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The supraspinatus muscle is the smallest of the four muscles that make up the shoulder joint's rotator cuff. It is the most superiorly located of the rotator cuff muscles and plays a crucial role in resisting gravitational forces acting on the shoulder joint, pulling the head of the humerus into the glenoid fossa of the scapula. Palpation of the supraspinatus muscle is an important skill for health professionals, especially manual therapists, as it is often associated with shoulder pain and tendinopathy of the rotator cuff. This text will provide an overview of how to palpate the supraspinatus muscle effectively.
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What You'll Learn
Palpation of the supraspinatus tendon
To palpate the supraspinatus tendon, the patient's hand must be placed behind their back in medial rotation. This is because the supraspinatus tendon lies between the infraspinatus and subscapularis tendons, and is under the acromion. By placing the arm behind the back, the humerus is medially rotated, bringing the tendon to the anterior part of the shoulder. The therapist can then trace the outline of the acromion until a prominent bump is felt at the most anterior portion of this bone. From there, the therapist drops their finger down half an inch or so to the tendon, which sits between the acromion and the head of the humerus.
The supraspinatus tendon can also be palpated by first locating the flat acromion process, and then sliding the fingers laterally off this area and onto the supraspinatus muscle as it attaches to the greater tubercle of the humerus. The patient should then be asked to gently oscillate their shoulder in and out in a very small range of shoulder abduction and adduction. This allows palpation of the supraspinatus tendon and ensures the deltoid is less likely to be activated.
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Locating trigger points
Palpation is a basic skill for health professionals, especially manual therapists, who use it to diagnose and treat patients. To locate trigger points, the supraspinatus tendon must be accessed. This can be done by placing the patient's arm behind their back, thus medially rotating the humerus and bringing the tendon to the anterior part of the shoulder. The therapist can then trace the outline of the acromion until a prominent bump is felt. The therapist's finger is then dropped down slightly to the tendon, which sits between the acromion and the head of the humerus.
The supraspinatus muscle tendon (SMT) is often palpated due to its correlation with shoulder pain and tendinopathy of the rotator cuff. It is the most lateral tendon of the rotator cuff group. The patient's shoulder should be relaxed, with the therapist placing their fingers on the patient's greater tubercle of the humerus. The patient should then gently oscillate their shoulder in a small range of abduction and adduction, allowing palpation of the supraspinatus tendon.
Myofascial pain syndrome is a chronic pain syndrome that affects a focal or regional part of the body. It is characterised by trigger points, which are local points of tenderness in the affected muscle. These trigger points can be identified by palpation or stretching, which produces intense local pain and referred pain. In patients with supraspinatus syndrome, the trigger point is found overlying the superior border of the scapula. Taut bands of muscle fibres are often identified when myofascial trigger points are palpated.
Ultrasound can be used to measure the SMT localisation and evaluate palpation concordance reliability. The European Society of Musculoskeletal Radiology (ESMR) protocol is used to determine the SMT. The distance from the skin surface to the SMT is measured using the greater tubercle of the humeral head as a reference point, with a 90-degree perpendicular line traced to the SMT.
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Patient positioning
For palpation of the supraspinatus tendon, the patient's shoulder should be relaxed. The therapist places their fingers on the patient's greater tubercle of the humerus. This can be located by first palpating the flat acromion process and then sliding the fingers laterally off this area and onto the supraspinatus muscle as it attaches to the greater tubercle of the humerus. The patient should then gently oscillate their shoulder in and out in a small range of shoulder abduction and adduction.
For self-treatment, the patient can place their forearm behind their back at waist level or across the front of their chest, grasping their elbow and actively stretching the muscle.
The patient's arm can also be brought into extension while the extremity is rotated internally and externally. The examiner may grasp the forearm to allow for rotational control of the extremity while the palpation is performed.
Another position for palpation of the supraspinatus muscle tendon (SMT) is with the patient seated on a backless bench, with their arm in medial maximum rotation, adduction, and light hyperextension. This is achieved by asking the patient to place their forearm behind their lower back, leaving no space between the arm and the chest.
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Therapist's examination
Therapists' Examination
The supraspinatus is the smallest of the four muscles that comprise the rotator cuff of the shoulder joint. It is considered the most superiorly located of the rotator cuff muscles. The supraspinatus muscle abducts the arm and pulls the head of the humerus into the glenoid fossa, preventing downward displacement of the humerus when the arm is dependent.
To access the supraspinatus tendon, the therapist must bring it to the anterior part of the shoulder. This is done by placing the patient's arm behind their back, thus medially rotating the humerus. The therapist must then trace the outline of the acromion until a prominent bump is felt at the most anterior portion of this bone. The therapist then drops their finger down half an inch or so to the tendon, which is wedged between the acromion and the head of the humerus.
The therapist should then place their fingers on the patient's greater tubercle of the humerus. They can do this by first palpating the flat acromion process and then sliding their fingers laterally off this area and onto the supraspinatus muscle as it attaches to the greater tubercle of the humerus. The patient should then be asked to gently oscillate their shoulder in and out in a very small range of shoulder abduction and adduction. This allows for palpation of the supraspinatus tendon and muscle in the range of motion where the deltoid is less likely to be activated.
Palpation will locate trigger points at the attachment of the tendon and through the trapezius muscle in the belly of the supraspinatus muscle. Pressure on these trigger points refers pain down the arm and often to the forearm or over the lateral epicondyle of the elbow. Taut bands of muscle fibers are often identified when myofascial trigger points are palpated. This referred pain may be misdiagnosed or attributed to other organ systems, leading to extensive evaluation and ineffective treatment.
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Diagnosis and treatment
Palpation is a basic skill for health professionals, especially manual therapists, who use it for diagnosis and treatment. The supraspinatus muscle is the smallest of the four muscles that comprise the rotator cuff of the shoulder joint. It is considered the most superiorly located of the rotator cuff muscles. The supraspinatus muscle abducts the arm and pulls the head of the humerus into the glenoid fossa, preventing downward displacement of the humerus when the arm is dependent.
Palpation of the supraspinatus tendon can be used to diagnose a full-thickness tear with a high degree of accuracy. This technique, known as the rent test, was first described by Codman in 1934. It requires the patient to be relaxed, with the arm dangling at their side. The examiner stands behind the patient, holding their forearm with the elbow flexed at 90 degrees. The shoulder is then brought back into full extension, allowing greater palpation of the humeral head and tendons. The other hand is placed in front of the anterior acromion, in the space before the greater tuberosity. This position is ideal for palpating and treating the supraspinatus tendon as it inserts into the greater tuberosity.
The Empty Can Test and the Full Can Test are also commonly used orthopedic examinations for supraspinatus impingement or integrity of the supraspinatus muscle and tendon. The arm to be tested is moved into 90 degrees of abduction in the plane of the scapula, with full internal rotation and the thumb pointing down, as if emptying a beverage can.
In terms of treatment, manual therapists often treat the supraspinatus muscle tendon due to its correlation with shoulder pain and tendinopathy of the rotator cuff. Passive modalities such as ultrasound, cryotherapy, and electrical muscle stimulation can provide temporary relief in the acute phase. Strengthening exercises, such as isometric exercises, should be considered to work out the shoulder girdle musculatures. Additionally, patients can benefit from low-energy extracorporeal shock wave therapy and neuromuscular control exercises to increase strength in the rotator cuff muscles and improve shoulder stability.
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Frequently asked questions
Palpation is a basic skill used by health professionals to physically examine a patient by touching or applying pressure to a part of their body.
To palpate the supraspinatus muscle, the patient's arm must be placed behind their back in medial rotation. The supraspinatus tendon lies between the infraspinatus and subscapularis tendons and is the most lateral tendon of the rotator cuff group. The therapist must trace the outline of the acromion until a prominent bump is felt. The therapist then drops their finger down half an inch to the tendon, which is wedged between the acromion and the head of the humerus.
The supraspinatus muscle abducts the arm and pulls the head of the humerus into the glenoid fossa. This prevents the downward displacement of the humerus when the arm is dependent.
The patient's hand is placed behind their back and the physiotherapist resists the abduction of the shoulder. Pain on resistance is a positive test for a lesion of the supraspinatus muscle.
