What is the treatment for a complete tear of the supraspinatus tendon?

Treatment for Complete Tear of Supraspinatus Tendon

For a complete (full-thickness) tear of the supraspinatus tendon, surgical repair is the definitive treatment in appropriate candidates, as it achieves tendon healing in approximately 71% of cases and results in superior strength outcomes compared to non-healed repairs. 1

Patient Selection and Surgical Candidacy

Age significantly impacts surgical outcomes and should guide treatment decisions:

• Patients under 65 years achieve complete tendon healing in 57% of cases, while those over 65 heal in only 43% of cases 1
• Workers' compensation status correlates with less favorable outcomes and should be discussed during surgical counseling 2
• Preoperative muscle quality matters: infraspinatus fatty degeneration and muscle atrophy, as well as supraspinatus muscle atrophy, correlate with worse healing and clinical outcomes 2

Surgical Approach

Arthroscopic repair using tension-band suture techniques is the standard surgical approach:

• Surgical techniques typically include excision of abnormal tendon tissue and longitudinal tenotomies to release scarring and fibrosis 2
• Arthroscopic repair of isolated supraspinatus tears achieves complete tendon healing in 71% of cases 1
• When tendon healing occurs, shoulder elevation strength averages 7.3 kg compared to only 4.7 kg when healing fails 1
• Patient satisfaction rates reach 95% (62 of 65 patients) following arthroscopic repair 1

Conservative Management (When Surgery is Declined or Contraindicated)

If surgery is not pursued, structured conservative management can improve pain and function, though it does not heal the tear:

Initial Phase (0-6 weeks)

• Relative rest by avoiding overhead activities and movements that reproduce pain 3
• Cryotherapy with ice applied through a wet towel for 10-minute periods immediately after pain-provoking activities 3
• NSAIDs (oral or topical) for short-term pain relief, though they provide no long-term benefit 2, 3

Rehabilitation Phase (6 weeks to 6 months)

• Eccentric strengthening exercises are the cornerstone of conservative treatment and should be continued for at least 3-6 months 3, 4
• One case report demonstrated that exercise therapy for 3 months improved pain and function in a complete supraspinatus tear, with improvements sustained at 15 months 5
• Progressive loading should be gradual to avoid symptom exacerbation 3

Adjunctive Interventions

• Extracorporeal shock wave therapy (ESWT) is safe and potentially effective for pain relief, though expensive 2, 3
• Ultrasound-guided hyaluronic acid injections into the subacromial-subdeltoid bursa may improve pain and function at 12 weeks in 60% of patients 6
• Corticosteroid injections should be used with extreme caution as they may provide acute pain relief but do not improve long-term outcomes, may inhibit healing, and can reduce tendon strength predisposing to rupture 2, 3

Surgical Referral Criteria

Refer to orthopedic surgery when:

• Pain persists despite 3-6 months of well-managed conservative treatment 2, 3
• Patient is younger (under 65 years) with good muscle quality and desires optimal functional restoration 1
• Significant functional limitations persist despite conservative measures 2

Critical Pitfalls to Avoid

• Do not inject corticosteroids into the tendon substance itself, only peritendinous injection may be considered, and even this should be used cautiously given unclear effects on healing 2
• Do not delay surgical referral beyond 6 months of failed conservative treatment, as chronic tears may develop muscle atrophy and fatty degeneration that worsen surgical outcomes 2
• Do not start with aggressive exercises in the conservative pathway; progression must be gradual to prevent symptom worsening 3
• Do not assume imaging changes correlate with treatment response; in one study, 50% of non-responders to conservative treatment showed no relevant US changes despite clinical failure 6