A 40-year-old falls on an abducted arm. She cannot initiate abduction but can complete it when passively brought past 15°. She has a positive drop arm sign. MRI confirms a complete supraspinatus tear with 3 cm retraction. What is the preferred management?
- A Physiotherapy and NSAID for 6 months
- B Arthroscopic rotator cuff repair ✓
- C Subacromial corticosteroid injection
- D Reverse total shoulder arthroplasty
Correct answer: B. Arthroscopic rotator cuff repair
Explanation
A complete full-thickness supraspinatus tear with 3 cm retraction in a 40-year-old active patient is a surgical indication. Arthroscopic repair restores anatomy, prevents further retraction and fatty degeneration, and achieves excellent functional outcomes in patients under 65. Conservative management is acceptable for small partial tears or frail patients with low demand. Reverse shoulder arthroplasty is reserved for massive irreparable tears with cuff-tear arthropathy, typically in elderly patients. Injection may mask symptoms but does not restore the torn tendon.
Reference: Maheshwari Essential Orthopaedics, 6th ed.
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Written and medically reviewed by the StethoPrep medical team.