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Supraspinatus Audio

Integrated functional anatomy of the supraspinatus. Attachments, nerves, palpation, joint actions, arthrokinematics, fascia, triggerpoints, and behavior in postural dysfunction. Common activation exercises, subsystems, foam rolling, stretches, and strength exercises for the rotator cuff.

Supraspinatus

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This course describes the anatomy and integrated function of the supraspinatus (a.k.a. the abductor of the rotator cuff muscles, the superior rotator cuff muscle, and superior rotator cuff tendon, or elevator of the glenohumeral joint rotators). As the name implies, the supraspinatus originates within the supraspinous fossa of the scapula (superior to the spine of the shoulder blade), the supraspinatus tendon crosses the glenohumeral joint (shoulder joint), and the tendon inserts into the greater tubercle of the humerus. This muscle is located deep to the upper trapezius. The supraspinatus is enclosed within its own fascial compartment, separated from the trapezius by the supraspinatus fascia, which is continuous with the infraspinatus fascia; however, the supraspinatus and infraspinatus are separated by the spine of the scapula. Research suggests the supraspinatus is a relatively small muscle contributing to approximately 2.0% of the total upper body muscle mass (compared to the pectoralis major which contributes approximately 10% of the upper body mass). Additionally, research suggests that the supraspinatus is composed primarily of type I muscle fibers.

The supraspinatus muscle crosses the shoulder (glenohumeral) joint, contributing to shoulder abduction, and as part of the rotator cuff aids in the stabilization of the shoulder during all joint actions. This course also discusses the supraspinatus and shoulder (glenohumeral) joint arthrokinematics, fascial integration, subsystem integration, and postural dysfunction. For example, "

, are correlated with altered rotator cuff recruitment and EMG activity, most often including an increase in supraspinatus activity, and a reduction in stability, strength, and range of motion of the 

. This implies this muscle should most often be released.

Sports medicine professionals (personal trainers, fitness instructors, physical therapists, massage therapists, chiropractors, occupational therapists, athletic trainers, etc.) must be aware of the integrated function of the supraspinatus for the detailed analysis of human movement, and the development of sophisticated exercise programs and therapeutic (rehabilitation) interventions. For example, altered activity and length of the supraspinatus may contribute to rotator cuff injury, rotator cuff tears, shoulder pain, shoulder impingement syndrome (SIS), supraspinatus tendon strain, biceps tendon impingement, and the resulting weakness and pain during motions such as shoulder abduction and flexion. Altered supraspinatus activity may also result in a reduction in infraspinatus, teres minor, and anterior deltoid activity, resulting in a significant reduction in upper extremity speed, agility, and strength, and a reduction in the effectiveness of resistance training intended to improve upper body strength and hypertrophy (bodybuilding). Deeper knowledge of supraspinatus anatomy is essential for optimal assessment, intervention selection, and building a repertoire of supraspinatus-specific techniques.

This course also provides detailed descriptions of etymology, attachments, innervations, joint actions, location, palpation, integrated actions, arthrokinematics, fascial integration, subsystem integration, postural dysfunction, assessment, clinical implications, and interventions.

Sample Intervention: Loss of Shoulder Range of Motion

: "Weak" or "with Compensation" (abduction)

Shoulder External Rotation Isolated Activation

Squat to Row (Posterior Oblique Subsystem)

Brookbush Institute’s most recommended techniques for the supraspinatus (see videos below):

The supraspinatus muscle attaching from the scapula to the humerus

 Course Description: Supraspinatus

Attachments and innervations of the supraspinatus from the course study guide

Course Study Guide: Supraspinatus

Coures Summary Webinar: Supraspinatus

 1794, intransitive, back-formation from 

. Transitive sense from 1823. Related: Rotated; rotating. Rotator “muscle which allows a part to be moved circularly” is recorded from the 1670s. (

 “bottom of a sleeve,” mid-14c., cuffe “hand covering, mitten, glove,” perhaps somehow from Medieval Latin cuffia “head covering,” of uncertain origin. Sense of “band around the sleeve” is first attested 1520s; sense of “hem of trousers” is 1911. (

 word-forming element meaning "above, over, beyond, before," from Latin supra "above, over, before, beyond, on the upper side," in supera (parte), literally "on the upper (side)," from old fem. ablative singular of superus (adj.) "above," related to super" above, over" (see 

). In English interchangeable with, but somewhat more technical than, super-. Rare as a prefix in Latin, more common in Medieval Latin, in English chiefly scientific or technical. (

 c. 1400, "backbone," later "thornlike part" (early 15c.), from Old French espine "thorn, prickle; backbone, spine" (12c., Modern French épine), from Latin spina "backbone," originally "thorn, prickle." (

 late 14c., "of or pertaining to birthdays," from Latin natalis "pertaining to birth or origin," (Old Latin gnasci; see 

"originating superior to the spine of the scapula"

The attachment of the supraspinatus on the scapula and humerus

https://upload.wikimedia.org/wikipedia/commons/thumb/3/34/Supraspinatus_muscle_back4.png/1024px-Supraspinatus_muscle_back4.png

The supraspinatus muscle attachment on a cadaver dissection of the humerus

http://jbjs.org/content/91/Supplement_2_Part_1/1

Etymology of Terms Related to the Supraspinatus

 The proximal attachment invests in the medial 2/3 of the supraspinous fossa of the scapula (1, 2).

 The distal attachment invests in the superior facet of the greater tubercle of the head of the humerus, and superior joint capsule (1, 2)

This muscle is innervated by the suprascapular nerve, arising from the upper trunk of the brachial plexus via the ventral rami of nerve roots C5 and C6, and occasionally C4 (1, 2).

The suprascapular nerve passes through the scapular notch, underneath the transverse ligament, innervating the supraspinatus before wrapping around the lateral border of the spine of the scapula and innervating the infraspinatus. Both the scapular notch and lateral border of the spine of the scapula may be subject to entrapment (8).

Suprascapular notch.

Supraspinatus Relative Size and Muscle Fiber Type:

The supraspinatus is a relatively small muscle, contributing approximately 2.0% of the total muscle mass of the muscles in the upper body. In comparison, the pectoralis major muscle contributes approximately 10.7% (3).

Two studies demonstrate that the supraspinatus is primarily type I muscle fibers, approximately 60% type 1 (3, 4).

Attachment & Innervation: Supraspinatus

, with the tendon covered by the acromion shelf. Inferior to the supraspinatus is the spine of the scapula, and deep (anterior) to the supraspinatus lies the supraspinous fossa and part, or all of the suprascapular notch. The suprascapular nerve passes through the suprascapular notch (under the superior transverse scapular ligament), and courses between the supraspinatus and supraspinous fossa providing neural innervation to the supraspinatus as it courses around the lateral edge of the spine of the scapula to the 

. The suprascapular artery also passes deep to the supraspinatus (but runs through the suprascapular notch over the superior transverse scapular ligament) supplying branches to the supraspinatus. Medially, the most superficial layers of the supraspinatus fascia run nearly continuously over the root of the spine of the scapula to invest in the fascia of the 

Laterally the tendon of the supraspinatus runs underneath the acromion shelf, between the infraspinatus tendon posteriorly, and anterior to the fascial web of the subscapularis tendon, superior and middle glenohumeral ligaments, coracohumeral ligaments, and the transverse humeral ligament. This tendon inserts into the periosteum of the superior facet of the greater tubercle, as well as the superior joint capsule.

Muscles and ligaments of the anterior shoulder

Where is the Supraspinatus Located?

Ask your partner to assume a prone lying position.

Sit at the end of the table with a view of the top of the head and top of the shoulder girdle.

Have your partner rotate their head away and laterally flex the neck toward the side you will be palpating (contralateral rotation and ipsilateral flexion).

Allow your partner to rest the side of their face on the table to relax all of the muscles of the neck.

Locate the spine of the scapula and press your thumb caudally (toward the tailbone) through the trapezius, toward the spine of the scapula until your fingers are resting in the supraspinous fossa.

Place your other hand on the lateral side of the humerus and have your partner abduct into your hand until you feel the supraspinatus fibers stiffen under your palpating thumb.

Have your partner abduct and relax rhythmically to assist in your palpation as you follow the fibers of the supraspinatus laterally until they course under the acromion.

The supraspinatus, infraspinatus, and teres minor on a cadaver dissection

Supraspinatus, infraspinatus, teres minor and teres major - cadaver dissection - http://www.rvuanatomy.com/uploads/1/3/4/5/13457421/s2_animated.gif

Palpating the Supraspinatus

The supraspinatus will contribute to abduction of the shoulder (1, 2, 6).

The supraspinatus will contribute to the stabilization of the glenohumeral joint in the glenoid fossa (compression). Some texts note a contribution to external rotation; however, no EMG studies have been able to confirm this notion (1, 2, 7).

Note: The supraspinatus was thought to play a larger role in the initiation of abduction; however, studies and clinical findings show that recruitment of the supraspinatus during arm elevation (flexion, scaption, and abduction) mirrors the deltoid muscles and that supraspinatus paralysis only results in a small decrease in strength during arm elevation (8, 9, 10).

The supraspinatus eccentrically decelerates shoulder adduction.

 is the prime mover, and the supraspinatus is a synergist.

As part of the rotator cuff musculature, the subscapularis, supraspinatus, infraspinatus, and teres minor contribute synergistically to dynamically stabilize the glenohumeral joint.

The supraspinatus attaching from the scapula to the humerus

Young Lae Moon [CC BY 3.0 (http://creativecommons.org/licenses/by/3.0)], via Wikimedia Commons

The deltoid and rotator cuff muscle direction of force

Arthrokinematics

Supraspinatus Muscle Actions

Our understanding of fascia has benefited from an exponential increase in research over the past two decades. This includes more research on its traditional functions as a passive medium that supports, protects, and encapsulates tissues (11), and its capacity to store elastic energy for explosive activity (12, 13). This also includes exciting new research that implicates fascia as a medium of communication. 

Levangin, H. hypothesized that this may occur via electrical, cellular, and/or mechanical signals (14). Histological studies have shown this tissue to be densely innervated by free 

 endings, as well as by Pacinian corpuscles and Ruffini endings (14, 15). This inspires consideration of fascia as a sensory organ with a strong link to motion and neuromuscular reflex. Further, Stecco et al. have demonstrated that deep fascia is arranged in layers that may 

 over one another (12). This finding is likely more responsible for inspiring various fascia-specific interventions and is most often referred to when describing fascia’s role in “interpreting” 

Fascia as a Passive Tissue (Traditional Functions):

Fascia as an Active Medium of Communication

 endings, Pacinian corpuscles, and Ruffini endings

May transmit the force of multiple muscles to aid in joint stabilization

Fibroblasts may play a role in increasing 

Image of the fascial system of the body connecting muscles

 The supraspinatus is enclosed within its own fascial compartment, separated from the 

 by the supraspinatus fascia. The supraspinatus fascia is continuous with the infraspinatus fascia; however, these muscles are separated by the spine of the scapula. Further, the supraspinatus fascia has some continuity with the 

 fascia (and the prevertebral layer of the cervical fascia). The continuity between the supraspinatus and levator scapulae is noted by Tom Myers and is included in the hypothesized Deep Back Arm Line (15). All of these muscles are considered in the predictive model of 

; however, this myofascial continuity may imply it is necessary to include the supraspinatus and infraspinatus in treating cervical dysfunction.

 The supraspinatus blends with the superior shoulder capsule between the more posterior 

 tendons, and the more anterior and inferior fascial web created by the subscapularis tendon, superior and middle glenohumeral ligaments, coracohumeral ligaments, and the transverse humeral ligaments. Additionally, the long head of the biceps brachii, long head of the triceps brachii, and 

 invest in this complex fascial network (15). This myofascial continuity may enhance the rigidity of various portions of the shoulder capsule, maintain optimal arthrokinematic alignment, and optimize muscle recruitment and shoulder stability.

A) posterior deltoid fascia B) trapezius C) Infraspinatus fascia D) Latissimus dorsi E) Teres Majnor F) Rhomboids G.) Vertebral border of scapula H) Inferior angle of scapula - Moccia, D., Nackashi, A. A., Schilling, R., & Ward, P. J. (2016). Fascial bundles of the infraspinatus fascia: anatomy, function, and clinical considerations. Journal of anatomy, 228(1), 176-183.

Fascial Integration

Research Summary: Supraspinatus EMG Activity

Research Review: Healthy Individuals and Supraspinatus EMG Activity

Research Review: Dysfunction and Supraspinatus EMG Activity

Supraspinatus Research

 Research demonstrates a relative increase in the electromyographic (EMG) activity of the supraspinatus in those exhibiting signs of 

 and potentially cervical dysfunction. Changes in relative length are challenging to determine; however, it is likely that the increase in scapula downward rotation (relative humeral abduction) and inferior glide of the humeral head result in some adaptive shortening (10, 41). These changes imply that the supraspinatus should be treated as "over-active and short" and addressed with release and lengthening techniques. Note that attempting to lengthen the supraspinatus using stretching techniques is likely impractical; however, some lengthening may result from shoulder mobilization techniques.

 Over-activity is addressed with release techniques (self-administered or manual). Shoulder instability may be addressed with activation techniques (self-administered).

Movement Impairment and Postural Dysfunction:

: Signs correlated with UBD include "arms fall" and "shoulder girdle elevation" during an 

," and excessive humeral internal rotation and scapula downward rotation and anterior tipping (rounded shoulder posture) during static posture. During an 

, the supraspinatus may contribute to "arms fall" by restricting end-range shoulder flexion and may contribute to "shoulder girdle elevation" by contributing to scapula downward rotation (relative glenohumeral abduction). Identification of these signs may imply that the supraspinatus should be specifically addressed with 

 techniques and potentially additional shoulder mobilization techniques.

Lumbo Pelvic Hip Complex Dysfunction (LPHCD)

: The supraspinatus does not play a significant role.

 The supraspinatus does not play a significant role.

Shoulder impingement syndrome (anterior and posterior) (33, 34, 36)

Shoulder instability (anterior capsule laxity) (27 35, 39, 42)

Supraspinatus trigger points (referral pain anterior deltoid) (43, 44, 45)

Rotator cuff tears (18, 22, 27, 33, 34, 38)

Neck pain resulting from scapular dyskinesis

Signs of Altered Length/Tension and Tone:

Top Arm: Inability to reach T7, or the opposite superior angle of the scapula, may indicate supraspinatus over-activity.

Bottom Arm: Apprehension in reaching for T7, or the opposite inferior angle of the scapula, may indicate shoulder instability.

Increased stiffness or laxity during anterior-to-posterior or posterior-to-anterior passive accessory motion of the shoulder.

The common trigger points and referral pain of the supraspinatus

Common Trigger Point Locations and Referral Pain Patterns for Supraspinatus

Movement Impairment and the Supraspinatus

Supraspinatus (Self-administered) Static Release

Self-administered Shoulder Mobilization

Manual Shoulder Mobilization

Case Study and Sample Routine: Loss of Shoulder Range of Motion

Exercises and Techniques for the Supraspinatus 

Johnson, M. A., Polgar, J., Weightman, D., & Appleton, D. (1973). Data on the distribution of fibre types in thirty-six human muscles: an autopsy study. 

Lovering, R. M., & Russ, D. W. (2008). Fiber type composition of cadaveric human rotator cuff muscles. 

journal of orthopaedic & sports physical therapy

Florence Peterson Kendall, Elizabeth Kendall McCreary, Patricia Geise Provance, Mary McIntyre Rodgers, William Anthony Romani

Dark A, Ginn KA, Halaki M. (2007). Shoulder muscle recruitment patterns during commonly used rotator cuff exercises: an electromyographic study. 

Joint Structure and Function: A Comprehensive Analysis: Fifth Edition

Inman VT, Saunders JB, Abbot JC, Observatinos on the function of the shoulder joint. J Bone Joint Surg 26:1 - 30, 1944

Reed D, Cathers I, Halaki M, Ginn K. (2013). Does supraspinatus initiate shoulder abduction? 

Journal of Elecrtromyography and Kinesiology.

Lawrence, R.L., Braman, J.P., Staker, J.L., Laprade, R.F., Ludewig, P.M. (2014) Comparison of 3-dimensional shoulder complex kinematics in individuals with and without shoulder pain, Part 2: Glenohumeral joint. 

Journal of Orthopaedic & Sports Physical Therapy

Benjamin, M. (2009). The fascia of the limbs and back–a review. 

Stecco, C., Porzionato, A., Lancerotto, L., Stecco, A., Macchi, V., Day, J. A., & De Caro, R. (2008). Histological study of the deep fasciae of the limbs. 

Journal of bodywork and movement therapies

Stecco, C., Pavan, P. G., Porzionato, A., Macchi, V., Lancerotto, L., Carniel, E. L., … & De Caro, R. (2009). Mechanics of crural fascia: from anatomy to constitutive modelling. 

: a body-wide signaling network? Med. Hypotheses 66, 1074-1077

Gaudet, S., Tremblay, J., & Begon, M. (2018). Muscle recruitment patterns of the subscapularis, serratus anterior and other shoulder girdle muscles during isokinetic internal and external rotations. Journal of sports sciences, 36(9), 985–993. https://doi.org/10.1080/02640414.2017.1347697

Reinold, M. M., Wilk, K. E., Fleisig, G. S., Zheng, N., Barrentine, S. W., Chmielewski, T., Cody, R. C., Jameson, G. G., & Andrews, J. R. (2004). Electromyographic analysis of the rotator cuff and deltoid musculature during common shoulder external rotation exercises. 

The Journal of Orthopaedic and Sports Physical Therapy

https://doi.org/10.2519/jospt.2004.34.7.385

Wattanaprakornkul, D., Cathers, I., Halaki, M., & Ginn, K. A. (2011). The rotator cuff muscles have a direction specific recruitment pattern during shoulder flexion and extension exercises. 

(5), 376–382. https://doi.org/10.1016/j.jsams.2011.01.001

Wickham, J., Pizzari, T., Stansfeld, K., Burnside, A., & Watson, L. (2010). Quantifying 'normal' shoulder muscle activity during abduction. 

Journal of electromyography and kinesiology : official journal of the International Society of Electrophysiological Kinesiology

https://doi.org/10.1016/j.jelekin.2009.06.004

Supraspinatus

Related Courses:

Course Description: Supraspinatus

Course Study Guide: Supraspinatus

Coures Summary Webinar: Supraspinatus

Etymology of Terms Related to the Supraspinatus

Attachment & Innervation: Supraspinatus

Where is the Supraspinatus Located?

Palpating the Supraspinatus

Supraspinatus Muscle Actions
1 Sub Section

Fascial Integration

Supraspinatus Research
3 Sub Sections

Movement Impairment and the Supraspinatus
1 Sub Section

Exercises and Techniques for the Supraspinatus
4 Sub Sections

Bibliography

Related Courses:

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Supraspinatus

Related Courses:

Course Description: Supraspinatus

Course Study Guide: Supraspinatus

Coures Summary Webinar: Supraspinatus

Etymology of Terms Related to the Supraspinatus

Attachment & Innervation: Supraspinatus

Where is the Supraspinatus Located?

Palpating the Supraspinatus

Supraspinatus Muscle Actions1 Sub Section

Fascial Integration

Supraspinatus Research3 Sub Sections

Movement Impairment and the Supraspinatus1 Sub Section

Exercises and Techniques for the Supraspinatus 4 Sub Sections

Bibliography

Related Courses:

Comments

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Supraspinatus Muscle Actions
1 Sub Section

Supraspinatus Research
3 Sub Sections

Movement Impairment and the Supraspinatus
1 Sub Section

Exercises and Techniques for the Supraspinatus
4 Sub Sections