From the Guidelines
For rotator cuff tendinosis, full-thickness and partial-thickness tears of the supraspinatus tendon, and subacromial bursitis with impingement, I strongly recommend initiating treatment with a nonsurgical approach using exercise and/or NSAIDs, as this has been shown to be beneficial in decreasing pain and improving function in patients without a full-thickness tear. This approach is supported by several level II studies, including one that reported significant improvements in pain scores on the visual analog scale (VAS) after 8 weeks of treatment with exercise and manual therapy 1. Another study found that patients had significant improvements in pain at rest, pain at night, and Constant-Murley scores after 3 months of a home exercise program 1. The use of NSAIDs, such as ibuprofen or naproxen, can also help reduce inflammation and alleviate pain. It is essential to note that full-thickness tears, especially in active individuals with significant functional limitations, may require surgical consultation, as they typically do not heal without intervention. However, for partial-thickness tears and tendinosis, conservative treatment may be sufficient. Subacromial bursitis and impingement often improve as the underlying rotator cuff pathology is addressed. Key components of the treatment plan include:
- Rest from aggravating activities
- Ice application for 15-20 minutes several times daily
- Anti-inflammatory medications, such as ibuprofen 400-600mg three times daily or naproxen 500mg twice daily with food for 1-2 weeks
- Physical therapy, focusing on gentle stretching and progressive strengthening of the rotator cuff muscles, typically 2-3 sessions weekly for 6-8 weeks
- Corticosteroid injection into the subacromial space, which may provide temporary relief. MRI can aid in detecting osseous and soft tissue abnormalities, including tendinosis, partial-thickness tears, and full-thickness tears, and can help guide treatment decisions 1.
From the Research
Rotator Cuff Tendinosis
- Rotator cuff tendinosis is part of a spectrum of pathology that includes subacromial bursitis and full-thickness rotator cuff tears, as noted in subacromial impingement syndrome 2.
- The relationship between subacromial impingement and rotator cuff disease in the etiology of rotator cuff injury is a matter of debate, with both extrinsic compression and intrinsic degeneration potentially playing a role 2.
- Management of rotator cuff conditions, including tendinosis, typically starts with conservative care such as physical therapy, anti-inflammatory drugs, and injection therapies, but may eventually include surgical repair 3.
Full-Thickness and Partial-Thickness Tears of Supraspinatus Tendon
- Full-thickness and partial-thickness tears of the supraspinatus tendon can be part of the spectrum of pathology seen in subacromial impingement syndrome 2, 3.
- Partial-thickness tears have limited self-healing capacity and can progress to full-thickness defects over time, making surgical repair a consideration for patients who have failed non-operative measures 4.
- Platelet-rich plasma (PRP) injections have been shown to provide superior short-term pain relief and functional improvement compared to corticosteroid injections for patients with partial-thickness rotator cuff tears or tendinopathy 5.
- Magnetic resonance imaging (MRI) can be used to depict soft-tissue and bony abnormalities associated with impingement syndrome, including supraspinatus tendinitis and rotator cuff tears 6.
Subacromial Bursitis and Bursal Impingement
- Subacromial bursitis is a common cause of shoulder pain and can be part of the spectrum of pathology seen in subacromial impingement syndrome 2, 3.
- Bursal-sided defects in partial-thickness rotator cuff tears may have worse results and higher rates of tear progression compared to articular-sided defects 4.
- Management of subacromial bursitis and bursal impingement typically involves conservative care, but may also include surgical interventions such as acromioplasty and tear repair 3, 4.