Management of Full Thickness Supraspinatus Tear with 2mm Retraction

Initial Assessment and Imaging

The American College of Radiology recommends MRI without contrast or ultrasound as the preferred imaging modality to evaluate rotator cuff tears, providing information about tear size, retraction, and muscle quality 4, 5
Full-thickness tears show increased signal intensity extending from inferior to superior surface of the tendon on all MRI sequences, according to the American College of Radiology 4
Important prognostic factors to assess include tendon retraction, muscle atrophy, and fatty infiltration, which influence treatment decisions and prognosis, as stated by the American College of Radiology 4

The American Academy of Orthopaedic Surgeons recommends beginning with non-surgical management for symptomatic full-thickness tears, particularly for small tears with minimal retraction 1, 2
NSAIDs and acetaminophen should be used as initial pain management, with NSAIDs or COX-2 inhibitors used concurrently with acetaminophen for more effective pain control, according to Praxis Medical Insights 6
A single corticosteroid injection with local anesthetic may be considered for short-term improvement in both pain and function, as recommended by the American Academy of Orthopaedic Surgeons 2, 6

The American Academy of Orthopaedic Surgeons reports that one level III study showed that 81% of surgical patients reported excellent results, compared with 37% with nonsurgical treatment 2, 7
Asymptomatic rotator cuff tears are common, especially in older populations, and surgery is not recommended for asymptomatic tears, according to the American Academy of Orthopaedic Surgeons 1, 2, 3

A 2mm retraction is considered minimal and may respond well to conservative management, but monitoring for progression is important, as stated by the American College of Radiology 4
Overuse of corticosteroid injections should be avoided, limiting to single injections for short-term relief, according to Praxis Medical Insights 6
Older age is associated with higher failure rates and poorer outcomes after rotator cuff repair, as reported by Praxis Medical Insights 6