Supraspinatus tendon tear

Supraspinatus tendon tears are rotator cuff injuries affecting the supraspinatus tendon and are a common cause of shoulder pain.

Epidemiology

They are the most common rotator cuff injuries and around 1/3 of them are isolated only affecting the supraspinatus tendon ¹. Incidence is estimated to be around 6.7% for complete thickness supraspinatus tears ^2,3.

Clinical presentation

Patients will present with shoulder pain and tenderness along the supraspinatus tendon. Many might present with a limited range of motion, especially in abduction. The Jobe test can be performed to elicit any injury to this tendon ². Atrophy of the muscle may be visible in chronic cases.

Associations

Supraspinatus tendon tears are often associated with other types of rotator cuff injuries including posterosuperior tear extension into the infraspinatus tendon and muscle and the rotator interval. Other associated conditions include the following:

• acromioclavicular joint osteoarthritis

• proximal biceps tendon injury

• superior labral anterior posterior (SLAP) lesions

Pathology

Classification

A modification of the original Codman classification (1930) may be used to categorize tears:

• full-thickness tear 

  • Fosbury flop tear

• partial-thickness tear

  • ​intrasubstance tear: not in communication with the joint surface or with the bursal surface of the tendon ⁷

  • articular-sided tear

    • rim rent tear: articular surface tear of the footprint

    • tendon delamination or interstitial tear

    • cleavage tear: tendon delamination with fluid signal intensity filling the gap

  • bursal-sided tear

• critical zone tear: partial or full-thickness

Radiographic features

Plain radiograph

Signs of calcific tendonitis may be visible around the greater tubercle. There might be signs of cystic changes in the greater tubercle. Superior migration of the proximal humerus might be noted with large rotator cuff tears or rotator cuff athropathy.

Ultrasound

Sensitivity is around 93% and specificity is around 89% for isolated supraspinatus tendon injury. The study has noted a significant difference in diagnosing partial tear of this tendon with ultrasound compared to MRI, but no significant difference in diagnosing full thickness or chronic tears ⁶. It also allows for dynamic evaluation of the tear and tendon.

MRI

MRI remains the gold standard in the diagnosis of supraspinatus tendon injury. MRI can play an important role in diagnosis as well as in pre-operative planning. It can help in diagnosing the size of the tear, retraction, location of the tear, muscle atrophy, level of fatty infiltration or any other degenerative changes.

Treatment and prognosis

Prognosis and therapeutical decision are based on the patient age, activity level, size of tear and mechanism of tear ^4,7. Small isolated tears in younger patients <65 years do not necessarily progress with time ⁷. They can be managed conservatively or with surgical options. Conservative options include physiotherapy, corticosteroid injections or non-steroidal anti-inflammatories. Surgical options include arthroscopic or open repair of the tendon. Re-tears after isolated tendon repair is around 17% ⁸.

Differential diagnosis

• infraspinatus tendon tear