What is the treatment for a complete supraspinatus (shoulder muscle) tear?

Treatment of Complete Supraspinatus Tear

For a complete supraspinatus tear, surgical repair is the preferred treatment to achieve tendon-to-bone healing, which is directly associated with superior strength outcomes and functional recovery, particularly in patients under 65 years of age. 1, 2

Initial Treatment Decision Algorithm

Patient Age Considerations

• Patients under 65 years: Proceed with surgical repair as the primary treatment, as healing rates are significantly higher (57% complete healing rate in patients over 65 versus 71% overall) 2
• Patients over 65 years: Surgical repair remains beneficial but counsel regarding lower healing rates (only 43% achieve complete tendon healing) 2

Surgical Approach

• Arthroscopic repair using tension-band suture technique is the recommended surgical method, achieving 71% complete tendon-to-bone healing rates 2
• The American Academy of Orthopaedic Surgeons confirms that rotator cuff repair involves reattaching the torn tendon to bone using arthroscopic, mini-open, or open techniques 1
• Acromioplasty is NOT required during rotator cuff repair for normal acromial bone morphology (including type II and III), as studies show no significant outcome differences with or without acromioplasty 1

Critical Assessment of Associated Pathology

Evaluate Adjacent Tendon Involvement

• Check for subscapularis and infraspinatus delamination tears, as their presence significantly reduces healing rates (p = 0.02) 2
• If isolated supraspinatus tear: Expect 71% complete healing with standard arthroscopic repair 2
• If associated with partial tears of adjacent tendons: Repair the partial tears concurrently through curettage-closure of delamination tears to optimize outcomes 3

Tear Characteristics Matter

• Measure tear retraction and width to guide surgical planning 1
• For high-grade partial thickness tears (≥50% tendon thickness): Consider completion to full-thickness tear followed by repair, which paradoxically shows lower retear rates (3.6%) compared to primary full-thickness tear repair (16.3%) 4

Surgical Outcomes and Prognostic Factors

Expected Functional Improvement

• Constant score improves from average 51.6 preoperatively to 83.8 postoperatively (p < 0.001) 2
• UCLA score improves from 11.5 to 32.3 (p < 0.001) 2
• Shoulder elevation strength is significantly better when tendon heals (7.3 kg) versus non-healed repairs (4.7 kg) (p = 0.001) 2

Negative Prognostic Factors

• Age over 65 years (p < 0.001) 2
• Associated delamination of subscapularis or infraspinatus (p = 0.02) 2
• Irreparable supraspinatus combined with irreparable subscapularis leads to poor outcomes and may not warrant surgical intervention 5

Non-Surgical Treatment (Limited Role)

Non-surgical management may be considered only in specific circumstances:

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

However, these approaches do not achieve tendon-to-bone healing and result in inferior strength outcomes compared to surgical repair 2

Postoperative Protocol

• Sling immobilization for 4-6 weeks followed by progressive rehabilitation over several months 1
• Rehabilitation should focus on restoring range of motion first, then progressive strengthening 1
• Patient satisfaction is high: 62 of 65 patients (95%) satisfied with surgical outcomes 2

Common Pitfalls to Avoid

• Do not ignore partial tears of adjacent tendons during surgical planning, as they significantly impact healing rates and should be addressed concurrently 2, 3
• Do not perform unnecessary acromioplasty in patients with normal acromion morphology 1
• Do not assume equivalent outcomes in elderly patients—counsel appropriately about reduced healing rates in those over 65 2
• Do not rely on non-surgical treatment when surgical repair is feasible, as tendon-to-bone healing is the key determinant of strength recovery 2