From the Guidelines
For supraspinatus tendinopathy with a small partial-thickness tear and subacromial bursitis, I recommend a comprehensive treatment approach combining rest, medication, physical therapy, and gradual return to activity. This approach is based on the most recent and highest quality evidence available, which suggests that conservative management is effective in treating partial-thickness tears and reducing symptoms 1. The treatment plan should include:
- Relative rest by avoiding overhead activities and movements that cause pain for 2-4 weeks
- NSAIDs such as ibuprofen (400-600mg three times daily with food) or naproxen (500mg twice daily with food) for 1-2 weeks to reduce inflammation and pain
- Applying ice to the shoulder for 15-20 minutes several times daily, especially after activity
- Physical therapy focusing on gentle range of motion exercises, followed by progressive strengthening of the rotator cuff muscles and scapular stabilizers
- Specific exercises such as pendulum stretches, wall crawls, and external rotation with a resistance band Corticosteroid injections into the subacromial space may be considered if pain persists despite 4-6 weeks of conservative treatment, although the evidence for their use is inconclusive 1. It is essential to note that surgery is rarely needed for small tears unless symptoms persist after 6 months of appropriate conservative treatment, and factors such as increasing age, MRI tear characteristics, and workers’ compensation status may correlate with less favorable outcomes after rotator cuff surgery 1. Overall, the goal of treatment is to reduce pain, improve function, and promote healing of the tendon, while also addressing any underlying factors that may be contributing to the condition.
From the Research
Supraspinatus Tendinopathy with Small Partial-Thickness Tear and Subacromial Bursitis
- The condition involves a partial-thickness tear of the supraspinatus tendon, which is a common cause of shoulder pain and dysfunction 2, 3, 4, 5, 6.
- Subacromial bursitis is an inflammation of the subacromial bursa, which can occur in conjunction with a partial-thickness tear of the supraspinatus tendon 2, 3.
Treatment Options
- Platelet-rich plasma (PRP) injection has been shown to be effective in reducing tear size and improving functional scores in patients with partial-thickness tears of the supraspinatus tendon 2.
- Corticosteroid injection is commonly used to decrease pain in patients with partial-thickness tears, but it may not significantly affect tear size 2.
- Subacromial decompression without repair of the supraspinatus tendon can lead to significant clinical improvement in patients with grade I and II articular-sided tears 4.
- Repair of high-grade partial-thickness supraspinatus tears after surgical completion of the tear has been shown to have a lower retear rate compared to full-thickness tear repair 5.
Diagnostic Considerations
- MRI is a useful diagnostic tool for evaluating partial-thickness tears of the supraspinatus tendon, including those with delamination 3, 6.
- Ultrasound examination can also be used to study the different tendon layers without the use of contrast agent 3.
- The interpretation of MRI findings can be challenging, and anatomic considerations are important for diagnosing partial-thickness tears 6.