Treatment of Partial Articular Supraspinatus Tendon Avulsion (PASTA Lesions)

Initial Conservative Management

The American Academy of Family Physicians recommends starting with non-surgical treatment for all PASTA lesions, particularly those involving less than 50% of tendon thickness, and using physical therapy as the primary treatment modality, focusing on strengthening, flexibility, and functional restoration of the shoulder 1
Relative rest by reducing activities that involve repetitive loading of the damaged tendon, while avoiding complete immobilization to prevent muscular atrophy, is recommended 2
NSAIDs (topical or oral) can be used for pain relief, though their role is primarily analgesic since chronic tendinopathy involves degeneration rather than acute inflammation 3
Activity modification to eliminate repetitive stresses and overhead movements that aggravate the tendon is advised 3
Cryotherapy applied through a wet towel for 10-minute periods can help reduce pain 3

The American College of Surgeons recommends proceeding to arthroscopic repair when conservative treatment fails after 3-6 months or when the patient has significant functional limitations 1
The primary surgical goal is achieving tendon-to-bone healing, which correlates with improved clinical outcomes 4, 1
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 4, 1

Sling immobilization for 4-6 weeks immediately post-surgery is recommended 4, 1
A structured rehabilitation program lasting several months is essential for optimal recovery 1

Avoid complete immobilization during conservative treatment, as this leads to muscular atrophy and deconditioning 2
Avoid intratendinous corticosteroid injections, as they may inhibit healing and reduce tensile strength, predisposing to spontaneous rupture 3
Avoid premature surgical intervention before completing an adequate trial of conservative management (3-6 months minimum) 1
Avoid routine acromioplasty during rotator cuff repair, as it provides no additional benefit 4, 1