The supraspinatus tendon is part of the rotator cuff, a group of muscles and tendons that stabilize and move the shoulder joint. A partial thickness tear occurs when this tendon is damaged or frayed but not completely severed. This injury can cause discomfort and limit arm movement, affecting daily activities.
Evaluating the Tear’s Severity
Evaluating a partial supraspinatus tear involves a physical examination and advanced imaging. A healthcare provider assesses shoulder pain, range of motion, and strength. Magnetic Resonance Imaging (MRI) visualizes the tear’s size, depth, and location, determining if it’s on the articular (joint) side, bursal (outer) side, or interstitial (within the tendon).
Ultrasound imaging also provides real-time visualization. Tears are often classified by depth, such as less than or greater than 50% of the tendon’s thickness. This evaluation guides the treatment strategy.
Conservative and Non-Surgical Management
Initial management for a partial supraspinatus tear often begins with conservative approaches aimed at reducing pain and promoting healing without surgery. Rest from aggravating activities, application of ice to the affected area, and modifications to daily movements are frequently recommended. This initial phase helps to decrease inflammation and prevent further irritation to the injured tendon.
Over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, can be used to manage pain and reduce inflammation. These medications work by inhibiting specific enzymes involved in the inflammatory response. While effective for symptom relief, they do not directly repair the tendon.
Physical therapy is a cornerstone of non-surgical management, aiming to alleviate pain, restore range of motion, and strengthen the surrounding shoulder musculature. Initial exercises often focus on gentle passive and active-assisted range of motion activities to prevent stiffness and improve flexibility. As pain subsides, therapists guide patients through progressive strengthening exercises targeting the rotator cuff muscles, particularly the supraspinatus, and the scapular stabilizers. This comprehensive approach helps to improve shoulder mechanics, enhance stability, and build compensatory strength around the injured tendon.
Corticosteroid injections, like betamethasone or triamcinolone, may be given into the subacromial space to reduce pain and inflammation. These injections offer short-term relief, helping patients engage in physical therapy. However, effects are temporary, and repeated injections are limited due to potential tissue weakening. Biologic injections, such as Platelet-Rich Plasma (PRP), involve injecting concentrated platelets from the patient’s blood. PRP aims to stimulate tissue repair and reduce inflammation, though evidence for partial rotator cuff tears is still evolving.
Surgical Intervention Procedures
When conservative management strategies do not adequately resolve symptoms, or if the partial supraspinatus tear is particularly severe, surgical intervention may be considered. These procedures are typically performed arthroscopically, involving small incisions and the use of a miniature camera and specialized instruments to visualize and work within the joint. Arthroscopic techniques generally result in less post-operative pain and a quicker initial recovery compared to open surgery.
One surgical option is debridement, where the surgeon removes frayed or damaged tissue from the tendon surface. This procedure smooths the tendon and eliminates irritation. Debridement is typically for smaller, lower-grade partial tears, especially when pain is the primary symptom. Its goal is to reduce mechanical impingement and improve the tendon’s environment.
For more significant partial tears, such as those over 50% thickness, a formal tendon repair may be recommended. This involves re-anchoring the torn tendon portion to its attachment point on the humerus. Techniques often use sutures secured to the bone with small anchors. Factors influencing repair include tear size, depth, patient age, activity level, and functional demands. Repair aims to restore tendon integrity for better healing and long-term outcomes.
Post-Treatment Rehabilitation and Outlook
Following treatment for a partial supraspinatus tear, rehabilitation plays a significant role in restoring shoulder function and achieving a positive outlook. For those managed non-surgically, rehabilitation is an ongoing process focused on maintaining strength, flexibility, and proper shoulder mechanics to prevent recurrence of symptoms. This often involves a consistent home exercise program and activity modification to avoid re-aggravation.
Following surgical repair, rehabilitation typically follows a structured, phased protocol to protect the healing tendon while progressively restoring motion and strength. The initial phase often involves a period of immobilization, usually four to six weeks, where the arm is held in a sling to protect the repair site from undue stress. During this time, the focus is on pain management and protecting the surgical repair.
The next phase introduces passive range of motion exercises, where a physical therapist gently moves the patient’s arm without the patient’s muscle activation. This helps to prevent stiffness and restore joint mobility without stressing the healing tendon. As healing progresses, patients begin active motion exercises, gradually moving their arm independently. The final phase concentrates on strengthening the rotator cuff and surrounding shoulder muscles, progressing from light resistance to more challenging exercises.
Return to daily activities typically occurs within three to six months following surgery. More strenuous activities or sports often require six to twelve months or longer, depending on individual progress and activity demands. The outlook for a partial supraspinatus tear is generally favorable, with most individuals achieving significant pain relief and improved shoulder function through treatment and rehabilitation.