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

Treatment of Supraspinatus Tear

Initial conservative treatment with physical therapy is the recommended first-line approach for supraspinatus tears, particularly for small tears (<50% tendon thickness) and in patients older than 55 years, as operative treatment shows no superior outcomes compared to conservative management in this population. 1, 2

Initial Conservative Management

Conservative treatment should be attempted first for 3-6 months before considering surgery. 1 The evidence strongly supports this approach:

• Physical therapy focusing on rotator cuff and scapular stabilizer strengthening is the cornerstone of treatment, with complete rest from aggravating activities until asymptomatic 3, 1
• Anti-inflammatory medications should be used concurrently to manage pain and inflammation 1
• Corticosteroid injections may provide temporary relief for persistent inflammation 1
• Activity modification is essential to avoid overhead movements and aggravating positions during healing 1

The rehabilitation program should specifically target:

• Rotator cuff muscle strengthening (supraspinatus, infraspinatus, external rotators) 3
• Scapular stabilizer strengthening to address dyskinesis 3
• Restoration of pain-free range of motion 3
• Re-establishment of proper shoulder and spine mechanics 3

Patients with well-preserved supraspinatus and infraspinatus function are the best candidates for conservative treatment and typically respond favorably 4

When Surgery Is Indicated

Surgical intervention should be considered when:

• Conservative treatment fails after 3-6 months 1
• Significant functional limitations persist despite therapy 1
• Tear involves >50% of tendon thickness 1
• Progressive muscle atrophy or fatty degeneration is present 1

Surgical Options

Arthroscopic repair using double-row technique is highly effective, achieving 94% healing rates for isolated small supraspinatus tears 5:

• Arthroscopic, mini-open, or open repair approaches are all acceptable, with no technique showing clear superiority 1
• Acromioplasty is NOT required for normal acromial morphology (including type II and III) during rotator cuff repair 1
• The primary surgical goal is tendon-to-bone healing, which correlates with improved clinical outcomes 1
• Adjacent partial tears of infraspinatus or subscapularis should be addressed during surgery with curettage-closure to optimize outcomes 6

Age-Specific Considerations

For patients older than 55 years with small, nontraumatic supraspinatus tears, conservative treatment is equally effective as surgery at 5+ years follow-up 2:

• Mean Constant score improvement was similar: 18.5 points (physiotherapy alone) vs. 20.0 points (surgical repair) with no statistical difference (p=0.84) 2
• Surgery does not prevent glenohumeral osteoarthritis or rotator cuff tear arthropathy progression 2
• Conservative treatment is the reasonable primary option for this population 2

Prognostic Factors

Factors predicting poor response to conservative treatment:

• High risk of tear expansion 4
• Significant fatty degeneration of rotator cuff muscles 1, 4
• Less functional rotator cuff muscles at baseline 4
• Workers' compensation status 1

Factors predicting good surgical outcomes:

• Reparable supraspinatus tendon 7
• Minimal fatty infiltration 1
• Younger age and higher activity level 1

Post-Treatment Recovery

After surgical repair:

• Sling immobilization for 4-6 weeks 1
• Structured rehabilitation program lasting several months 1
• Progressive return to activities based on healing 3

After conservative treatment:

• Gradual return to throwing/overhead activities over 1-3 months once pain-free motion and strength achieved 3
• Functional, progressive, individualized program before return to competition 3

Critical Pitfall

Symptoms may recur after successful conservative treatment due to tear expansion 4. Patients should be counseled about this possibility and monitored for progression, particularly those with risk factors for tear expansion.