From the Guidelines
The recommended treatment for bilateral severe supraspinatus tendinosis with high-grade partial thickness intrasubstance avulsion typically begins with conservative management for 3-6 months, focusing on relative rest, eccentric strengthening exercises, and pain management with NSAIDs, as this approach has been shown to promote tendon healing and improve outcomes 1.
Key Components of Conservative Management
- Relative rest and reduced activity to prevent further damage and promote healing, although the exact duration of rest is not well-defined 1
- Eccentric strengthening exercises, which have been proven effective in treating tendinopathy and may reverse degenerative changes 1
- Pain management using NSAIDs, such as ibuprofen or naproxen, for short-term relief, with the option of topical NSAIDs for reduced systemic side effects 1
- Cryotherapy, including icing, to provide acute relief of tendinopathy pain 1
Considerations for Surgical Intervention
- Surgical intervention, typically arthroscopic debridement and repair of the partial thickness tear, should be considered if conservative treatment fails after 6 months 1
- Surgery is particularly indicated when pain persists despite conservative measures or when tears involve more than 50% of tendon thickness, as in this case with 60% involvement 1
Additional Treatment Options
- Corticosteroid injections may be administered for acute-phase pain relief, but their use should be limited to 2-3 injections spaced at least 6 weeks apart to prevent tendon weakening 1
- Other treatment options, such as ultrasonography, shock wave therapy, orthotics, and massage, may be considered, but their effectiveness is less well-established 1
From the Research
Treatment Options for Bilateral Severe Supraspinatus Tendinosis
- The condition involves high-grade partial thickness intrasubstance avulsion of up to 60% of the tendon thickness, measuring 4 x 11 mm on the right and 9 x 11 mm on the left.
- Treatment options for supraspinatus tendinosis include conservative approaches such as platelet-rich plasma (PRP) injections and extracorporeal shockwave therapy (ESWT) 2.
- A study comparing PRP injection and ESWT found that PRP showed non-inferiority in terms of efficacy and safety compared to ESWT 2.
- Another study found that PRP injection resulted in significant improvement in pain and function at 6-month follow-up, superior to corticosteroid injection 3.
Surgical Treatment Options
- For high-grade partial thickness supraspinatus tears, surgical completion of the tear and subsequent repair may be considered 4.
- A study found that repair of high-grade partial thickness supraspinatus tears after surgical completion of the tear had a lower retear rate compared to full-thickness tear repair 4.
- However, nonoperative treatment of high-grade partial thickness tears may also be effective, with some tears showing improvement or no change in size over time 5.
Considerations for Treatment
- The severity of tendinosis, graded using MRI, may be a factor in determining the likelihood of tear progression or improvement 5.
- Patient-reported outcome measures, such as visual analog scale (VAS) and Oxford Shoulder Score (OSS), can be used to evaluate the efficacy of treatment 3.
- The choice of treatment, whether conservative or surgical, should be based on individual patient factors and the severity of the condition 4.