I had the good fortune to work for an upper extremities orthopedic surgeon several years ago. He performed many successful rotator cuff repair surgeries. Quite a few of the surgeries were performed on total separations (100% tear of the supraspinatus). He also recommended conservative treatment (physical therapy) for many patients who had less severe injuries to the supraspinatus.
I also noticed that either surgery in combination with physical therapy, or physical therapy alone, as the two primary methods of treatment, both took about the same time for recovery for the patients who only had partial tears. The recovery time was as long as ONE YEAR to full recovery for some patients in either group. The only drawback to surgical intervention other than the obvious risks, was the additional scar tissues in the shoulder region.
One problem that occurred in most patients with a supraspinatus injury was subacromial impingement. Inflammation from the injury was the major contributing factor for most patients. Although, some patients had a visibly reduced subacromial space seen on x-rays. Overuse injuries can also cause impingement. Impingement occurs when the area in the subacromial space that typically allows for normal movement of the supraspinatus tendon becomes greatly diminished due to inflammation. Impingement causes additional pain and loss of normal range of motion secondary to the initial injury. If surgery was to be performed to repair the supraspinatus, in some cases, a subacromial decompression was performed at the same time to help prevent future problems with impingement.
In conservative treatment, it seemed obvious to me that shoulder (glenohumeral) stability and inflammation management should be the primary goal of physical therapy. Typical physical therapy would work on internal and external rotation and abduction exercises with some stretching. Completely missing the scapular stabilizing exercises.
After spending time reviewing the biomechanics of the whole shoulder complex, I realized that strengthening the muscles that retracted and depressed the scapula (middle and lower trapezius and rhomboids), strengthening the external rotators (infraspinatus and teres minor), and very cautious exercise of the effected the supraspinatus would probably work quite well.
I also realized that managing inflammation was imperative. Immediate R.I.C.E. after all physical modalities on the effected shoulder to manage inflammation. N.S.A.I.D.’s could also be beneficial in conjunction with R.I.C.E.
I know this conservative approach worked quite well due to fact that I had to use it on my own partial supraspinatus tear!
After about one year I was stronger then I was pre-injury! I attribute my recovery to better stability, better muscular proprioception and better form when lifting heavy loads.
Either way you decide to go, take your time to avoid re-injury. Manage it well and you will be better then before!
I hope this sheds some light!