1018 - The Supraspinatus Strikes Back: Recurrent Rotator Cuff Tear After Surgical Repair

Case Diagnosis: Full thickness supraspinatus retear after rotator cuff repair

Case Description: A 66-year-old male with a history of diabetes and coronary artery disease presented to the rehabilitation clinic with persistent right shoulder pain. The pain began following an episode of heavy lifting and has remained severe (9-10/10), limiting overhead activities. He previously underwent arthroscopic supraspinatus repair a year ago, after which symptoms had resolved.

On examination, the patient demonstrated pain and limited range of motion with active shoulder abduction and positive Neer, Hawkins, and empty can tests, consistent with rotator cuff pathology. MRI of the right shoulder showed evidence of prior rotator cuff repair with a full-thickness retracted retear of the supraspinatus tendon, along with articular surface tears of the infraspinatus and subscapularis tendons. Despite orthopedic consultation regarding surgical options, the patient declined further operative intervention and has been engaged in physical therapy and using topical and oral anti-inflammatory medications for pain control.

Discussions: Rotator cuff repair is associated with retear rates ranging from 20–70%, influenced by age, comorbidities, tendon quality, and postoperative activity. Full-thickness supraspinatus retears are particularly common in older adults with degenerative tissue. Complications of retears include persistent pain, reduced range of motion, weakness, and progression to cuff arthropathy. Preventive measures include adherence to postoperative rehabilitation protocols, avoidance of heavy lifting in the early healing phase, and optimization of metabolic conditions such as diabetes, which can impair tendon healing. For patients unable or unwilling to undergo revision surgery, nonoperative management with structured rehabilitation, pain control, and activity modification remains central.

Conclusions: This case highlights a full-thickness retear of the supraspinatus tendon in a patient with prior surgical repair. Supraspinatus retears are common, particularly in older patients with medical comorbidities. Careful rehabilitation, patient education on activity precautions, and optimization of systemic health are essential in reducing the risk of recurrence and improving outcomes.