Treatment of Partial Thickness Supraspinatus Tears
Start with conservative management for all partial thickness supraspinatus tears, particularly those involving less than 50% of tendon thickness, using physical therapy as the primary treatment modality for 3-6 months before considering surgery. 1, 2
Initial Conservative Management (First-Line Treatment)
Physical therapy is the cornerstone of initial treatment, focusing on strengthening exercises, flexibility training, and functional restoration of the shoulder 1, 2. This should be combined with:
- Relative rest by reducing repetitive overhead activities and loading of the damaged tendon, while avoiding complete immobilization which leads to muscular atrophy and deconditioning 1
- NSAIDs (topical or oral) for pain relief, though their role is primarily analgesic since partial tears involve chronic degeneration rather than acute inflammation 1
- Activity modification to eliminate repetitive stresses and overhead movements that aggravate the tendon 1, 2
- Cryotherapy applied through a wet towel for 10-minute periods to reduce pain 1
- Corticosteroid injections may provide temporary relief for inflammation, but avoid intratendinous injections as they inhibit healing, reduce tensile strength, and predispose to spontaneous rupture 1, 2
When to Proceed to Surgery
Surgical intervention is indicated when conservative treatment fails after 3-6 months OR when the patient has significant functional limitations despite non-surgical treatment. 1, 2 The decision should account for:
- Patient age (younger patients heal better; average age 51.8 years for intact repairs vs 62.6 years for persistent defects) 3
- Activity level and functional demands 2
- Severity of symptoms 2
- Presence of muscle atrophy and fatty degeneration (correlates with worse outcomes and healing potential) 2
- Workers' compensation status (correlates with less favorable outcomes) 2
Surgical Approach
The primary surgical goal is achieving tendon-to-bone healing, which correlates with improved clinical outcomes. 1, 2 The technique involves:
- Arthroscopic conversion of the partial-thickness tear to a full-thickness tear followed by repair, which results in an 88% healing rate at 11 months 3
- Do NOT perform routine acromioplasty for normal acromial bone (including type II and III morphology), as studies show no significant difference in outcomes with or without acromioplasty 1, 2
- When adjacent partial tears of infraspinatus or subscapularis are present, perform thorough treatment with curettage-closure of delamination tears 4
Postoperative Recovery Protocol
- Sling immobilization for 4-6 weeks immediately post-surgery 1, 2
- Structured rehabilitation program lasting several months is essential for optimal recovery 1, 2
Critical Pitfalls to Avoid
- Never completely immobilize during conservative treatment—this causes muscular atrophy 1
- Never inject corticosteroids intratendinously—only consider subacromial injections if needed 1
- Never rush to surgery before completing 3-6 months of conservative management 1
- Never perform routine acromioplasty—it provides no additional benefit 1, 2