Full-Thickness Supraspinatus Tear: Clinical Observation Report | Prolotherapy

Full-Thickness Supraspinatus Tendon Tear: Observations on Early Functional Response Following Injection Therapy - Full-thickness tears of the supraspinatus tendon represent a common condition in the adult population, particularly among individuals engaged in repetitive manual activities or exposed to chronic functional overload.

In clinical practice, the management of such lesions is often directed towards surgical tendon reconstruction, particularly in cases presenting with significant functional impairment. However, a proportion of patients decline surgical intervention or request a conservative approach.

The clinical response to injection-based treatments in the presence of a full-thickness tear is not standardisable and demonstrates considerable inter-individual variability. Systematic observation of individual cases may contribute to a better understanding of functional dynamics during the early stages of the therapeutic pathway.

Case Description

A 56-year-old male patient engaged in manual work reported right shoulder pain persisting for several months, without documented major trauma.

The initial clinical assessment revealed:

• nocturnal pain, with inability to lie on the affected side

• marked functional limitation

• complete loss of abduction against resistance

Direct ultrasound examination demonstrated a discontinuity of the supraspinatus tendon consistent with a full-thickness tear, subsequently confirmed by magnetic resonance imaging (MRI).

The patient had previously been evaluated by an orthopaedic specialist, who recommended surgical tendon reconstruction; this option was declined by the patient.

Procedure

An ultrasound-guided injection treatment was performed at the level of the supraspinatus and infraspinatus tendons.

The procedure was carried out according to standard technique, with real-time ultrasound guidance to ensure accurate needle placement and appropriate delivery of the solution into the peri-tendinous structures.

No immediate complications were observed.

30-Day Follow-Up

At clinical review one month later, the following findings were noted:

• significant reduction in pain symptoms

• partial recovery of active abduction up to approximately 30°

Abduction against resistance remained impaired, although less markedly than at the initial assessment.

Discussion

In the presence of a full-thickness supraspinatus tear, spontaneous anatomical structural recovery is unlikely. However, pain reduction and early functional improvement may be associated with several mechanisms, including:

• modulation of the local inflammatory response

• improvement in scapulohumeral biomechanics

• compensatory neuromuscular adaptation

• individual biological variability

Based on a single case and short-term follow-up, it is not possible to attribute the observed clinical improvement exclusively to the injection procedure.

Rather, this case highlights a central aspect of real-world clinical practice: functional response is not binary (success/failure), but gradual and multifactorial.

Final Considerations

This case confirms that:

• therapeutic decisions must be individualised

• early clinical evolution may differ from theoretical expectations

• systematic case observation contributes to understanding outcome variability

Medium- and long-term follow-up are necessary to assess the stability of improvement and the potential evolution of the functional condition.

PROLOTHERAPT FAQ –

Clinical Observation Report

Full-Thickness Supraspinatus Tear

1️⃣ Can a full-thickness supraspinatus tear heal without surgery?

Full-thickness supraspinatus tendon tears do not typically achieve spontaneous anatomical healing. However, some patients may experience symptomatic and functional improvement through biological adaptation and neuromuscular compensation. Management should always be individualised.

2️⃣ Does pain reduction mean the tendon has structurally repaired?

Not necessarily. Pain reduction may result from several mechanisms, including modulation of local inflammation, changes in tendon loading patterns, or improved motor control. Clinical improvement does not automatically imply complete structural restoration.

3️⃣ Is prolotherapy indicated for full-thickness supraspinatus tears?

Therapeutic indication depends on the overall clinical context, patient age, functional demands, imaging findings, and patient preference. In cases where surgery is declined or not indicated, conservative strategies may be considered. Treatment decisions should always be made in consultation with a qualified healthcare professional.

4️⃣ How predictable are the outcomes of injection-based treatments?

Response to injection-based therapies shows significant inter-individual variability. It is not possible to reliably predict the magnitude or duration of clinical improvement based on a single case observation.

5️⃣ Is early functional improvement a definitive result?

Early functional changes represent an initial phase of clinical evolution. Medium- and long-term follow-up are necessary to assess stability, progression, or potential deterioration of the condition.

6️⃣ Why publish individual clinical observations?

Single case observations do not constitute evidence of efficacy. However, they contribute to the understanding of biological variability and the complexity of real-world clinical practice. Clinical Observation Reports are intended for documentation and critical reflection, not promotional purposes.

Disclaimer - This clinical case is presented for informational and scientific discussion purposes only. The results described are not generalisable nor predictive of individual outcomes. Therapeutic decisions must always be individualised and made in consultation with the treating physician based on a comprehensive clinical evaluation.