The shoulder joint is a complex, highly mobile structure stabilized by the rotator cuff, a group of four tendons and muscles. These tendons center the upper arm bone in the socket and facilitate a wide range of motion. A full-thickness tear of the supraspinatus tendon is a significant injury that compromises the shoulder’s primary lifting mechanism. Careful evaluation and management are required to ensure the best possible functional outcome.
Understanding the Supraspinatus and Full Thickness Tears
The supraspinatus tendon is one of the four tendons in the rotator cuff, originating from the shoulder blade and inserting onto the upper arm bone. This tendon plays a primary role in the initial movement of lifting the arm away from the body, known as abduction. Its function is also to help stabilize the head of the humerus within the socket during arm movement.
A “full thickness tear” describes a complete disruption of the tendon fibers, extending through the entire thickness. This is distinct from a partial tear, which only damages some fibers. The tear often detaches the tendon completely from its bony attachment, creating a gap. Due to the tendon’s poor blood supply, this injury will not heal on its own.
Immediate Functional Impact and Severity
A full-thickness supraspinatus tear is serious because it immediately and substantially impairs shoulder mechanics. Patients experience significant pain, often described as intense, especially when attempting to lift the arm or when lying on the affected side at night. This pain is coupled with profound weakness, as the primary muscle responsible for initiating arm lift is disconnected.
This functional loss can manifest as an inability to lift the arm against gravity, sometimes called pseudoparalysis. The lack of an intact tendon allows the head of the humerus to migrate upward over time, which can lead to further joint damage and the development of rotator cuff arthropathy. Early intervention is often considered because the torn tendon can retract, or pull back, making surgical repair more difficult the longer the injury is left untreated.
Treatment Pathways: Non-Surgical vs. Surgical Options
Management of a full-thickness tear involves selecting the most appropriate path based on patient factors, tear characteristics, and functional goals. Non-surgical treatment is often the first approach, particularly for older, less active individuals or those with significant health risks. This pathway focuses on pain relief and strengthening the other, intact rotator cuff muscles and surrounding shoulder stabilizers to compensate for the lost function of the supraspinatus.
Non-surgical interventions include rest, activity modification, nonsteroidal anti-inflammatory drugs (NSAIDs), and supervised physical therapy. Corticosteroid injections may provide temporary pain relief and reduce inflammation, but they do not help the tendon heal. For patients with lower functional demands, non-operative management often successfully relieves pain and improves function.
Surgical repair is generally recommended for younger, active patients, acute tears, or when non-surgical treatment fails to provide adequate function and pain relief after a few months. The goal of surgery is to re-attach the torn tendon directly back to the humerus bone. This procedure is commonly performed using an arthroscopic technique, which involves small incisions and specialized instruments to secure the tendon using suture anchors.
Surgery offers superior improvement in pain and function compared to non-operative treatment, but it is only the first step in a lengthy recovery. The procedure must be followed by an extensive rehabilitation program, often involving immobilization for four to six weeks to protect the repair while the tendon heals. This overall rehabilitation process is necessary for regaining strength and motion.
Factors Influencing Long-Term Recovery and Outlook
The long-term success and functional outlook depend on several biological and patient-specific variables, regardless of the treatment path. Tear characteristics are highly influential, particularly the size and degree of tendon retraction. Larger tears and those where the tendon has pulled back significantly are associated with poorer healing rates and require a more cautious rehabilitation approach.
The underlying quality of the tissue also plays a determinant role in recovery. Factors like muscle atrophy and fatty infiltration can compromise the functional outcome. These degenerative changes make the tissue weaker and less elastic, slowing the healing process and increasing the risk of recurrence. Patient-related health factors, such as advanced age, smoking status, and diabetes, also negatively impact tendon healing.
The most actionable factor under the patient’s control is adherence to the post-treatment rehabilitation program, which is necessary for maximizing functional return. Modern treatment protocols offer a high likelihood of a successful functional return, though the process is slow, often requiring six to twelve months for substantial recovery. Understanding these variables allows for the development of a tailored treatment plan with realistic expectations for the eventual return to activity.