What is the treatment for a full thickness tear of the supraspinatus tendon?

Treatment of Full Thickness Supraspinatus Tear

For symptomatic full-thickness supraspinatus tears, begin with a trial of non-surgical management including physical therapy, anti-inflammatory medications, and activity modification for 3-6 months; if symptoms persist or the patient has significant functional limitations, proceed with surgical rotator cuff repair. 1, 2

Initial Non-Surgical Management

Start with conservative treatment for all symptomatic patients:

• Physical therapy is the first-line treatment to improve shoulder strength, flexibility, and function 1, 2
• Anti-inflammatory medications should be used concurrently to manage pain and inflammation 1, 2
• Activity modification to avoid overhead activities and aggravating movements during the healing process 1, 2
• Corticosteroid injections may provide temporary relief, though evidence is inconclusive—one level II study showed no significant difference between corticosteroid with lidocaine versus lidocaine alone at 6 weeks 3
• Continue conservative management for 3-6 months before considering surgical intervention 2

Important caveat: Asymptomatic full-thickness tears should NOT be treated surgically, as asymptomatic rotator cuff disease is highly prevalent in older populations, and the morbidity and risks of repair are not warranted without symptoms 3

Surgical Management Indications

Proceed to surgery when:

• Conservative treatment fails after 3-6 months 2
• Patient has significant functional limitations despite non-surgical treatment 2
• Chronic, symptomatic full-thickness tears persist—one level III study showed 81% of surgical patients reported excellent results compared to 37% with non-surgical treatment, with statistically significant less pain on shoulder range of motion and at night 3

Surgical Technique Considerations

Technical approach:

• Arthroscopic, mini-open, or open repair are all acceptable options with no specific technique showing superiority 1, 2
• The primary goal is achieving tendon-to-bone healing, which correlates with improved clinical outcomes 1, 2
• Acromioplasty is NOT required for normal acromial bone (including type II and III morphology), as studies show no significant difference in outcomes with or without acromioplasty 1, 2
• If partial tears of adjacent tendons (infraspinatus or subscapularis) are present, thorough treatment of these tears during supraspinatus repair leads to optimal functional and anatomical outcomes 4

Prognostic Factors Affecting Outcomes

Factors predicting worse outcomes:

• Age over 65 years—only 43% of patients over 65 had completely healed tendons compared to higher rates in younger patients 5
• Presence of muscle atrophy and fatty degeneration in the supraspinatus correlates with worse healing potential 2
• Associated delamination of subscapularis or infraspinatus tendons negatively affects healing rates 5
• Workers' compensation status correlates with less favorable outcomes 2

Healing rates: Arthroscopic repair achieves complete tendon healing in approximately 71% of patients, with strength of shoulder elevation significantly better when the tendon heals (7.3 kg) versus when it does not (4.7 kg) 5

Post-Surgical Recovery

Recovery protocol:

• Sling immobilization for 4-6 weeks is required 1, 2
• Rehabilitation program lasting several months is essential for optimal recovery 1, 2
• Fatty degeneration may worsen regardless of repair healing, particularly when partial tears of adjacent tendons are present 4