From the Guidelines
I recommend proceeding with a subacromial bursal injection to treat your supraspinatus tendinopathy with small partial-thickness tear and subacromial bursitis, as the most recent and highest quality study suggests that this treatment can provide relief, despite some conflicting evidence 1. The injection typically consists of a corticosteroid (such as methylprednisolone 40mg or triamcinolone 40mg) mixed with a local anesthetic (like lidocaine 1% or bupivacaine 0.5%, 4-5ml). The procedure involves:
- Cleaning the skin
- Identifying the subacromial space (about 1cm below the lateral edge of the acromion)
- Injecting the medication using a 22-25 gauge needle You should expect some immediate relief from the anesthetic, followed by potential temporary pain flare for 24-48 hours before the anti-inflammatory benefits begin. Some key points to consider:
- Apply ice for 15-20 minutes every 2-3 hours if discomfort occurs
- Limit heavy shoulder activities for 2-3 days post-injection
- This treatment works by reducing inflammation in the bursa, which creates more space for the rotator cuff tendons to move without impingement, thereby decreasing pain and improving function
- Physical therapy focusing on rotator cuff strengthening and proper shoulder mechanics should accompany this treatment for optimal long-term results, as suggested by previous studies 1.
From the Research
Supraspinatus Tendinopathy and Subacromial Bursitis Treatment
- A subacromial bursal injection can be considered for treating supraspinatus tendinopathy with a small partial-thickness tear and subacromial bursitis 2.
- The use of platelet-rich plasma (PRP) injection has been shown to reduce tear size in partial-thickness tears of the supraspinatus tendon, with better functional scores compared to corticosteroid injection 2.
- Alternatively, corticosteroid injection can improve functional scores, but may not significantly affect tear size 2.
Partial-Thickness Tear Classification and Treatment
- Partial-thickness tears of the supraspinatus tendon can be classified into different types, including lesions of the superficial, deep, and central surface, or tendon delamination 3, 4.
- The treatment of high-grade partial-thickness supraspinatus tears can involve completion of the tear to a full-thickness tear, followed by repair, which has been shown to have a lower retear rate compared to full-thickness tear repair 5.
- The choice of treatment for partial-thickness supraspinatus tears depends on various factors, including the size and location of the tear, as well as the patient's symptoms and medical history 5, 4.
Diagnostic Imaging
- Magnetic resonance imaging (MRI) and ultrasound (US) examination can be used to study the different layers of the supraspinatus tendon and diagnose partial-thickness tears without the use of contrast agent 3.
- Contrast-enhanced examination, such as arthrography or bursography, can also be used to study the deep and superficial surfaces of the tendon 3.