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Atlas · Shoulder

Supraspinatus

Supraspinatus lies above the scapular spine and contributes to arm elevation and cuff stability. Lateral shoulder pain, night pain and weakness require a cuff assessment rather than assuming a tender muscle explains them.

Supraspinatus
Body region
Shoulder
Trigger points
3
documented in this muscle
Common symptoms
3
patterns cataloged
Contributors
3
Factors to assess

Muscle overview

Symptoms and first steps

Practical first steps

  • Keep comfortable shoulder motion and temporarily reduce painful overhead loads.
  • Support the arm at night if this improves sleep.
  • Return to reaching in measured steps.

When to seek assessment

  • Arrange prompt examination for traumatic weakness or inability to raise the arm.
  • Persistent night pain, increasing movement loss or neurological symptoms warrant reassessment.

Its muscle belly is in the supraspinous fossa; the tissue at the greater tuberosity is tendon insertion, not a freely accessible muscle belly.

Examination, palpation and treatment evidence

Illustrated overview

Supraspinatus

Blue highlights the muscle. Crosses mark representative trigger-point sites; shaded areas show possible referred pain. These examples do not correspond one-to-one with the numbered points below. Patterns vary and cannot diagnose the cause of pain.

Illustrated overview

Supraspinatus · Trigger-point examples 1

Representative source regions. The illustrated markers and pain pattern are not individual assignments to the numbered trigger points.

Open full-size image

Trigger points

1. TrP1

Location. Top of shoulder blade, above spine

Trigger point map
Supraspinatus — Trigger point mapOpen full-size image

Shared muscle diagram; it may show several trigger points.

Referred pain map
Supraspinatus — Referred pain mapOpen full-size image

Regional muscle reference; this is not an individual map of the selected numbered trigger point.

Pain referral. Outer shoulder, down arm

Pain Pattern

  • Outer shoulder
  • Down outer arm
  • Elbow
  • Wrist
  • Deltoid area

What This Pain Feels Like

A lateral shoulder ache may intensify during elevation or when lying on that side. Record the painful arc and compare strength and passive range to guide a cuff assessment.

What Patients Report

  • Pain when reaching for seatbelt
  • Night pain disturbing sleep
  • Pain when lifting arm sideways
  • Weakness when raising arm

What Makes It Worse

  • Lifting arm between 60-120 degrees
  • Overhead reaching
  • Carrying heavy objects
  • Sleeping on affected side
  • Repetitive arm movements
Browse related exercises (5)

Symptoms patients report

Lateral shoulder pain during elevation Record the movement and load that provoke it.

Sleep interruption A pillow under the arm may modify symptoms, but night pain is not muscle-specific.

Loss of lifting strength Acute or substantial weakness changes the need for tear assessment.

Contributors to assess

Increased overhead activity Compare current activity with the recent baseline.

Cuff tendinopathy or partial tear Tendon disease can coexist with muscle tenderness.

Shoulder trauma Immediate weakness or inability to elevate needs prompt assessment.

For clinicians and supervised training

Clinical reference

A painful arc or elbow ache is not specific to supraspinatus trigger points. Distinguish muscle-region tenderness from tendon and neurological findings.

Anatomy and palpation

Anatomical relationships

Supraspinatus originates in the supraspinous fossa and passes beneath the acromion to the superior facet of the greater tuberosity.[3]

  • Scapular spine below the belly and acromion laterally.
  • Greater tuberosity at the lateral proximal humerus marks the tendon region.

Nearby structures. Trapezius covers the belly; deltoid and the subacromial bursa cover parts of the tendon. The suprascapular nerve supplies the muscle.

Palpation

Patient position. Seated or prone with the examined forearm supported and shoulder relaxed.

Find the landmarks

  • Trace the palpable scapular spine toward the acromion.
  • Identify the supraspinous fossa immediately above the spine; the humeral greater-tuberosity region is a separate tendon landmark.

Examination sequence

  1. Use broad gentle contact through the overlying trapezius.
  2. Ask for a brief low-load elevation effort, then relax to compare tenderness.
  3. Assess the humeral tendon region separately and record familiar pain during movement.

Document the findings

  • Separate belly-region sensitivity from lateral tendon-region pain.

Limits and precautions

  • Do not dig under the acromion or infer a tear from tenderness.
[3][4]

Examination and tests

2

Active versus supported passive shoulder motion[4]

Distinguish painful effort from a substantial restriction of joint movement.

Position
Seated for active elevation; supine with scapula and arm supported for passive testing.
Technique
Record active elevation and external rotation, then gently compare examiner-assisted motion in the same planes. Note familiar pain, range and whether the shoulder blade substitutes early.
Positive finding
Active limitation with better passive range differs from marked restriction of both.
Interpretation
A large active/passive gap with weakness warrants cuff or nerve assessment; global passive restriction suggests a joint/capsular pathway.
Limitations
Pain, guarding and measurement position influence motion. Neither pattern identifies an individual trigger point.

Full-can resisted elevation[5][4]

Measure familiar pain and force during a defined shoulder effort.

Position
Seated or standing, arm elevated in the scapular plane with thumb upward; use a lower angle if 90° is intolerable.
Technique
Apply gradually increasing downward resistance while the patient holds the arm. Record pain and force separately and compare the other shoulder.
Positive finding
Familiar pain, reduced force or inability to hold the position compared with the other arm.
Interpretation
Pain with retained force supports a load-sensitive cuff presentation; marked weakness after trauma raises concern for tear. This is not an isolated supraspinatus test.
Limitations
Pain inhibition and neighboring muscles affect performance. These are cuff-function findings, not trigger-point confirmation.

Distinguishing other causes

Rotator-cuff tear[5][4]

Findings that matter. New loss of strength after trauma, a lag sign or inability to raise the arm despite better passive motion.

Next step. Arrange timely examination and imaging when it will change management.

Adhesive capsulitis or glenohumeral arthritis[4]

Findings that matter. Several passive directions are restricted, especially external rotation; the limitation exceeds one painful effort.

Next step. Assess the joint and select movement/loading accordingly.

Suprascapular nerve dysfunction or cervical nerve-root disorder[4]

Findings that matter. Weakness out of proportion to pain, visible muscle wasting, altered sensation or symptoms affected by neck movement.

Next step. Perform a neurological examination; consider electrodiagnostic or imaging assessment for a persistent objective deficit.

Treatment selection and progression

Clinician-delivered care

High-intensity laser (HILT) for subacromial shoulder pain[2][1]

Consider when. Clinically assessed subacromial shoulder pain that limits elevation or rehabilitation.

Clinician-delivered HILT accompanies shoulder exercise to reduce pain and improve movement-related function. Patient and operator use eye protection rated for the device wavelengths and exposure.

Dose and review
The trial assessed a three-week treatment course and outcomes at week 12; its accessible abstract does not specify laser settings or session count.
Progression
Compare pain and reach during the same overhead task, then progress cuff loading when tolerated.
Stop or reassess
Stop for skin discomfort or a sustained flare; reassess new marked weakness.
Evidence and limits
A 63-patient sham-controlled trial supports regional subacromial outcomes, without establishing treatment of an isolated supraspinatus trigger point or tendon healing.

Self-care and activity

Adjust overhead load while maintaining use[4]

Consider when. Assessed cuff-related pain with preserved function.

Use a lower shelf, divide carrying loads and reduce the most provocative overhead repetitions while keeping easy daily reach.

Dose and review
Try the change during the provoking task and review its effect on pain and task tolerance before continuing.
Progression
Restore height, then weight or duration.
Stop or reassess
Reduce the load for a lasting flare; new marked weakness, numbness or sharp injury pain requires reassessment.
Evidence and limits
The cited references support anatomical orientation or regional care. The activity and starting dose are clinical adaptations, with no isolated-muscle efficacy established by those references.

Exercise and rehabilitation

Graded scapular-plane elevation[3][4]

Consider when. Tolerable elevation without acute major weakness.

Raise the arm slightly forward of the side with thumb up, starting below the painful range; lower slowly.

Dose and review
Starting example: one set of 5–8 comfortable repetitions on alternate days; adjust to irritability and the next-day response.
Progression
Extend the arc before adding a light weight.
Stop or reassess
Reduce the load for a lasting flare; new marked weakness, numbness or sharp injury pain requires reassessment.
Evidence and limits
The cited references support anatomical orientation or regional care. The activity and starting dose are clinical adaptations, with no isolated-muscle efficacy established by those references.

Clinician-delivered care

Shockwave for confirmed calcific cuff tendinopathy[4]

Consider when. Persistent symptoms with imaging-confirmed calcification judged relevant to the painful cuff tendon.

Discuss extracorporeal shockwave directed to the calcific tendon target while continuing an appropriate loading program.

Dose and review
Device settings and treatment course are selected clinically; a muscle marker does not determine them.
Progression
Review pain, sleep and overhead function after the agreed course before further procedures.
Stop or reassess
Reassess substantial worsening or new weakness; avoid continuing solely because a deposit remains visible.
Evidence and limits
The 2025 cuff guideline permits ESWT for calcific tendinopathy and recommends against it for noncalcific cuff tendinopathy. This is a tendon indication, not evidence for supraspinatus muscle-point treatment.

Reassessment and follow-up

  • Repeat full-can pain/force and active/passive elevation.
  • Track a shelf-reaching task and sleep interruption.
  • Count controlled repetitions at the same light elevation load, noting a loss of reaching height or new weakness before progressing resistance.

Evidence and sources

  1. OSHA: Guidelines for Laser Safety and Hazard Assessment

    2026 · Official laser-safety guidance; accessed 2026

    Access year. Protective eyewear must match the laser wavelength and required optical density; Class IV operation requires eye protection and beam controls.

  2. The effectiveness of high-intensity laser therapy on pain, range of motion, functional capacity, quality of life, and muscle strength in subacromial impingement syndrome: a 3-month follow-up, double-blinded, randomized, placebo-controlled trial

    2022 · Randomized placebo-controlled trial

    Sixty-three patients received HILT plus exercise or sham plus exercise. Pain and shoulder-function outcomes favored HILT at weeks 3 and 12. Online publication was in 2021.

  3. University of Washington Muscle Atlas: Supraspinatus

    2026 · University anatomical reference

    Accessed September 2026; access year. Used for attachments and actions, not treatment efficacy or point-map validation.

  4. Desmeules et al. Rotator Cuff Tendinopathy Diagnosis, Nonsurgical Medical Care, and Rehabilitation

    2025 · Clinical practice guideline

    Adults with cuff tendinopathy, including partial-thickness tears; not full-thickness tears. Recommends active rehabilitation, distinguishes calcific from noncalcific shockwave indications.

  5. Jain et al. The Diagnostic Accuracy of Special Tests for Rotator Cuff Tear: The ROW Cohort Study

    2017 · Prospective diagnostic cohort

    208 participants; strength/lag tests inform tear assessment, not muscle trigger-point diagnosis. Negative subscapularis tests can miss tears.

Associated Trigger Points