From the Guidelines
Surgical repair is a viable option for patients with chronic, symptomatic full-thickness tears, as it has been shown to result in statistically significant less pain on shoulder range of motion and at night compared to non-surgical treatment 1. A full thickness tear and a complete supraspinatus tear refer to the same condition where the tendon is completely torn from its attachment to the humeral head. Treatment options depend on several factors including age, activity level, and symptom severity.
- For patients with minimal pain and functional limitations, conservative treatment is often recommended first, consisting of physical therapy for 6-12 weeks focusing on rotator cuff strengthening and scapular stabilization exercises, along with pain management using NSAIDs like ibuprofen (400-800mg three times daily) or naproxen (500mg twice daily) 1.
- Corticosteroid injections may provide temporary relief but should be limited to 2-3 injections per year.
- If conservative treatment fails after 3 months, or for younger, active patients with acute tears, surgical repair is typically recommended, as it has been shown to result in excellent outcomes in 81% of patients compared to 37% with non-surgical treatment 1. Surgery involves reattaching the torn tendon to the bone using suture anchors, usually performed arthroscopically.
- Recovery requires wearing a sling for 4-6 weeks followed by physical therapy for 3-6 months. The decision between conservative and surgical management should consider the patient's functional demands, as untreated full thickness tears may lead to progressive muscle atrophy and fatty infiltration, potentially compromising long-term shoulder function and increasing the risk of developing rotator cuff arthropathy.
- Additionally, factors such as increasing age, MRI tear characteristics, and workers’ compensation status have been identified as potential factors influencing outcomes and healing after rotator cuff surgery 1.
From the Research
Full Thickness Tear vs Complete Supraspinatus Tear
- A full-thickness tear of the supraspinatus tendon can lead to significant pain and dysfunction, as noted in a study published in the Journal of Biomechanics 2.
- A complete supraspinatus tear can cause superior humeral migration, decrease functional deltoid abduction force, and increase passive range of motion, as demonstrated in a cadaveric study published in the Orthopaedic Journal of Sports Medicine 3.
Treatment Options
- Nonoperative treatment modalities, such as supervised physical therapy, corticosteroid injections, and nonsteroidal anti-inflammatory drugs, can be efficacious for patients with chronic, massive, irreparable rotator cuff tears, as shown in a systematic review published in the Journal of Shoulder and Elbow Surgery 4.
- Arthroscopic rotator cuff repair is a common surgical treatment option, and postoperative rehabilitation protocols have been developed to aid in the recovery process, as described in a consensus statement published in the Journal of Shoulder and Elbow Surgery 5.
- A systematic review of postoperative rehabilitation following arthroscopic rotator cuff repair found similar outcomes between early and delayed mobilization, and supported the use of supervised physical therapy and adjunctive treatments for pain management, as published in Sports Medicine and Arthroscopy Review 6.
Biomechanical Comparison
- A biomechanical comparison between a small, incomplete rotator cuff tear and a large, complete rotator cuff tear found that the incomplete tear did not significantly alter the biomechanics of the shoulder, while the complete tear led to a significant superior humeral migration and decreased deltoid abduction force, as demonstrated in a cadaveric study published in the Orthopaedic Journal of Sports Medicine 3.
- The finite element analysis of full-thickness tears of the supraspinatus tendon found that the anterior tears were at greater risk of propagating than the central or posterior tears, as published in the Journal of Biomechanics 2.