A partial thickness tear of the supraspinatus tendon involves damage to the tissue that forms part of the rotator cuff in the shoulder. The supraspinatus tendon is located on the upper part of the shoulder blade and is essential for lifting the arm away from the body and stabilizing the joint. A partial tear means that some tendon fibers are damaged or frayed, but the tendon has not been completely severed. This condition commonly causes shoulder pain and weakness, often aggravated by overhead activities and persistent discomfort, particularly at night. Treatment aims to reduce pain, restore function, and prevent the tear from progressing to a full-thickness rupture.
Initial Conservative Treatment Strategies
The first-line approach for managing a partial thickness supraspinatus tear is conservative, focusing on reducing inflammation and protecting the tendon from further stress. This initial phase often lasts for several weeks or months and centers on activity modification, requiring the avoidance of painful movements, such as lifting the arm overhead or carrying heavy objects. Rest helps calm acute irritation within the tendon.
Pharmaceutical management includes non-steroidal anti-inflammatory drugs (NSAIDs), which are used to manage pain and swelling around the tendon. Physical therapy begins almost immediately, focusing initially on maintaining passive range of motion and improving the mechanics of the shoulder blade and joint. Therapists guide patients through exercises designed to promote proper shoulder mechanics and postural control without placing excessive strain on the injured tendon.
This early rehabilitation phase seeks to prevent shoulder stiffness while strengthening the surrounding rotator cuff muscles, which stabilizes the joint. The goal is to maximize shoulder function and minimize pain, allowing the tendon time to heal. Success in this initial conservative treatment is common, especially for smaller tears, and often prevents the need for more invasive procedures.
Advanced Non-Surgical Interventions
When symptoms persist after three to six months of initial conservative care, advanced non-surgical options are considered before surgery. Therapeutic injections are a primary intervention, with corticosteroid injections being a common choice for their anti-inflammatory effects. These injections are often ultrasound-guided to ensure accurate placement, providing short-term pain relief and allowing the patient to engage more effectively in physical therapy.
A biological approach involves Platelet-Rich Plasma (PRP) therapy, which uses a concentration of the patient’s own platelets, rich in growth factors, injected directly into the tear site. PRP aims to stimulate the body’s natural healing process and promote tissue regeneration.
Advanced physical therapy techniques are also employed in this phase, moving beyond basic range-of-motion work to more aggressive strengthening and manual therapy. This includes targeted resistance exercises and hands-on techniques to improve muscle endurance and loosen stiff tissues. These techniques push the limits of the shoulder’s functional capacity to prepare it for return to activity, following a careful assessment of the patient’s progress.
Surgical Repair Considerations
Surgical intervention is reserved for patients who have persistent, significant pain and functional limitations despite a dedicated course of non-operative treatment lasting six months or more. The decision to operate is influenced by the tear size; tears involving more than 50% of the tendon thickness are considered for repair due to the risk of progression. Patient factors, such as age, activity level, and occupation, also play a significant role in surgical planning.
The goal of surgery is to debride, repair, or smooth the damaged tendon tissue, often performed arthroscopically through small incisions. For smaller partial tears (less than 50% thickness), the surgeon may perform a debridement, which involves smoothing the frayed edges, often combined with an acromioplasty to remove irritating bone spurs. For larger tears, a formal repair is performed, which may involve in situ repair or converting the partial tear to a full-thickness tear and securing it to the bone using suture anchors.
The choice of procedure depends on the tear’s location, the quality of the surrounding tissue, and the risk of long-term progression. While arthroscopic methods are favored for their minimally invasive nature, success hinges on proper patient selection and meticulous post-operative rehabilitation.
Post-Treatment Physical Rehabilitation
Following any significant intervention, particularly surgical repair, a structured, multi-phase physical rehabilitation program is essential for achieving a successful outcome. The process is divided into distinct stages to protect the healing tissue while progressively restoring full function. The initial phase lasts several weeks and focuses on protection and pain management, often requiring a sling to immobilize the shoulder and protect the repair site.
The next phase introduces passive range of motion, where the therapist or the patient moves the injured arm gently without using the repaired muscles. This is followed by active-assisted and then active range of motion phases, gradually allowing the patient to use their own muscles through increasing arcs of motion.
The final and longest phase is dedicated to strength training, starting with light resistance and progressing to challenging exercises designed to rebuild the endurance and power of the shoulder girdle. Exercises often use elastic bands or light weights, aiming to regain at least 80 to 90% of the pre-injury range of motion. The entire process can take many months, with the tendon requiring up to a year or more for full maturation. Patient adherence to the long-term, home-based exercise program is a defining factor in the quality of the final recovery.