What is the treatment for a supraspinatus tendon tear?

From the Guidelines

Treatment for a supraspinatus tendon tear should initially focus on conservative measures, including rest, ice, anti-inflammatory medications, and physical therapy, with surgical intervention considered if conservative treatment fails after 3-6 months or if the tear is large (>3cm). This approach is based on the most recent and highest quality evidence available, which emphasizes the importance of a structured treatment plan to restore function and prevent further damage to the rotator cuff tendon 1.

Conservative Treatment

Conservative treatment typically includes:

• Rest and ice to reduce inflammation and pain
• Anti-inflammatory medications, such as ibuprofen 400-800mg three times daily or naproxen 500mg twice daily, for 1-2 weeks
• Physical therapy focusing on gentle range of motion exercises and gradual strengthening of the rotator cuff muscles, with sessions 2-3 times weekly for 6-12 weeks
• Pain management with acetaminophen (up to 3000mg daily) alongside NSAIDs
• Corticosteroid injections, limited to 2-3 injections per year, for temporary relief of significant pain

Surgical Intervention

If conservative treatment fails or if the tear is large, surgical intervention may be necessary. Surgery options include:

• Arthroscopic repair
• Mini-open repair
• Open repair, depending on tear size and complexity Recovery after surgery requires wearing a sling for 4-6 weeks followed by 3-6 months of rehabilitation. The choice of surgical technique can impact postoperative pain scores, with studies suggesting that arthroscopic approaches and the use of platelet-rich plasma may reduce pain scores and opioid consumption after surgery 1.

Factors Influencing Outcomes

Several factors can influence outcomes after rotator cuff repair, including:

• Increasing patient age, which has been identified as a potential factor influencing outcomes and healing after rotator cuff surgery 1
• MRI tear characteristics, such as fatty degeneration and muscle atrophy, which can correlate with worse outcomes and healing 1
• Workers’ compensation status, which has been associated with less favorable outcomes after rotator cuff repair 1

From the Research

Treatment Options for Supraspinatpus Tendon Tear

• Physiotherapy: a common treatment method for supraspinatus tendon tears, which can improve function and reduce pain 2, 3, 4
• Platelet-rich Plasma (PRP) Injection: a treatment method that has shown promising results in reducing tear size and improving functional scores 2, 5, 4, 6
• Corticosteroid Injection: a treatment method that can provide short-term pain relief, but may not be effective in reducing tear size 5, 6
• Surgical Repair: a treatment option for supraspinatus tendon tears, which can be considered for patients who do not respond to conservative treatment 3

Comparison of Treatment Outcomes

• PRP injection has been shown to be more effective than corticosteroid injection in reducing tear size and improving functional scores 5, 6
• PRP injection has been shown to be as effective as physiotherapy in improving function and reducing pain, but may have a slight edge in the short-term 2
• Physiotherapy has been shown to be a reasonable option for the primary initial treatment of small, nontraumatic, single-tendon supraspinatus tears in patients older than 55 years 3

Factors Affecting Treatment Outcomes

• Tear size: larger tears may require more aggressive treatment, such as surgical repair 3
• Patient age: older patients may be more likely to benefit from conservative treatment, such as physiotherapy 3
• Treatment duration: longer treatment durations may be necessary to achieve optimal outcomes 4