Treatment of Full-Thickness Partial-Width Supraspinatus Tear with 1.4 cm Retraction
Surgical repair is recommended for this full-thickness tear with 1.4 cm of retraction, as this degree of retraction indicates a significant injury that is unlikely to respond adequately to conservative management and requires tendon-to-bone healing for optimal outcomes. 1, 2
Understanding Your Injury
Your injury represents a full-thickness tear (complete disruption through the entire thickness of the tendon) that is partial-width (9 mm width, not involving the entire tendon breadth), with significant retraction (1.4 cm gap between torn edges). 1 This is distinct from a partial-thickness tear where some tendon fibers remain intact through the thickness.
Why Surgery is Indicated
The 1.4 cm retraction is a critical factor - this degree of tendon retraction indicates the tear will not spontaneously heal and conservative treatment is unlikely to restore function 1, 2
Full-thickness tears require surgical repair to achieve tendon-to-bone healing, which is directly associated with improved clinical outcomes and restoration of shoulder strength 1, 3
Conservative management (physical therapy, injections) is primarily recommended for partial-thickness tears involving less than 50% of tendon thickness, not full-thickness tears with significant retraction 2
Surgical Approach and Technique
Arthroscopic repair is the preferred technique, which involves converting the tear pattern and reattaching the tendon to bone using suture anchors 1, 4
Acromioplasty (bone shaving) is not required during your repair if the acromion bone is normal, as studies show no significant difference in outcomes with or without this additional procedure 1, 2
The surgical goal is achieving firm tendon-to-bone healing at the humeral footprint, which correlates directly with better strength and function 1, 3
Expected Healing Rates
Approximately 71-88% of full-thickness supraspinatus tears achieve complete tendon healing after arthroscopic repair 3, 4
Age significantly impacts healing: patients under 65 years have substantially better healing rates (57% complete healing in those over 65 versus higher rates in younger patients) 3, 4
Shoulders with healed tendons demonstrate significantly better strength (7.3 kg elevation strength) compared to those that don't heal (4.7 kg) 3
Important Prognostic Factors
Factors that may reduce your healing potential:
Age over 65 years is associated with lower healing rates (43% complete healing versus higher rates in younger patients) 3, 4
Presence of fatty degeneration or atrophy in the supraspinatus muscle correlates with worse outcomes 2, 5
Associated partial tears of adjacent tendons (infraspinatus or subscapularis) may indicate more advanced disease and should be addressed during surgery 5, 3
Workers' compensation status correlates with less favorable outcomes 2
Recovery Timeline
Sling immobilization for 4-6 weeks immediately post-surgery to protect the repair 1, 2
Formal rehabilitation program lasting several months is essential for optimal recovery and return to function 1, 2
Imaging follow-up (ultrasound or MRI) at 6-12 months can confirm tendon healing 3, 4
Common Pitfalls to Avoid
Do not delay surgery - prolonged delay allows progressive muscle atrophy and fatty degeneration, which negatively impacts healing potential and outcomes 2, 5
Ensure any adjacent partial tears are identified and treated during surgery, as untreated delamination tears of infraspinatus or subscapularis are associated with lower healing rates 5, 3
Commit to the full rehabilitation protocol - premature return to activities or inadequate physical therapy compromises the repair 2