From the Guidelines
A full thickness tear of the supraspinatus tendon in a 65-year-old patient should initially be managed with conservative measures, including rest, ice application, and pain management with NSAIDs, due to the decreased healing capacity with age and potential increased surgical risks 1.
Initial Management
- Conservative measures should be the first line of treatment, including:
- Rest
- Ice application for 15-20 minutes several times daily
- Pain management with NSAIDs such as ibuprofen 400-600mg three times daily or naproxen 500mg twice daily for 2-3 weeks (with food to minimize GI effects)
- Physical therapy is essential and should begin with gentle passive range of motion exercises, progressing to active assisted exercises and eventually strengthening of the rotator cuff and scapular stabilizers over 8-12 weeks
Considerations for Surgery
- If conservative treatment fails after 3-6 months or if the tear is large (>3cm), associated with significant weakness, or in an active patient, surgical repair may be necessary 1
- Surgery options include arthroscopic repair, mini-open repair, or open repair depending on tear size and configuration
- Recovery after surgery requires wearing a sling for 4-6 weeks followed by 3-6 months of rehabilitation
Factors Influencing Outcomes
- Increasing patient age has been identified as a potential factor influencing outcomes and healing after rotator cuff surgery, with older patients having less favorable outcomes 1
- Workers’ compensation status has also been shown to correlate with less favorable outcomes after rotator cuff repair 1
- Preoperative infraspinatus fatty degeneration and muscle atrophy, as well as preoperative supraspinatus muscle atrophy, have been correlated with worse outcomes and healing 1
From the Research
Treatment Options for Full Thickness Tear of Supraspinatus
- Exercise therapy has been shown to be effective in improving pain and function in patients with full thickness supraspinatus tears, as demonstrated in a case report of a 53-year-old man with a total tear of the supraspinatus tendon and biceps tendinitis 2.
- A 12-week exercise therapy program was found to improve glenohumeral kinematics, strength, and patient-reported outcomes in patients with symptomatic full-thickness supraspinatus tears 3.
- Platelet releasate and extracorporeal shock wave therapy (ESWT) have also been used to treat partial supraspinatus tears, with promising results in accelerating recovery 4.
Considerations for Elderly Patients
- Elderly patients with full thickness rotator cuff tears may benefit from non-surgical treatment, as surgical treatment may not always be necessary or effective 5.
- A systematic review protocol has been developed to synthesize the best available evidence on the effectiveness of non-surgical and surgical treatment on the clinical and functional outcomes of elderly patients with full thickness rotator cuff tears 5.
- Open repair of combined anterosuperior rotator cuff tears, including supraspinatus and subscapularis tendon tears, has been shown to achieve good postoperative results despite a residual rotator cuff strength deficit 6.
Outcomes and Prognosis
- Successful exercise therapy for treatment of small full-thickness supraspinatus tears can result in improvements in glenohumeral joint kinematics and patient-reported outcomes 3.
- The retear rate for supraspinatus tendon repairs has been reported to be around 19% 6.
- Patient-reported outcomes, such as the American Shoulder and Elbow Surgeons score and the Western Ontario Rotator Cuff Index, can be used to evaluate the effectiveness of treatment for full thickness supraspinatus tears 3.