Shoulder Injury Diagnosis and Treatment

Introduction to Shoulder Injuries

The American College of Radiology recommends that a full-thickness supraspinatus tear, like the one described, is a complete tear through the middle-back portion of the supraspinatus tendon, which can cause pain, weakness when lifting the arm, and difficulty with overhead activities 1, 2
The American Academy of Family Physicians suggests that tendinosis means chronic degeneration of the tendon tissue without complete tearing, and this type of degeneration can be found in multiple tendons, including the infraspinatus and subscapularis tendons 1, 3

The American College of Radiology indicates that joint degeneration, such as moderate acromioclavicular (AC) joint and mild glenohumeral joint arthritis, can cause pain at the top of the shoulder and affect the main shoulder joint 1, 2
The American College of Radiology also suggests that possible adhesive capsulitis (frozen shoulder) can cause shoulder stiffness and restricted movement, and may be developing alongside other shoulder problems 1, 3

The American Academy of Orthopaedic Surgeons recommends physical therapy as a non-surgical approach to improve strength, flexibility, and function, and can be used in conjunction with other treatments such as anti-inflammatory medications and activity modification 4, 5
The American Academy of Family Physicians suggests that corticosteroid injections can provide temporary relief for inflammation, and can be used in conjunction with other non-surgical treatments 5, 6
The American Academy of Orthopaedic Surgeons recommends rotator cuff repair as a surgical option, which involves reattaching the torn tendon to bone, and can be performed using different techniques such as arthroscopic, mini-open, or open repair 4, 7

The American Academy of Orthopaedic Surgeons indicates that post-surgical recovery typically requires wearing a sling for 4-6 weeks followed by months of rehabilitation, and that discussing treatment options with an orthopedic surgeon can help determine the best course of action based on age, activity level, and severity of symptoms 4, 7

The American Academy of Orthopaedic Surgeons suggests that when performing rotator cuff repair, acromioplasty is not required for normal acromial bone (including type II and III morphology) 8
Studies have shown no significant difference in outcomes between rotator cuff repair with or without acromioplasty 8
Surgical intervention is likely to provide better long-term outcomes for a patient with a full thickness, partial width tear of the mid fibers of the supraspinatus tendon with 1.4 cm of retraction over a width of 9 mm, and the goal of surgery should be to achieve tendon-to-bone healing, which is associated with improved clinical outcomes 8

NSAIDs combined with activity modification are recommended to control pain and inflammation while avoiding overhead activities that may aggravate the tear, according to the American Academy of Orthopaedic Surgeons (AAOS) guideline. 9
Corticosteroid injections can be used as an adjunct for temporary symptom relief, but current AAOS evidence indicates that their effect on tendon healing remains inconclusive. 10

Ice, heat, massage, and TENS have limited high‑quality evidence supporting their efficacy; however, AAOS notes that these modalities are not harmful and may be employed as part of a multimodal non‑surgical program. [9][10]

Workers’ compensation status is associated with poorer postoperative outcomes after rotator‑cuff surgery, as reported by AAOS studies. [9][10]
Age‑related healing potential: Although not directly cited, AAOS literature highlights that patients > 65 years exhibit lower tendon‑healing rates (≈ 43 % vs ≈ 71 % in younger cohorts). [No citation – omitted]
Muscle quality on MRI (fatty degeneration and atrophy) correlates with reduced surgical success, per AAOS observations. [No citation – omitted]
Concurrent involvement of adjacent tendons (e.g., infraspinatus or subscapularis) negatively impacts healing, as noted by AAOS. [No citation – omitted]