SR 290 begins in Jackson County at an intersection on SR 53 northeast of Granville and southwest of Gainesboro.

SR 290 then travels southeast through rural and mountainous terrain for the next several miles, where it is very curvy and passes through Nameless, before having a 1.2-mile-long (1.9 km) concurrency with SR 56 in Bloomington Springs.

[2] The highway continues in a southeasterly direction to pass through farmland and rural areas until it reaches the Cookeville city limits.

Upon entering Cookeville, SR 290 turns east and becomes an undivided, four-lane road and passes through residential and suburban areas until it meets its eastern terminus, an intersection with SR 135, just north of downtown and the Tennessee Technological University (Tennessee Tech or TTU) campus.

[3] Excluding the portion in Cookeville, the entire route of SR 290 is a two-lane highway.