Treatment of Small Partial Thickness Supraspinatus Tear and Posterior Labrum Tear
Begin with conservative management for at least 3-6 months before considering surgery, as this approach provides equivalent outcomes to operative treatment for small supraspinatus tears, while the posterior labrum tear typically requires surgical intervention only if conservative measures fail and significant functional limitations persist. 1, 2, 3
Initial Conservative Management (First-Line Treatment)
For the Partial Thickness Supraspinatus Tear
Start with physical therapy as the primary treatment modality, focusing on strengthening, flexibility, and functional restoration of the shoulder, particularly for tears involving less than 50% of tendon thickness 1
Implement relative rest by reducing activities involving repetitive loading of the damaged tendon, but avoid complete immobilization to prevent muscular atrophy and deconditioning 1
Use NSAIDs (topical or oral) for pain relief, recognizing their role is primarily analgesic since chronic tendinopathy involves degeneration rather than acute inflammation 1
Modify activities to eliminate repetitive stresses and overhead movements that aggravate the tendon 1
Apply cryotherapy through a wet towel for 10-minute periods to help reduce pain 1
Do NOT use intratendinous corticosteroid injections, as they may inhibit healing and reduce tensile strength, predisposing to spontaneous rupture 1
For the Posterior Labrum Tear
Conservative management with physical therapy should be attempted initially, as labral tears often respond to non-operative treatment when not associated with instability 4
Focus rehabilitation on scapular stabilization and rotator cuff strengthening to compensate for labral dysfunction 4
Surgical Indications (After 3-6 Months of Failed Conservative Treatment)
When to Proceed to Surgery
Proceed to arthroscopic repair when conservative treatment fails after 3-6 months OR when the patient has significant functional limitations 1, 2
For the supraspinatus tear, research demonstrates that tears below 40% thickness are sufficiently stable for continued physiotherapy, while tears above 60% thickness should prompt consideration of surgery 5
For middle-aged or older patients (>35 years) with persistent symptoms, surgical intervention may be warranted earlier, though evidence shows no significant advantage over conservative treatment for small tears in patients over 55 years 3
Surgical Technique Considerations
The primary surgical goal is achieving tendon-to-bone healing for the supraspinatus, which correlates with improved clinical outcomes 1, 4
For the posterior labrum tear, arthroscopic repair with labral fixation to the glenoid is the standard approach 6
Do NOT perform acromioplasty for normal acromial bone (including type II and III morphology), as studies show no significant difference in outcomes with or without acromioplasty 1, 4, 2
Postoperative Recovery Protocol
Sling immobilization for 4-6 weeks immediately post-surgery is required 1, 2
A structured rehabilitation program lasting several months is essential for optimal recovery 1, 2
Critical Pitfalls to Avoid
Never perform complete immobilization during conservative treatment, as this leads to muscular atrophy and deconditioning 1
Never inject corticosteroids into the tendon substance, as this inhibits healing and increases rupture risk 1
Never proceed to surgery before completing an adequate 3-6 month trial of conservative management unless there are acute traumatic circumstances requiring immediate intervention 1, 2
Never routinely perform acromioplasty during rotator cuff repair, as it provides no additional benefit and adds unnecessary surgical morbidity 1, 4, 2
Evidence Quality Note
The recommendation for conservative management is supported by high-quality randomized controlled trial data showing no significant differences in Constant scores, pain scores, or patient satisfaction between operative and conservative treatment at over 5-year follow-up for small supraspinatus tears 3. This study found mean improvements in Constant scores of 18.5 for physiotherapy alone, 17.9 for acromioplasty with physiotherapy, and 20.0 for rotator cuff repair with acromioplasty and physiotherapy, with no statistically significant differences (P = 0.84) 3.