment with Barry Harpur at Kinesis Clinic in October 2023. The scar from my spinal operation is approximately eight inches long and was, in Barry's word's, like concrete. No wonder I couldn't move much.Under his care and more recently Zaneta Kwiecien, things have much improved. Zaneta has a special interest in scar tissue and has worked hard on mine, additionally giving me exercises to improve my core and general mobility and introduced me to acupuncture which I believe has been beneficial.My mobility has much improved and the scar tissue itself has improved so much that it no longer restricts my ability to bend. I only wish I had attended the clinic sooner.Today I spent four hours walking around RHS Wisley Gardens, without once resorting to the support of my cane. It is difficult to express how this feels and how grateful I am to the Kinesis Team for getting me this far in improving both my physical and mental health. I have had a particular walking goal for the last three years, and I know that this year I will achieve it.I would encourage anyone with scar tissue that has an adverse affect on health and mobility to consider a consultation at Kinesis Clinic
Chris Costa
Chris Costa
1712779072
I injured myself weightlifting and my backpain was waking me up and preventing sleep. Jason was fantastic, very professional, calm and great at explaining everything he was doing and why, which made me feel very comfortable and literally 'in safe hands'. He not only manipulated the injured area but also used a laser therapy which felt amazing. He kept the exercises I needed to do at home simple, and sent a video for future reference. Having had an awful experience of another osteopath who literally sat behind his desk, lectured me and did nothing re actually treating my injury beyond a few at home exercises, Jason and Kinesis were brilliant. The pain gradually got better and now I simply come in for a top up if anything tweaks.I cannot recommend them highly enough.
Sally Davis
Sally Davis
1711782111
Six years ago I fell out of a raft whilst white water rafting, bouncing over some rocks I cracked some vertebrae.The following year having fallen again I started to have severe pains in my hip and leg making it painful to walk.Over the next years I tried all sorts of treatment, painkillers, injections and manipulation. Nothing seemed to work and I was beginning to give up.In October last year a friend suggested I try once again with a practice in Guildford called Kinesis Clinic.I made an appointment for an initial assessment and met Miss Zaneta Kwiecien. Having been assured that something could be done to lesson the pain I booked for treatment to begin.I could not believe it but after just a few sessions I began to feel an improvement. Now months on I walk my dogs for a hour or more a day with only a little discomfort and some days NO pain.The mixture of laser, aquapuncture, manipulation and most important designed exercises has changed my life.Many, many thanksRobin Gardner
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robing
1711465023
I came to Zaneta with severe lower back pain and symptoms of sciatica. She was able to quickly diagnose the root cause as weakness stemming from pregnancy and labour. The treatments provided significant relief from the pain and she has been equipping me with functional exercises to improve strength and ensure that it doesn't flare up again. I've been amazed by the results so far, Zaneta has been fantastic.
Hannah E
Hannah E
1700852974
I cannot recommend the Kinesis Clinic highly enough. Earlier this year I came to Barry on the recommendation of my son for muscle pain in different areas of my body. To date he has worked a miracle and seem to be relatively pain free. Throughout this process I have tried other practitioners and none compare with Barry and his in depth knowledge. One of the most impressive things is the knowledge of his individual patients and the attention he gives you. I must also add that Lucy on reception is a real asset and is always willing to help in any way for the benefit of the clients.
Maureen kulik
Maureen kulik
1700686071
There's simply no one better than Kinesis. If you're looking for an osteopath, you've found the answer! ⭐️⭐️⭐️⭐️⭐️
Marc Gorman
Marc Gorman
1700459240
I had been in pain for 7 years and thought that was what life had to be like, and then I found Barry! He worked out immediately what my issue was (a long list of people had failed!!) and in one session reduced my pain significantly. Over 4 sessions he has made significant progress on my hip and shown me what the plan is going forward. Finding Barry literally changed my life and I couldn't be more grateful to him.
Ellie Apperly
Ellie Apperly
1693281266
I went to see Barry for rehab after fracturing my spine. He’s an excellent Osteopath, taking time to understand the issues, and provide the right treatment and a tailored home exercise program. His YouTube exercise videos are also very helpful to follow. My mobility and strength improved significantly as well as much less discomfort. Thank you Barry!
Tom
Tom
1692120023
I had a reoccurring shoulder dislocation injury due to playing various contact sports and after numerous operations my shoulder was weak, the muscles trembled as I tried to strengthen it. After struggling with it for over 10yrs I went to see Zaneta in the clinic. The main problem for me was the trembling and shaking as I tried to exercise and lack of flexibility. Zaneta used some instrument (big stainless-steel spoon in my non-medical world) to breakdown the scar tissue. After a few weeks my shoulder was unrecognisable. I can now exercise without the shaking, meaning I can strengthen it. Interestingly, I now have a greater range of movement than my ‘good’ shoulder.
Richard Leader
Richard Leader
1692114852
Ms Zaneta helped me a lot, especially when my back was falling apart after pregnancy! Huge thanks!
Ola Dos
Ola Dos
1688457910
Gareth has provided to me a fantastic and very personal service regarding my shoulder and lower back problems. I would thoroughly recommend him – well done
Peter Craig
Peter Craig
1660667097
I can't praise Jason highly enough, I've been seeing him for a few months and he's helped me so much, he's much more than my osteo, he's also a counsellor, business coach and all round great listener.Whenever I leave our session I feel better inside and out.
Susan Walsh
Susan Walsh
1652885930
Cannot rate Barry and the clinic higher, I have met everyone there and they are all professional but very friendly. They have been great at fitting me in, supporting me and making me feel like a valued customer. Have recommended to a number of friends that have had the same experience.
Lisa Collins
Lisa Collins
1636450785
I am so grateful to the whole team at Kinesis Clinic for all of the treatment I have had with them over the past 2.5 years following an accident. For the past year, Barry has helped me to heal my neck, and the dizziness associated with the injury. I feel that he really cares about his patients' recovery, and has so much wisdom to share. He has helped me to see how my mind and emotions also play a role in recovering, and this has prompted me to change patterns in my life that were worsening my symptoms. His approach to treatment has been gentle, but very effective. I can't recommend Kinesis Clinic enough. Thank you :)
Megan McInnes
Megan McInnes
1632602100
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Barry Harpur

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