From the Guidelines
Immobilization for a supraspinatus tear typically involves wearing a sling or shoulder immobilizer for 4-6 weeks, depending on the severity of the tear and whether surgical repair was performed. The goal of immobilization is to reduce tension on the repaired tendon, minimize pain, and create optimal conditions for healing by preventing movements that could disrupt the repair or healing process.
When considering immobilization options, it's essential to prioritize the patient's morbidity, mortality, and quality of life. In the context of supraspinatus tears, prolonged immobilization can lead to significant morbidity, as seen in other types of injuries, such as cervical spine injuries, where prolonged immobilization has been shown to have attributable morbidity, with most complications appearing and rapidly escalating after 48-72 hours 1.
Key considerations for immobilization of a supraspinatus tear include:
- Wearing a sling or shoulder immobilizer consistently, especially during the first few weeks
- Removing the immobilization device for gentle pendulum exercises and hygiene as directed by a healthcare provider
- Gradually introducing a rehabilitation program supervised by a physical therapist to restore range of motion and strength while avoiding re-injury to the healing tendon.
It's crucial to note that the evidence provided regarding cervical spine injuries 1 may not directly apply to supraspinatus tears, but it highlights the importance of balancing immobilization with the need to avoid prolonged periods of restricted movement, which can have negative consequences on patient outcomes.
From the Research
Immobilization for Supraspinatus Tear
The type of immobilization required for a supraspinatus tear can vary depending on the severity of the injury and the treatment approach.
- Immobilization is often used to protect the tendon and promote healing after a supraspinatus tear, especially in the initial stages of treatment 2.
- A study found that decreasing the activity level by immobilizing the shoulder improves tendon to bone healing, which progresses by first increasing the organization of the collagen and then increasing the mechanical properties 2.
- However, another study suggested that early passive motion should be authorized, as functional results were better with no significant difference in healing 3.
- The use of immobilization in combination with other treatments, such as botulinum toxin A, has also been explored, but the results are mixed, with some studies showing benefits and others showing harm to rotator cuff healing 4.
Duration of Immobilization
The duration of immobilization for a supraspinatus tear can also vary, but it is typically recommended for a period of several weeks.
- A study found that immobilization for 4 or 16 weeks had a positive effect on the mechanical properties of the healing supraspinatus tendon insertion site 2.
- Another study compared immediate passive motion versus immobilization for 6 weeks after arthroscopic repair of a non-retracted supraspinatus tear, and found that functional results were better with immediate passive motion, but healing seemed to be slightly better with immobilization 3.
Factors Affecting Healing
Several factors can affect the healing of a supraspinatus tear, including age, associated delamination of other tendons, and the presence of intratendinous extensions.
- A study found that increasing age and associated delamination of the subscapularis or infraspinatus tendon were negatively associated with tendon healing 5.
- Another study found that incomplete-thickness tears and concomitant intratendinous extensions can continue to rupture after the initial injury, highlighting the importance of proper treatment and immobilization 6.