A full-thickness tear of the supraspinatus tendon is a common orthopedic challenge, often leading individuals to question if surgery is necessary. The supraspinatus is part of the rotator cuff, a group of four tendons that stabilize the shoulder joint. Located at the top of the shoulder, it originates from the shoulder blade and attaches to the upper arm bone (humerus). Its primary function is to initiate the lifting motion of the arm (abduction) and assist in shoulder rotation. A full-thickness tear represents a complete discontinuity of the tendon, where it is either entirely severed or fully detached from its insertion point on the bone.
Understanding Full-Thickness Tears
A full-thickness supraspinatus tear occurs through two main mechanisms: acute trauma or chronic degeneration. Acute tears often result from a sudden, forceful event, such as falling onto an outstretched arm or lifting a heavy object, frequently causing immediate, intense pain and significant arm weakness. Conversely, degenerative tears are far more common, developing slowly over time as the tendon tissue wears down due to repetitive stress, diminished blood supply, or bone spurs.
Symptoms typically include pain that worsens when lifting the arm, especially in the 60- to 120-degree range, and noticeable weakness when attempting to hold the arm out to the side. Night pain is also a frequent complaint, particularly when lying on the affected side, which can severely disrupt sleep. The injury is officially confirmed through imaging techniques like magnetic resonance imaging (MRI) or ultrasound, which visualize the extent of the tear and its retraction from the bone.
Non-Operative Treatment Options
Non-operative management is the initial and preferred course of action for many patients, particularly those with chronic, smaller tears or those who are less physically demanding. This approach focuses on relieving pain, restoring functional range of motion, and maximizing the strength of the remaining rotator cuff muscles to compensate for the torn supraspinatus. Physical therapy is the centerpiece of conservative treatment, typically involving a structured program over several months to improve shoulder mechanics and stability.
Therapy starts with gentle range-of-motion exercises and progresses to strengthening the surrounding muscles, including the deltoid and the other rotator cuff components. Specific exercises target scapular stabilization to ensure the shoulder blade provides a stable base for arm movement. Activity modification is also necessary, requiring patients to avoid overhead reaching, heavy lifting, and other actions that place direct stress on the damaged tendon.
Pharmacological interventions include nonsteroidal anti-inflammatory drugs (NSAIDs) to manage pain and reduce swelling. Corticosteroid injections are sometimes used to provide temporary pain relief, especially when pain limits participation in physical therapy. However, these injections do not heal the tear, and clinicians must use caution, as repeated use may compromise the success of a future surgical repair.
Criteria for Recommending Surgery
Surgery is generally not mandatory for every full-thickness tear, but specific criteria guide the decision toward intervention. The primary indication for surgery is the failure of a structured course of non-operative treatment, defined as persistent, limiting symptoms after three to six months of dedicated physical therapy. Since the tendon cannot heal on its own due to retraction, surgery is the only method to physically reattach it to the bone.
Tear characteristics are a major factor, with larger tears, often exceeding three centimeters, and tears with significant tendon retraction being more likely to require repair. When the torn tendon pulls back substantially, the muscle may become fatty (atrophy), which makes a successful repair more challenging over time.
Patient factors also play a crucial role. Younger, highly active individuals, or those whose occupation requires repetitive overhead work or heavy lifting are often steered toward early surgical repair. Acute traumatic tears are another strong indication for prompt surgery, especially if the repair can be performed within six weeks of the injury. The presence of significant weakness or a complete loss of function, demonstrated by an inability to lift the arm against gravity (a positive “drop arm” sign), also strongly supports a surgical solution.
Surgical Procedures and Rehabilitation
The most common surgical approach for a full-thickness supraspinatus tear is arthroscopic repair, a minimally invasive procedure. The goal is to mobilize the retracted tendon and securely re-anchor it to the humerus bone using specialized surgical anchors and strong sutures. This process promotes biological healing, allowing the tendon to scar back down to the bone over several weeks.
The post-operative phase is highly structured and begins with an immediate period of immobilization, typically lasting four to six weeks, where the arm is kept in a sling to protect the delicate repair. This is followed by a phased rehabilitation protocol that gradually restores motion and strength.
The initial phase focuses on passive range of motion, where the therapist or the patient’s opposite arm moves the operative arm to prevent stiffness without engaging the repaired tendon. The intermediate phase, beginning around six to ten weeks, transitions to active range of motion. Strengthening exercises, starting with light resistance, begin in the later phases, typically around three to four months post-surgery, focusing on the entire rotator cuff and scapular muscles. Adherence to this strict, multi-month physical therapy protocol is paramount for a successful outcome.