From the Guidelines
The initial treatment for a bursal side supraspinatus tear should be conservative management, focusing on non-surgical interventions to reduce pain and improve function, as recommended by the most recent and highest quality studies, such as 1 and 1. The conservative approach typically involves:
- Rest, activity modification, and avoiding overhead movements that aggravate symptoms
- Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (400-600mg three times daily with food) or naproxen (500mg twice daily) for pain and inflammation for 1-2 weeks
- Applying ice to the affected shoulder for 15-20 minutes several times daily to reduce inflammation
- Physical therapy initiated early, focusing on gentle range of motion exercises, followed by progressive strengthening of the rotator cuff and scapular stabilizers over 6-12 weeks
- A subacromial corticosteroid injection (such as 40mg methylprednisolone with local anesthetic) may be considered for persistent pain, as suggested by 1 and 1.
This approach is supported by studies such as 1, which suggests that patients with rotator cuff-related symptoms in the absence of a full-thickness tear be initially treated nonsurgically using exercise and/or NSAIDs, and 1, which highlights the need for high-quality research to improve confidence in specific treatment practices and to better standardize care. Surgery is typically reserved for cases that fail to improve after 3-6 months of conservative management or for large, acute tears in active individuals, as implied by the lack of high-level studies refuting current popular treatment practices, as mentioned in 1. It's worth noting that, while study 1 provides recommendations for rotator cuff repair surgery, including the use of arthroscopic approach, systemic analgesia, and regional analgesic techniques, it does not directly address the initial treatment for bursal side supraspinatus tears, and therefore, its findings are not directly applicable to this specific question.
From the Research
Initial Treatment for Bursal Side Supraspinatus Tears
The initial treatment for bursal side supraspinatus tears typically involves conservative management. Some of the key points to consider include:
- Conservative treatment is often the first line of treatment for small, nontraumatic supraspinatus tears, especially in patients older than 55 years 2
- Physical therapy, non-steroidal anti-inflammatory drugs (NSAIDs), cold/heat therapy, and corticosteroid injections are common conservative treatment options 3
- Platelet-rich plasma (PRP) injections have also been used as a conservative treatment option, with some studies showing promising results 4, 3, 5
- Exercise therapy, including home-based exercises, can also be an effective treatment option for partial-thickness supraspinatus tears 6
Comparison of Treatment Options
Some studies have compared the effectiveness of different treatment options for bursal side supraspinatus tears, including:
- A study comparing PRP injections and corticosteroid injections found that both treatments provided significant pain relief and functional improvement at 1-month follow-up, but PRP injections showed superior benefits at 6-month follow-up 5
- Another study compared the effects of corticosteroid injections, prolotherapy, and exercise therapy on partial-thickness supraspinatus tears, and found that corticosteroids provided a fast pain-relieving effect, while prolotherapy provided a long-lasting effect 6
- A randomized controlled trial found that operative treatment was no better than conservative treatment for small, nontraumatic supraspinatus tears in patients older than 55 years 2
Key Considerations
When considering treatment options for bursal side supraspinatus tears, some key points to keep in mind include:
- The size and location of the tear, as well as the patient's age and overall health, can influence treatment decisions 2
- Conservative treatment options can be effective for small, nontraumatic tears, but may not be sufficient for larger or more severe tears 2
- PRP injections and other biologic treatments may offer promising results, but more research is needed to fully understand their effectiveness 4, 3, 5