From the Guidelines
The initial treatment for a bursal side supraspinatus tear should focus on conservative management, prioritizing rest, activity modification, and physical therapy to reduce pain and inflammation, as the current evidence does not strongly support the use of subacromial injections for rotator cuff tears 1. When managing a bursal side supraspinatus tear, it's essential to consider the following steps:
- Start with rest and activity modification to avoid aggravating the injury
- Use non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen for 1-2 weeks to reduce pain and inflammation
- Apply ice to the shoulder for 15-20 minutes several times daily, especially after activity
- Begin a structured physical therapy program focusing on gentle range of motion exercises, followed by progressive strengthening of the rotator cuff and scapular stabilizers as pain allows, typically for 6-12 weeks The use of subacromial corticosteroid injections is not recommended as a first-line treatment due to the lack of conclusive evidence supporting its effectiveness for rotator cuff tears, as noted in a study published in The Journal of the American Academy of Orthopaedic Surgeons 1. It's crucial to monitor the patient's progress and consider surgery if there is no improvement after 3-6 months of conservative treatment or for large, acute tears in active individuals. The goal of the initial treatment is to reduce pain and inflammation, improve range of motion, and strengthen the surrounding muscles to support the rotator cuff, thereby improving the patient's quality of life and reducing morbidity and mortality associated with the condition.
From the Research
Initial Treatment for Bursal Side Supraspinatus Tear
The initial treatment for a bursal side supraspinatus (rotator cuff) tear can vary depending on the severity of the tear and the patient's overall health.
- Conservative treatment options are often considered first, including:
- Studies have shown that PRP injections can be an effective treatment option for partial supraspinatus tears, with some studies demonstrating superior benefits over corticosteroid injections at 6-month follow-up 3, 5
- Exercise therapy, including home-based exercises, can also be an effective treatment option, especially when combined with other treatments such as prolotherapy or corticosteroid injections 6
- The choice of treatment will depend on the individual patient's needs and circumstances, and may involve a combination of these options.
Comparison of Treatment Options
- A study comparing PRP injections and corticosteroid injections for partial supraspinatus tears found that both treatments resulted in significant improvement in pain and function at 1-month follow-up, but PRP injections showed superior benefits at 6-month follow-up 3
- Another study comparing PRP injections and physical therapy for chronic partial supraspinatus tears found that both treatments resulted in significant improvement in range of motion and pain, but PRP injections showed better improvement in functional scores 4
- A study comparing operative and conservative treatment for small, nontraumatic supraspinatus tears in patients over 55 years found that conservative treatment was a reasonable option for initial treatment, with no significant differences in outcomes between operative and conservative treatment at 5-year follow-up 2
Considerations for Treatment
- The treatment options for bursal side supraspinatus tears should be individualized based on the patient's specific needs and circumstances.
- The patient's age, overall health, and activity level should be taken into consideration when selecting a treatment option.
- A thorough evaluation, including imaging studies and physical examination, should be performed to determine the severity of the tear and guide treatment decisions.