From the Guidelines
Management of a 53-year-old female with a 7mm full-thickness supraspinatus tendon tear should begin with a conservative approach for 3 months before considering surgical intervention, as recommended by the most recent and highest quality study 1. The initial treatment should include:
- Activity modification to avoid overhead movements
- NSAIDs such as ibuprofen 400-600mg three times daily or naproxen 500mg twice daily for pain and inflammation
- Physical therapy focusing on rotator cuff strengthening exercises 2-3 times weekly A subacromial corticosteroid injection (40mg methylprednisolone with 4-5ml of lidocaine 1%) may provide temporary relief if pain is significant. If conservative management fails after 3 months or if functional limitations persist, arthroscopic repair should be considered, especially given the patient's age and the relatively small tear size (7mm). This approach is recommended because many small to medium-sized tears respond well to conservative treatment, avoiding surgical risks. However, delaying surgery too long in symptomatic tears can lead to tear progression, muscle atrophy, and fatty infiltration, potentially compromising surgical outcomes, as noted in 1. Regular follow-up every 4-6 weeks during conservative treatment is essential to monitor progress and adjust the treatment plan accordingly. It is also important to consider the patient's overall health and potential factors that may influence outcomes, such as workers' compensation status, as discussed in 1. Additionally, the use of manual therapy, exercise, and education can be beneficial in the management of musculoskeletal pain, as recommended in 1. The patient's treatment plan should be individualized and based on the most recent and highest quality evidence available, with a focus on minimizing morbidity, mortality, and improving quality of life.
From the Research
Management of Full Thickness Tear in Supraspinatus Tendon
- The management of a full thickness tear in the supraspinatus tendon at its footprint with an anteroposterior (AP) dimension of 7mm in a 53-year-old female can be approached through both surgical and non-surgical methods.
- A study by 2 found that repair of high-grade partial thickness supraspinatus tears after surgical completion of the tear have a lower retear rate when compared to full-thickness tear repair, which may inform the decision-making process for surgical intervention.
- However, the size and location of the tear, as well as the patient's overall health and activity level, are important factors to consider when determining the best course of treatment.
Considerations for Surgical Intervention
- Research by 3 using three-dimensional finite element analysis suggests that the location and size of the tear can impact the risk of propagation, with anterior full-thickness tears being at greater risk.
- A study by 4 found moderate correlation between measurements of tear width and retraction by arthroscopy and magnetic resonance imaging (MRI), highlighting the importance of accurate imaging in preoperative planning.
Non-Surgical Management
- A study by 5 found that nonoperative treatment is an effective and lasting option for many patients with chronic, full-thickness rotator cuff tears, with approximately 75% of patients remaining successfully treated at 5 years.
- Compensatory activation of periscapular muscles, as observed in a study by 6, may aid in active abduction in patients with massive rotator cuff tears, suggesting a potential role for physical therapy in non-surgical management.
Treatment Outcomes
- The outcomes of both surgical and non-surgical management can vary depending on the individual patient, with factors such as tear size, location, and patient activity level influencing the success of treatment.
- Further research is needed to fully understand the optimal management strategies for full thickness tears in the supraspinatus tendon, including the potential benefits and drawbacks of surgical versus non-surgical approaches.