Tears of the supraspinatus tendon are classified according to their size, type, and location:

1. Partial tear: The tendon is only partially damaged, usually on the underside or top side.
2. Complete tear: The tendon is completely severed, often accompanied by significant loss of function.
3. Acute tear: Occurs due to sudden stress or injury, such as a fall.
4. Degenerative tear: Develops gradually due to wear or chronic overuse.
5. Massive tear: Several tendons of the rotator cuff are affected.
6. Traumatic tear: Occurs after direct impact or severe injuries.

The main causes of a tear in the supraspinatus tendon can be divided into acute and chronic factors:

- **Acute causes:**

- Sudden strains, for example when lifting heavy objects or during falls.

- Traumatic injuries from direct blows or falls on the shoulder.

- **Chronic causes:**

- Degenerative changes that occur with age or repeated overhead movements.

- Overuse from occupational or athletic activities, especially in sports like tennis or weightlifting.

- **Accompanying factors:**

- Impingement syndromes that additionally stress the tendon.

- Poor posture or weaknesses in the shoulder and back muscles.

The symptoms vary depending on the type and severity of the tear, but typically include:

- **Pain:** Sharp or pulling pain in the shoulder, especially with movements above shoulder height.

- **Loss of strength:** Difficulty lifting the arm or performing overhead work.

- **Movement restrictions:** Limited rotational and lifting movements of the arm.

- **Night pain:** Pain when lying on the affected side, disrupting sleep.

- **Cracking or snapping noises:** Occurring with movements, especially with complete tears.

The diagnosis is made through a combination of medical history, physical examination, and imaging techniques:

- **Medical History:**

- The doctor inquires about the nature of the symptoms, possible injuries, and strenuous activities.

- **Physical Examination:**

- Special tests such as the Jobe test or the Neer test to check the supraspinatus function.

- Palpation of the shoulder for tenderness and movement restrictions.

- **Imaging:**

- **MRI:** Detailed depiction of tendon damage, fluid accumulations, and muscle atrophy.

- **Ultrasound:** Detection of tendon tears and fluid accumulations in the shoulder.

- **X-ray:** Exclusion of accompanying bone injuries or calcifications.

Conservative Therapy

For partial tears or minor symptoms, non-operative treatment is often sufficient:

• Medication Therapy:
  • NSAIDs: To relieve pain and inflammation.
• Physiotherapy:
  • Strengthening the rotator cuff and restoring mobility.
  • Exercises to improve shoulder stability and coordination.
• Pain Management:
  • Application of heat or cold therapy to relax the muscles.
• Injections:
  • Corticosteroids to reduce inflammation in acute phases.

Surgical Therapy

For complete tears, persistent pain, or loss of function, surgery is necessary:

• Arthroscopic Repair: Minimally invasive technique to restore the tendon.
• Open Repair: Used for larger or more complex tears.
• Tendon Transfer: Replacement of the supraspinatus tendon with adjacent tendon tissue.
• Prosthesis: Use of shoulder prostheses for irreparable damage.

To prevent a tear of the supraspinatus tendon and to avoid relapses, the following measures are suitable:

1. Shoulder strengthening: Targeted training of the rotator cuff and surrounding muscles.
2. Warming up before activities: Preparing the shoulder for sports or occupational stresses.
3. Avoiding overstrain: Protecting the shoulder during intense or repetitive stresses.
4. Correction of poor posture: Improving body posture and movement patterns.
5. Regular check-ups: Consult a doctor promptly at the first signs of discomfort or existing risk.