From the Guidelines
For supraspinatus tendinopathy with a small partial-thickness tear and subacromial bursitis, I strongly recommend a comprehensive treatment approach combining rest, medication, physical therapy, and possibly injections, as this approach has been shown to effectively address both the inflammation in the bursa and allow the tendon tissue to heal while gradually strengthening the supporting musculature 1.
Treatment Approach
The treatment approach should start with activity modification to avoid overhead movements and activities that cause pain.
- Take NSAIDs like ibuprofen (400-600mg three times daily with food) or naproxen (500mg twice daily) for 1-2 weeks to reduce inflammation and pain, as supported by evidence from 1 and 1.
- Apply ice for 15-20 minutes several times daily, especially after activity, to reduce pain and inflammation.
- Begin physical therapy focusing on rotator cuff strengthening exercises and scapular stabilization; this typically requires 6-12 weeks of consistent therapy, 2-3 times weekly, as recommended by 1.
Additional Considerations
For persistent pain, consider a corticosteroid injection into the subacromial space, as suggested by 1 and 1.
- Most partial-thickness tears heal with conservative treatment within 3-6 months.
- If symptoms persist beyond 3-6 months despite conservative treatment, imaging reassessment and surgical consultation may be necessary, as implied by 1 and 1.
Imaging and Diagnosis
MRI can aid in detecting osseous and soft tissue abnormalities that may predispose to or be the result of shoulder impingement, including the soft tissue abnormalities in the supraspinatus tendon, subacromial bursa, and biceps tendon, as noted in 1.
- The presence of tendinous enlargement and a heterogeneous signal pattern on MRI can indicate tendinosis or tendinopathy, suggesting a chronic degenerative process 1.
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.
- Subacromial bursitis is often associated with rotator cuff tears, including partial-thickness tears of the supraspinatus tendon 2, 4.
- Treatment options for partial-thickness supraspinatus tears include conservative management, subacromial decompression, and repair of the tear 4, 5.
Treatment Outcomes
- A study comparing intralesional platelet-rich plasma (PRP) injection and subacromial corticosteroid injection for partial-thickness supraspinatus tears found that PRP injection resulted in significant tear size reduction and improved functional scores 2.
- Subacromial decompression without repair of the supraspinatus tendon can lead to significant clinical improvement in patients with grade I and II articular-sided partial tears, with a low rate of progression to full-thickness 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 rotator cuff tears, including supraspinatus and infraspinatus tendon tears 3, 6.
- The interpretation of MRI findings can be challenging, and a thorough understanding of the anatomic considerations and classification of partial-thickness tears is essential for accurate diagnosis 6.