Supraspinatus Trigger Points

Introduction

The supraspinatus is a key rotator cuff muscle responsible for shoulder stabilization, arm abduction, and upper limb control. When trigger points develop in this muscle, they can cause shoulder pain, weakness, and limited arm movement, often mimicking rotator cuff tears, shoulder impingement, or frozen shoulder.

Name and Area

  • Name: Supraspinatus

  • Area: Located in the supraspinous fossa of the scapula, running from the top of the shoulder blade to the greater tubercle of the humerus.

Indications

Supraspinatus trigger points may contribute to:

  • Pain in the shoulder that feels like a deep ache (mistaken for rotator cuff tear or shoulder arthritis).

  • Pain that radiates down the outer arm to the elbow (can mimic biceps tendinitis or nerve compression).

  • Weakness when lifting the arm (difficulty raising the arm overhead or holding objects at shoulder level).

  • Pain or clicking in the shoulder when moving the arm (common in athletes, weightlifters, and older adults).

  • Pain that worsens when sleeping on the affected shoulder (common in side sleepers and those with shoulder dysfunction).

  • Stiffness that limits arm mobility (can mimic frozen shoulder or impingement syndrome).

Pain from this muscle is often mistaken for rotator cuff impingement, shoulder bursitis, or nerve compression.

Muscle Action

  • Abducts the Shoulder: Lifts the arm away from the body, essential for throwing, lifting, and reaching overhead.

  • Stabilizes the Shoulder Joint: Prevents excessive movement of the humeral head during arm motion.

The supraspinatus is crucial for shoulder mobility, stability, and overhead function.

Signs and Symptoms

Individuals with supraspinatus trigger points often report:

  • Pain in the shoulder that feels like a "burning" or "tight" sensation

  • Weakness when lifting objects overhead or reaching to the side

  • Pain that extends to the outer arm and can be felt even when at rest

  • Clicking or popping in the shoulder joint during movement

  • Pain that increases after repetitive overhead motions (common in swimmers, tennis players, and painters)

  • Discomfort that worsens with poor shoulder posture or rounded shoulders

Pain worsens with repetitive overhead use, poor shoulder mechanics, or prolonged pressure on the shoulder.

Perpetuating Factors

Common causes of supraspinatus trigger points include:

  • Repetitive overhead movements (common in swimmers, tennis players, and weightlifters)

  • Poor shoulder posture (forward shoulder position can overload the rotator cuff muscles)

  • Weak or imbalanced shoulder muscles (can cause the supraspinatus to overcompensate for stability)

  • Sleeping on one shoulder for long periods (can cause chronic compression and reduced blood flow)

  • Previous shoulder injuries (can lead to chronic tightness and decreased shoulder mobility)

Trigger Point Referral Pattern

Trigger points in the supraspinatus refer pain to:

  • The top of the shoulder and outer arm (Can Mimic Rotator Cuff Tendinitis or Shoulder Bursitis)

  • The lateral elbow and forearm (Mistaken for Tennis Elbow or Radial Nerve Irritation)

  • The side of the neck (Can Resemble Trapezius Strain or Cervical Nerve Compression)

Pain from this muscle is often confused with rotator cuff tears, shoulder impingement, or cervical radiculopathy.

Differential Diagnosis

Supraspinatus trigger points may be mistaken for:

  • Rotator cuff tear (shoulder pain and weakness, worsens with overhead movements or lifting)

  • Shoulder impingement syndrome (pain in the shoulder that increases with repetitive overhead activity)

  • Biceps tendinitis (pain in the front of the shoulder, worsens with lifting and repetitive motion)

  • Frozen shoulder (severe shoulder stiffness and limited range of motion, worsens over time)

  • Cervical radiculopathy (neck pain that radiates to the shoulder and arm, due to nerve compression in the cervical spine)

A thorough shoulder, scapular, and upper limb examination is necessary to rule out these conditions.

Associated Trigger Points

Supraspinatus trigger points often co-exist with:

  • Infraspinatus (posterior shoulder and arm pain, affects shoulder stability and external rotation)

  • Upper trapezius (neck and shoulder tension, common in postural strain and chronic stress)

  • Subscapularis (anterior shoulder pain, affects internal rotation and shoulder mechanics)

  • Rhomboids (scapular and upper back pain, common in those with poor shoulder posture and weak back muscles)

Anatomy and Innervation

Muscle Origin Insertion Innervation
Supraspinatus Supraspinous fossa of the scapula Greater tubercle of the humerus Suprascapular nerve (C5–C6)

The supraspinatus is innervated by the suprascapular nerve (C5–C6), which also controls shoulder stabilization and arm abduction.

Patient Examination

A comprehensive examination should include:

  • Palpation: Identify tender nodules along the supraspinous fossa and outer shoulder.

  • Resisted Shoulder Abduction Testing: Assess pain and weakness when lifting the arm away from the body against resistance.

  • Scapular Mobility Testing: Look for restricted movement, scapular winging, or compensatory shoulder mechanics.

  • Shoulder Joint and Rotator Cuff Stability Testing: Rule out impingement, tendon injuries, or capsular restrictions.

Corrective Actions

Dry Needling

  • Dry needling can release trigger points in the supraspinatus, reducing shoulder tightness and improving abduction.

Manual Therapy

  • Trigger Point Release: Apply deep sustained pressure to tight spots in the supraspinatus and outer shoulder.

  • Myofascial Release: Helps improve circulation and reduce muscle tension in the shoulder girdle.

Stretching

  • Cross-Body Shoulder Stretch: Helps release tension in the supraspinatus and improve shoulder flexibility.

  • Sleeper Stretch: Helps increase shoulder internal rotation and prevent impingement.

Strengthening Exercises

  • Lateral Arm Raises (With Light Resistance): Strengthens the supraspinatus and improves shoulder abduction.

  • Scapular Stability Exercises (Wall Slides): Helps activate the scapular stabilizers and prevent shoulder impingement.

Postural and Movement Adjustments

  • Avoid forward shoulder posture (maintain proper scapular position to prevent chronic supraspinatus tightness).

  • Ensure proper shoulder mechanics during workouts (engage the rotator cuff muscles to reduce overuse of the supraspinatus).

  • Use ergonomic workstation adjustments (prevents shoulder strain and rounded shoulder posture).

Conclusion

The supraspinatus plays a crucial role in shoulder stabilization, arm abduction, and upper limb function, but trigger points in this muscle can cause significant shoulder, upper arm, and neck pain. By incorporating dry needling, manual therapy, stretching, and strengthening exercises, individuals can reduce pain, improve mobility, and prevent shoulder dysfunction.

➡️ Learn more about Trigger Points

➡️ Explore our Trigger Point Index

Sources:

  • Travell, J. G., & Simons, D. G. (1983). Myofascial Pain and Dysfunction: The Trigger Point Manual (2nd ed.). Williams & Wilkins.

  • Simons, D., & Travell, J. (1999). The Trigger Point Manual, Volume 2: The Lower Extremities. Williams & Wilkins.