What is the recommended treatment for a 54-year-old patient with a full thickness, partial width tear of the mid fibers of the supraspinatus tendon, with 1.4 cm of retraction over a width of 9 mm, presenting with ongoing right shoulder pain?

Treatment of Full Thickness, Partial Width Supraspinatus Tear

For a 54-year-old patient with a full thickness, partial width tear of the mid fibers of the supraspinatus tendon with 1.4 cm of retraction over a width of 9 mm, surgical repair is recommended as the most effective treatment option to improve pain, function, and strength outcomes.

Initial Treatment Considerations

• Initial non-surgical management may be attempted first, including:

  • Physical therapy to improve strength, flexibility, and function 1
  • Anti-inflammatory medications and activity modification 1
  • Corticosteroid injections for temporary relief of inflammation 1

• However, given the specific characteristics of this tear (full thickness with 1.4 cm retraction), surgical intervention is likely to provide better long-term outcomes 2, 3

Surgical Options

• Arthroscopic rotator cuff repair is the preferred surgical approach for this type of tear 1, 3

• For this specific tear pattern, surgical options include:

  • Complete repair of the torn supraspinatus tendon to bone 2, 3
  • Transtendon repair technique (for partial articular tears) 4, 5

• The goal of surgery should be to achieve tendon-to-bone healing, which is associated with improved clinical outcomes 2, 6

Evidence Supporting Surgical Repair

• Studies show that arthroscopic repair of supraspinatus tears leads to complete tendon healing in approximately 71% of cases 6
• Patients with healed tendons demonstrate significantly better strength (7.3 kg vs 4.7 kg in non-healed tendons) 6
• At 54 years old, this patient has a better chance of successful tendon healing compared to patients over 65 years (who have only 43% complete healing rates) 6
• Repair of high-grade partial thickness tears shows lower retear rates (3.6%) compared to full-thickness tear repairs (16.3%) 3

Surgical Technique Considerations

• The American Academy of Orthopaedic Surgeons suggests that when performing rotator cuff repair, acromioplasty is not required for normal acromial bone (including type II and III morphology) 2
• Studies have shown no significant difference in outcomes between rotator cuff repair with or without acromioplasty 2
• The surgical approach can be arthroscopic, mini-open, or open repair based on surgeon expertise 1

Recovery Process

• Post-surgical recovery typically requires:
  • Wearing a sling for 4-6 weeks 1
  • Several months of rehabilitation 1
  • Progressive return to activities as healing permits 1

Special Considerations

• Age is a significant factor affecting healing rates, with patients under 65 showing better outcomes 6
• The presence of associated tears in other tendons (subscapularis or infraspinatus) may negatively impact healing 6
• Patient satisfaction rates following appropriate surgical repair are high (91-95%) 4, 6

Pitfalls to Avoid

• Delaying surgical intervention in appropriate candidates can lead to tear progression and more difficult repairs 3, 6
• Conservative management alone may be insufficient for full thickness tears with significant retraction 6, 7
• Failure to address other potential sources of pain (such as AC joint arthritis) may result in persistent symptoms despite successful repair 1