From the Guidelines
Management of a full thickness supraspinatus tendon tear in a 53-year-old female should begin with conservative treatment, including physical therapy, as strong evidence supports that patient-reported outcomes (PROs) improve with physical therapy in symptomatic patients with full-thickness rotator cuff tears 1.
Initial Management
- Initial management includes rest, activity modification, and pain control with NSAIDs such as ibuprofen (400-800mg three times daily) or naproxen (500mg twice daily) for 1-2 weeks.
- Physical therapy should be started early, focusing on gentle range of motion exercises followed by progressive strengthening of the rotator cuff and scapular stabilizers.
Considerations for Surgical Management
- If conservative measures fail after 3 months, surgical options include arthroscopic repair, which has better outcomes when performed within 6 months of injury.
- The decision between conservative and surgical management should consider the patient's age, activity level, tear size, and functional demands.
- Surgery is generally more beneficial for younger, active patients with acute tears, while older patients with degenerative tears often respond well to conservative treatment.
Additional Considerations
- A corticosteroid injection (such as 40mg methylprednisolone with 4-5ml of lidocaine 1%) into the subacromial space may provide temporary pain relief to facilitate rehabilitation, though limited to 1-2 injections to avoid tendon weakening 1.
- Routine acromioplasty is not required at the time of rotator cuff repair, as two level II studies found no benefit in postoperative functional results 1.
Post-Surgical Rehabilitation
- Post-surgical rehabilitation requires 4-6 weeks of immobilization followed by 3-6 months of structured physical therapy to restore function and strength.
- The goal of rehabilitation is to improve patient-reported outcomes, reduce pain, and restore functional ability.
From the Research
Management and Treatment of Full Thickness Tear of Supraspinatus Tendon
- The management and treatment of a full thickness tear of the supraspinatus tendon in a 53-year-old female can be approached through various methods, including exercise therapy, arthroscopic repair, and physiotherapy 2, 3, 4.
- A study published in the Asian journal of sports medicine found that exercise therapy was effective in improving pain and function in a 53-year-old male with a total tear of the supraspinatus tendon and biceps tendinitis 2.
- Arthroscopic repair of full-thickness supraspinatus tears has been shown to achieve good functional results, with a rate of complete tendon healing equivalent to those reported in the literature with open or mini-open techniques 3.
- A randomised controlled trial published in The bone & joint journal found that operative treatment was no better than conservative treatment with regard to non-traumatic supraspinatus tears, and that conservative treatment should be considered as the primary method of treatment for this condition 4.
Factors Affecting Treatment Outcomes
- Factors that can affect treatment outcomes include age, with increasing age being negatively associated with tendon healing 3.
- The etiology of the tear, whether degenerative or traumatic, can also influence treatment outcomes, with traumatic tears showing greater score changes and higher overall scores after arthroscopic repair 5.
- The size and location of the tear, as well as the presence of associated delamination of the subscapularis or infraspinatus tendon, can also impact treatment outcomes 3.
Treatment Options
- Exercise therapy, including physical modalities such as swimming, mountain climbing, and running, can be an effective treatment option for full thickness tears of the supraspinatus tendon 2.
- Arthroscopic repair, including techniques such as tension-band suture, can be used to repair full-thickness supraspinatus tears 3.
- Physiotherapy, including glenohumeral range-of-motion measurement and the American Shoulder and Elbow Surgeons score, can be used to assess and improve functional outcomes after treatment 6, 4.