From the Guidelines
Treatment for a partial thickness tear of the supraspinatus tendon with associated tendinosis, biceps tendon subluxation, and bursitis should begin with conservative management, prioritizing relative rest to decrease repetitive loading of the damaged tendon, as recommended by 1.
Initial Treatment Approach
The initial treatment approach should include:
- Relative rest to reduce activity and decrease repetitive loading of the damaged tendon 1
- A structured physical therapy program focusing on rotator cuff strengthening and scapular stabilization exercises for 6-8 weeks
- Pain management using NSAIDs such as ibuprofen (400-800mg three times daily) or naproxen (500mg twice daily) for 2-3 weeks
Considerations for Corticosteroid Injections
While corticosteroid injections into the subacromial space may provide relief for persistent pain, the evidence for their use is inconclusive, with one level II study finding no statistically significant difference in pain or tenderness up to 6 weeks after injection 1. However, in the context of real-life clinical medicine, a corticosteroid injection may still be considered for short-term pain relief.
Surgical Options
If symptoms persist after 3-6 months of conservative treatment, surgical options including arthroscopic repair of the supraspinatus tear, biceps tenodesis to address the subluxed biceps tendon, and subacromial decompression may be considered. This comprehensive approach addresses both pain and underlying biomechanical issues, as the combination of tendon pathology and bursitis suggests rotator cuff impingement that requires both symptomatic treatment and correction of shoulder mechanics to prevent further deterioration.
Additional Considerations
Other treatment options, such as botulinum toxin injection, neuromodulating pain medications, and supportive devices, may be considered in specific cases, but their usefulness is not well established for this particular condition 1.
From the Research
Treatment Options
- Non-surgical treatment is often the first line of treatment for shoulder pain, including physiotherapy, anti-inflammatory medication, and local corticosteroid injections 2
- Rehabilitation strategies for shoulder injuries, such as partial thickness tear of the supraspinatus tendon and tendinosis of the infraspinatus, subscapularis, and biceps tendons, should follow a proximal-to-distal kinetic chain biomechanical model 3
- Closed chain axial loading exercises are the primary means of early shoulder rehabilitation and are the mainstays of functional rehabilitation protocols 3
Medication
- Nonsteroidal anti-inflammatory drugs (NSAIDs) can be used for postoperative pain management after rotator cuff surgery, and may reduce opioid requirements and decrease patient pain levels in the first week after surgery 4
- However, the use of NSAIDs after rotator cuff repair does not lead to an increased risk of tendon retear 4
Surgical Intervention
- Surgical intervention may be necessary in some cases to correct and restore the patient's prior level of shoulder function, such as in cases of large tears of the shoulder stabilizer muscles 2
- Arthroscopic rotator cuff repair is a common surgical procedure for treating rotator cuff injuries, and postoperative rehabilitation should follow a structured protocol to ensure optimal outcomes 4
Associated Conditions
- Tenosynovitis of the biceps tendon, which is subluxed, and associated subacromial/subdeltoid bursitis, should be treated concurrently with the underlying shoulder condition 2, 5
- Clinical practice guidelines for the management of atraumatic shoulder conditions, such as tendinosis and bursitis, can provide evidence-based recommendations for diagnosis and treatment 6