Treatment for Complete Tear of Supraspinatus Tendon

Patient Selection and Surgical Candidacy

Workers' compensation status correlates with less favorable outcomes and should be discussed during surgical counseling, according to the American Academy of Orthopaedic Surgeons 1
Preoperative muscle quality matters: infraspinatus fatty degeneration and muscle atrophy, as well as supraspinatus muscle atrophy, correlate with worse healing and clinical outcomes, as reported by the American Academy of Orthopaedic Surgeons 1

Surgical techniques typically include excision of abnormal tendon tissue and longitudinal tenotomies to release scarring and fibrosis, as described by the American Academy of Family Physicians 2, 3
The American Academy of Family Physicians recommends arthroscopic repair using tension-band suture techniques as the standard surgical approach 2, 3

Relative rest by avoiding overhead activities and movements that reproduce pain is recommended in the initial phase of conservative management, according to Praxis Medical Insights 4
Cryotherapy with ice applied through a wet towel for 10-minute periods immediately after pain-provoking activities is suggested in the initial phase of conservative management, as reported by Praxis Medical Insights 4
NSAIDs (oral or topical) can be used for short-term pain relief, though they provide no long-term benefit, as stated by the American Academy of Family Physicians 3 and Praxis Medical Insights 4
Eccentric strengthening exercises are the cornerstone of conservative treatment and should be continued for at least 3-6 months, according to Praxis Medical Insights 4
Progressive loading should be gradual to avoid symptom exacerbation, as recommended by Praxis Medical Insights 4
Extracorporeal shock wave therapy (ESWT) is safe and potentially effective for pain relief, though expensive, as reported by the American Academy of Family Physicians 3 and Praxis Medical Insights 4
Corticosteroid injections should be used with extreme caution as they may provide acute pain relief but do not improve long-term outcomes, may inhibit healing, and can reduce tendon strength predisposing to rupture, as warned by the American Academy of Family Physicians 5 and Praxis Medical Insights 4

Pain persists despite 3-6 months of well-managed conservative treatment, which is a criterion for referral to orthopedic surgery, as recommended by the American Academy of Family Physicians 2, 3 and Praxis Medical Insights 4
Significant functional limitations persist despite conservative measures, which is a criterion for referral to orthopedic surgery, as stated by the American Academy of Family Physicians 2

Do not inject corticosteroids into the tendon substance itself, only peritendinous injection may be considered, and even this should be used cautiously given unclear effects on healing, as warned by the American Academy of Family Physicians 5
Do not delay surgical referral beyond 6 months of failed conservative treatment, as chronic tears may develop muscle atrophy and fatty degeneration that worsen surgical outcomes, as reported by the American Academy of Orthopaedic Surgeons 1
Do not start with aggressive exercises in the conservative pathway; progression must be gradual to prevent symptom worsening, as recommended by Praxis Medical Insights 4