Subscapularis Tears

Category

Shoulder

Tears of the subscapularis tendon are less common than supraspinatus and infraspinatus tendon tears (commonly simply known as ' rotator cuff tears '). However, they can be much more painful, since the restraints to the long head of the biceps tendon are often also torn and the biceps tendon dislocates from its groove. The biceps tendon then also becomes painful and weak.

How is it diagnosed?
A person with a subscapularis tear will have pain at the front of the shoulder and weakness with activities that involve forward lifting, twisting the arm inwards, and sports. The clinician can detect the following on examination: increased passive external rotation, weak internal rotation, and positive tests for subscapularis tears

How is it treated?
Low demand and elderly patients can be well managed with physiotherapy rehabilitation.

In an active person, surgical repair is recommended. The surgery can be performed by arthroscopy or open surgery depending on the surgeon's expertise, tear pattern, and patient. If the biceps is affected a biceps tenodesis is generally required also.

Some tears may be too old (chronic) and large for direct repair. In these cases, a Pec Major transfer operation can be performed.

 

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