From the Guidelines
The recommended treatment for a patient with a partial supraspinatus tear typically begins with conservative management, including rest, activity modification, and a structured physical therapy program focusing on rotator cuff strengthening and scapular stabilization exercises. Pain management often involves nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (400-800mg three times daily with food) or naproxen (500mg twice daily with food) for 1-2 weeks to reduce inflammation and pain 1. Ice application for 15-20 minutes several times daily can help manage acute pain and swelling. Physical therapy should be continued for 6-12 weeks, with gradual progression from passive range of motion to resistance exercises.
Key Considerations
- If pain persists, a corticosteroid injection (such as methylprednisolone 40mg mixed with lidocaine) into the subacromial space may provide temporary relief, though typically limited to 2-3 injections per year.
- Surgical intervention is generally considered only after 3-6 months of failed conservative treatment, particularly for active individuals with persistent symptoms or tears greater than 50% 1.
- Conservative treatment is often successful because the supraspinatus has natural healing capacity when properly supported, and strengthening the surrounding musculature can compensate for the compromised tendon while it heals.
Treatment Approach
- The treatment approach should prioritize conservative management, with a focus on physical therapy and pain management, before considering surgical intervention.
- The use of corticosteroid injections should be limited and carefully considered, as the evidence for their effectiveness is inconclusive 1.
- The patient's overall health, activity level, and tear size should be taken into account when determining the best course of treatment.
From the Research
Treatment Options for Partial Supraspinatus Tears
- The recommended treatment for a patient with a partial supraspinatus tear may include a subacromial corticosteroid injection or a platelet-rich plasma (PRP) injection 2.
- A study comparing PRP injection and conventional steroid injection for pain relief and functional improvement in partial supraspinatus tears found that both treatments resulted in similar reduction in pain and improvement in function at 1 month, but PRP showed superior benefits at 6-month follow-up 2.
- Another study found that PRP injection paired with physical therapy resulted in significant improvement in range of motion, pain reduction, and functional improvement in patients with chronic partial supraspinatus tears 3.
Platelet-Rich Plasma (PRP) Treatment
- PRP treatment has emerged as a promising method for treating partial supraspinatus tears, with some studies showing significant improvement in pain and function 2, 3.
- A case study found that platelet releasate paired with extracorporeal shock wave therapy (ESWT) resulted in a 25% improvement in symptoms and allowed the patient to return to play in baseball 4.
- However, a randomized controlled trial found that PRP injections did not improve tendon healing or clinical scores compared to saline injections and were associated with more adverse events 5.
Conservative Treatment Solutions
- Conservative treatment solutions for supraspinatus tendinopathy include physical modalities such as laser, ultrasound, and shock-wave therapy, although the evidence for these treatments is limited and contradictory 6.
- Exercise in the form of eccentric training may be considered as a treatment option, as it seems to have beneficial effects, but more research is needed 6.