Management of Partial-Thickness Supraspinatus Tendon Tears
Start with conservative management for at least 3-6 months before considering surgery, using physical therapy as the cornerstone of treatment combined with NSAIDs and activity modification. 1
Initial Conservative Treatment (First-Line Approach)
All partial-thickness tears, particularly those involving less than 50% of tendon thickness, should begin with non-surgical management. 1
Core Conservative Interventions
Physical therapy is the primary treatment modality, focusing on strengthening exercises, flexibility training, and functional restoration of the shoulder. 1
Relative rest by reducing repetitive loading activities and overhead movements, while avoiding complete immobilization to prevent muscular atrophy and deconditioning. 1
NSAIDs (topical or oral) for pain relief, recognizing their role is primarily analgesic since chronic tendinopathy involves degeneration rather than acute inflammation. 1, 2
Activity modification to eliminate repetitive stresses and overhead movements that aggravate the tendon. 1, 3
Cryotherapy applied through a wet towel for 10-minute periods to reduce pain. 1
Adjunctive Options
Corticosteroid injections can provide temporary symptom relief, though evidence for their effect on tendon healing is inconclusive. 2, 3
Platelet-rich plasma (PRP) injections show promise, with one study demonstrating tear size reduction of 3.39 mm in the coronal plane and 2.97 mm in the sagittal plane at 6 months, superior to corticosteroid injections. 4
Critical Pitfalls to Avoid During Conservative Treatment
Never use intratendinous corticosteroid injections, as they may inhibit healing, reduce tensile strength, and predispose to spontaneous rupture. 1
Never completely immobilize the shoulder, as this leads to muscular atrophy and deconditioning. 1
Avoid premature surgical intervention before completing an adequate 3-6 month trial of conservative management. 1
Surgical Indications
Proceed to arthroscopic repair when conservative treatment fails after 3-6 months OR when the patient has significant functional limitations despite non-surgical treatment. 1, 3
Surgical Technique Principles
The primary goal is achieving tendon-to-bone healing, which correlates with improved clinical outcomes. 1, 3
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, 2, 3
For high-grade partial tears (≥50% thickness), completion of the tear followed by repair has lower retear rates (3.6%) compared to full-thickness tear repair (16.3%), with equivalent functional outcomes. 5
Transtendon repair produces good-to-excellent results and is a viable alternative to tear completion and repair. 6
Postoperative Protocol
Sling immobilization for 4-6 weeks immediately post-surgery. 1, 2, 3
Structured rehabilitation program lasting several months is essential for optimal recovery. 1, 3
Prognostic Factors Affecting Outcomes
Workers' compensation status correlates with poorer postoperative outcomes. 2, 3
Muscle atrophy and fatty degeneration on MRI correlate with worse healing potential and reduced surgical success. 2, 3
Concurrent involvement of adjacent tendons (infraspinatus or subscapularis) negatively impacts healing. 2
Expected Outcomes with Conservative Management
- For grade I and II articular-sided partial tears treated with subacromial decompression without repair, 76.1% achieve excellent results and 10.9% achieve good results, with only 6.5% progressing to full-thickness tears at 50-month follow-up. 7