From the Guidelines
Treatment for articular-sided supraspinatus tears should begin with conservative management, including rest, activity modification, and physical therapy, with surgical intervention considered for tears involving more than 50% of tendon thickness, using an arthroscopic approach whenever possible, as recommended by the most recent and highest quality study 1. The initial management of articular-sided supraspinatus tears typically involves conservative measures, such as:
- Rest and activity modification to reduce stress on the affected tendon
- NSAIDs like ibuprofen (400-600mg three times daily) or naproxen (500mg twice daily) for 1-2 weeks to manage pain and inflammation
- Physical therapy focusing on rotator cuff strengthening and scapular stabilization for 6-12 weeks to improve shoulder function and reduce pain Corticosteroid injections may provide temporary pain relief but should be limited to 2-3 injections per year, as their long-term effects on tendon healing are unclear 1. For tears involving more than 50% of tendon thickness, surgical intervention is often recommended, with arthroscopic repair being the preferred approach, as it is associated with reduced postoperative pain 1. The two main surgical techniques are:
- In-situ repair (suturing the tear without detachment)
- Tear completion followed by repair, with the choice depending on tear size and location Post-surgical rehabilitation is crucial, involving 4-6 weeks of immobilization followed by progressive physical therapy for 3-6 months, to promote tendon healing and improve shoulder function. It is essential to note that articular-sided tears have poorer healing potential than bursal-sided tears due to reduced vascularity on the articular surface, which explains why larger tears often require surgical intervention despite initial conservative attempts. The use of systemic analgesia, including paracetamol and NSAIDs, and regional analgesic techniques, such as interscalene brachial plexus blockade, can help manage postoperative pain and improve patient outcomes 1.
From the Research
Treatment Options for Articular-Sided Supraspinatus Tears
- Various treatment options are available for articular-sided supraspinatus tears, including platelet-rich plasma (PRP) injections, corticosteroid injections, prolotherapy, exercise therapy, and arthroscopic debridement or repair 2, 3, 4, 5.
- A study comparing PRP injections and corticosteroid injections for partial supraspinatus tears found that both treatments resulted in similar pain relief and functional improvement at 1 month, but PRP injections showed superior benefits at 6 months 2.
- Another study reported a case of an adolescent baseball player with a partial supraspinatus tear who was treated with platelet releasate and extracorporeal shock wave therapy (ESWT), resulting in a 25% improvement in symptoms and allowing the patient to return to play 3.
Efficacy of Different Treatment Options
- Arthroscopic debridement and repair are two surgical treatment options for articular-sided partial-thickness supraspinatus tears, with studies showing high patient satisfaction, good shoulder function, and high tendon integrity at minimum 2-year follow-up 4.
- A retrospective cohort study comparing the effectiveness of ultrasound-guided corticosteroid injections, prolotherapy, and exercise therapy for partial-thickness supraspinatus tears found that corticosteroids provided a fast pain-relieving effect, but the effects diminished over time, whereas prolotherapy provided a long-lasting effect 5.
- Exercise therapy, including eccentric training, may be beneficial for supraspinatus tendinopathy, but more research is needed to confirm its effectiveness 6.
Comparison of Treatment Outcomes
- A study comparing the outcomes of arthroscopic debridement and repair for articular-sided partial-thickness supraspinatus tears found that the debridement group had significantly better results on the Constant, American Shoulder and Elbow Surgeons (ASES), and visual analog scale (VAS) scores than the repair group 4.
- Another study found that prolotherapy provided a long-lasting effect, with significant improvements in pain and function at 3 months, whereas corticosteroid injections provided a fast pain-relieving effect, but the effects diminished over time 5.