What is the recommended management for a partial thickness tear of the supraspinatus?

Management of Partial Thickness Tear of Supraspinatus

For partial thickness tears of the supraspinatus, initial management should be non-surgical with physical therapy, while surgical intervention should be considered for tears involving more than 50% of tendon thickness or when conservative treatment fails. 1, 2

Initial Non-Surgical Management

• Physical therapy is the first-line treatment to improve strength, flexibility, and function of the shoulder 2
• Anti-inflammatory medications can be used concurrently with physical therapy to manage pain and inflammation 2
• Corticosteroid injections may provide temporary relief for inflammation and can be used alongside other non-surgical treatments 2
• Activity modification is recommended to avoid aggravating movements during the healing process 2

Factors Affecting Treatment Decisions

• Severity of tear (percentage of tendon thickness involved) is a critical factor in determining treatment approach 3
• Presence of muscle atrophy and fatty degeneration in the supraspinatus correlates with worse outcomes and healing potential 1
• Patient factors such as age, activity level, and severity of symptoms should guide treatment decisions 2
• Workers' compensation status correlates with less favorable outcomes after rotator cuff repair 1

Surgical Management Considerations

• Surgical intervention is indicated when:

  • Tear involves more than 50% of tendon thickness 3
  • Conservative treatment fails after 3-6 months 2
  • Patient has significant functional limitations 1

• Surgical options include:

  • Tear completion and repair for high-grade partial thickness tears (>50% thickness) 3
  • Transtendon repair techniques that preserve intact tendon fibers 4
  • Arthroscopic, mini-open, or open repair approaches (no specific technique has proven superiority) 1, 2

• Important surgical considerations:

  • Acromioplasty is not required for normal acromial bone (including type II and III morphology) during rotator cuff repair 1, 2
  • The primary goal of surgery should be to achieve tendon-to-bone healing, which is associated with improved clinical outcomes 1, 2
  • Partial tear repair of adjacent tendons may be necessary if there is involvement of infraspinatus or subscapularis 5

Recovery After Surgical Repair

• Post-surgical recovery typically requires wearing a sling for 4-6 weeks 2
• Rehabilitation program lasting several months is essential for optimal recovery 2
• Patients with repair of completed high-grade partial thickness tears have shown lower retear rates compared to those with full-thickness tear repairs (3.6% vs 16.3%) 3

Pitfalls and Caveats

• MRI evaluation should be used for accurate grading of partial thickness tears to guide treatment decisions 6
• Fatty degeneration of rotator cuff muscles may worsen regardless of repair healing 5
• Partial tears at the musculotendinous junction may require specialized repair techniques 7
• The presence of partial tears in adjacent tendons (infraspinatus/subscapularis) could be associated with poorer function if the supraspinatus repair fails 5