What is the diagnosis and treatment plan for a patient with a full-thickness supraspinatus tendon tear, tendinosis, and degenerative changes in the shoulder joint?

Understanding Your Shoulder MRI Results

Your MRI shows a full-thickness tear in the supraspinatus tendon with 5mm retraction, along with other shoulder issues including tendinosis and possible adhesive capsulitis that require treatment to improve pain and function.

Breakdown of Your MRI Findings:

Main Issues:

• Full-thickness supraspinatus tear: You have a complete tear through the middle-back portion of your supraspinatus tendon (one of your rotator cuff muscles) with the torn end pulled back about 5mm 1
• Infraspinatus tendon damage: There is moderate tendinosis (degeneration) and a small partial tear on the joint-facing surface 1
• Other tendon issues: Mild tendinosis of the subscapularis and biceps tendons, with mild inflammation of the biceps tendon sheath 1
• Joint degeneration: Moderate acromioclavicular (AC) joint and mild glenohumeral joint arthritis 1
• Possible frozen shoulder: Findings in the rotator interval suggest adhesive capsulitis (frozen shoulder) 1

What These Findings Mean:

Supraspinatus Tear

• This is the main rotator cuff muscle that helps you raise your arm to the side 1
• Full-thickness means the tear goes completely through the tendon 1
• The 5mm retraction indicates the torn end has pulled back slightly from where it should attach 2
• This type of tear typically causes pain, weakness when lifting your arm, and difficulty with overhead activities 1

Tendinosis and Partial Tears

• Tendinosis means chronic degeneration of the tendon tissue without complete tearing 1
• These changes suggest ongoing wear and tear in multiple tendons 3, 4
• The partial tear in the infraspinatus affects only part of the tendon thickness 1

Joint Degeneration

• AC joint arthritis is common and can cause pain at the top of your shoulder 1
• Glenohumeral arthritis affects the main shoulder joint 1

Possible Adhesive Capsulitis

• This condition causes shoulder stiffness and restricted movement 1
• It may be developing alongside your other shoulder problems 1

Treatment Options:

Non-Surgical Approaches (Often tried first):

• Physical therapy: Exercises to improve strength, flexibility and function 1
• Anti-inflammatory medications: To reduce pain and inflammation 1
• Activity modification: Avoiding movements that worsen symptoms 1
• Corticosteroid injections: Can provide temporary relief for inflammation 1

Surgical Options (If non-surgical treatment fails):

• Rotator cuff repair: Reattaching the torn tendon to bone 1
• Options for repair include:
  • Arthroscopic repair (using small incisions and a camera)
  • Mini-open repair
  • Open repair 1
• Success rates: About 70% of supraspinatus repairs heal completely, with better results in patients under 65 years old 2

Important Considerations:

• Age factor: Healing rates decrease significantly in patients over 65 years 2
• Multiple tendon involvement: Having multiple affected tendons (as in your case) may affect healing outcomes 2
• Timing: Earlier treatment generally leads to better outcomes 4, 5

Recovery Expectations:

• Post-surgical recovery: Typically requires wearing a sling for 4-6 weeks followed by months of rehabilitation 1
• Functional improvement: Most patients experience significant pain relief and improved function even if the tendon doesn't heal perfectly 2
• Strength recovery: Strength improves more when the tendon heals completely 2

Next Steps:

• Discuss with your orthopedic surgeon whether to try conservative treatment first or proceed directly to surgical repair based on your age, activity level, and severity of symptoms 1
• If you're experiencing significant pain or weakness, surgical repair may be recommended to prevent further tendon retraction and muscle degeneration 4, 2