Management of Supraspinatus Footprint Tear with Labral Tear and Bursitis
Conservative management is recommended initially for low-grade interstitial and articular tearing of the supraspinatus footprint with anterior superior labral tear and subacromial subdeltoid bursitis, as surgery is not required as first-line treatment. 1, 2, 3
Initial Conservative Management Approach
- Non-surgical treatment should be the first approach for this type of shoulder injury, as many patients can achieve symptom relief without surgery 2, 3
- Initial treatment options include:
- Non-steroidal anti-inflammatory medications to manage pain and inflammation 3
- Physical therapy focusing on rotator cuff strengthening and scapular stabilization 1
- Activity modification to avoid aggravating movements 1
- Corticosteroid injections (both intra-articular and subacromial) can serve diagnostic and therapeutic purposes 3, 4
Diagnostic Considerations
- MR arthrography is the gold standard for confirming and characterizing labral tears and associated pathology 2, 1
- Standard shoulder radiographs (anteroposterior views in internal and external rotation and an axillary or scapula-Y view) should be obtained to rule out bony abnormalities 1
- Diagnostic injections can confirm the shoulder as the source of pain 3
When to Consider Surgery
Surgery may be indicated if:
- Conservative management fails after 6-8 weeks of appropriate treatment 1, 2
- There is evidence of significant functional limitation despite conservative care 1
- The tear is causing persistent pain affecting quality of life 2, 3
- There is concern for progression of the tear that could lead to more extensive damage 2, 5
Surgical Options When Indicated
- Arthroscopic repair is the preferred approach if surgery becomes necessary 2, 5
- Surgical options include:
- Evidence suggests that tendon-to-bone healing of the rotator cuff improves outcomes in terms of strength and function 1, 7
Prognostic Factors
- Age is a significant factor in healing potential - patients over 65 years have significantly lower rates of healing following rotator cuff repair 7
- The presence of additional tears (such as subscapularis or infraspinatus delamination) negatively affects healing outcomes 7
- Even with partial healing or non-healing, most patients experience significant improvement in pain and function 5, 7
Rehabilitation After Treatment
- A structured rehabilitation protocol is essential following either conservative or surgical intervention 2, 3
- Regular monitoring for symptom recurrence or progression is advised, as untreated tears may lead to progressive cartilage damage 2, 3
Common Pitfalls and Caveats
- Acromioplasty during rotator cuff repair has not been shown to significantly improve outcomes and is not required for all cases 1
- Corticosteroid injections should be used judiciously, avoiding direct injection into the tendon 4
- Partial tears may be stable and not necessarily progress, so aggressive surgical intervention is not always warranted 5