Supraspinatus Tendinopathy Treatment London | Private Ultrasound Diagnosis & Injections

Supraspinatus Tendon Pain Explained

Rotator Cuff & Supraspinatus Tendon Anatomy

The supraspinatus tendon is the main tendon of the shoulder involved in lifting weight and performing overhead shoulder activities. It is part of a group of muscles and tendons called the rotator cuff.

The supraspinatus muscle originates from the supraspinous fossa, which is located along the ridge at the top of the shoulder blade (scapula). It forms the tendon that inserts onto the lateral front aspect of the humeral head of the shoulder.

What Causes Supraspinatus Tendon Pain?

Due to the heavy workload that the supraspinatus tendon endures during everyday life activities and sports, it is commonly affected by tendinopathy — a term used to describe inflammation or degeneration of either focal areas of the tendon or diffusely across the tendon.

Supraspinatus Tendon Pathology Diagnosis

Ultrasound clearly visualises the supraspinatus tendon down to its insertion point on the greater tuberosity of the anterior lateral aspect of the humerus. We are able to visualise the supraspinatus tendon’s characteristic beak shape when imaged in a longitudinal view.

The transverse view can be used to corroborate any area of tendon defect.

The supraspinatus tendon can appear on ultrasound in various forms. The scan may reveal irregularity at the interface between the greater tuberosity and the supraspinatus tendon insertion. There may be thickening and reduced echogenicity (signal) in parts of the tendon in some cases.

In some cases, the tendon may lay down calcific deposits within the tendon body as a failed healing response to inflammation or a small tendon tear. Calcific supraspinatus tendinopathy is commonly seen in clinical practice.

Often, when the supraspinatus tendon is significantly affected by tendinopathy, there may be an effusion present, with fluid distension or thickening of the subacromial-subdeltoid bursa, which overlies the supraspinatus tendon.

Ultrasound Guided Injections for Supraspinatus Tendinopathy

SubAcromial Injections for Supraspinatus Tendinopathy

If there has been a failure to respond to first-line management (which would typically involve physical therapy and rehabilitation exercises), the next line of treatment may be an ultrasound-guided injection to the subacromial-subdeltoid bursa.

An ultrasound-guided injection to the subacromial-subdeltoid bursa can be performed by placing the ultrasound probe in a longitudinal or oblique fashion across the supraspinatus tendon. This allows clear visualisation of the supraspinatus tendon, the underlying deltoid muscle, and the subacromial-subdeltoid bursa positioned between these two layers.

We are able to place the needle from the near side of the probe to pierce the subacromial-subdeltoid bursa, and the injectate (usually a steroid and local anaesthetic) can be seen flowing into the bursa.

What to Do After Your Rotator Cuff Injection

Needle Path & Post-Injection Pain
For supraspinatus tendinitis and subacromial bursitis, an ultrasound-guided subacromial bursal injection is administered at the side of the shoulder through the deltoid area. This approach usually does not cause significant pain from the needle path itself.

Very rarely, a post-injection flare may occur, causing increased pain for 2–3 days. This is thought to be related to the medication and injectate reacting with the synovial fluid in the bursa, rather than the injection technique itself.

Wound Care & Infection Risk
As with all ultrasound-guided injections, avoid exposing the injection site to dirty or public water (such as swimming pools) for 2–3 days due to the small risk of infection. Monitor for redness, swelling, or discharge at the injection site and contact me if these occur.

Activity Guidance
After this type of injection, it is best to rest the shoulder from heavy loading and overhead activity for one week. From one week onward, you can gradually increase exercise and loading of the shoulder, ideally under the guidance of a qualified physiotherapist, to safely and effectively rehabilitate the rotator cuff muscles and tendons.

Follow-Up
If you experience any unusual pain, swelling, redness, or other concerns following your injection, please contact me immediately.

Other Treatments for Supraspinatus Tendon Pain

Upper Body Flexibility Exercises for Rotator Cuff Tears

Scapular Strengthening Exercises for Rotator Cuff Tears

Progressive External Rotation Strengthening Exercises for Rotator Cuff Tears

Progressive Deltoid Strengthening Exercises for Rotator Cuff Tears

AC Joint Pain | Evidence base

There is strong evidence, including high-quality systematic reviews, supporting the use of progressive loading programs in the management of supraspinatus tendinopathy and rotator cuff-related shoulder pain. These programs improve tendon structure and function through mechanical adaptation and neurophysiological pain modulation. A biomechanical approach — addressing scapular dyskinesis and anterior shoulder tightness — is also supported by clinical research. Corticosteroid injections may provide short-term relief but are associated with poorer long-term outcomes if used repeatedly. Surgical decompression, once commonly used, has shown no superior outcomes compared to physiotherapy in large trials, further supporting a non-operative first-line strategy.

Questions about your shoulder pain?