Subscapularis Tendon Tear: Primary and Associated Signs on MRI

Purpose: The purpose of this work was to investigate signs of subscapularis tendon tear on MRI.

Method: Preoperative written interpretations of high field (n = 9) and low field (n = 7) MRI of 16 patients with tears confirmed at surgery or arthroscopy were reviewed, followed by retrospective review of these studies.

Results: A preoperative diagnosis of subscapularis tear was made in five (31%) cases. On retrospective review, primary signs of tear were present in 15 (94%) cases and in two-thirds were limited to the cranial third of the tendon. Supraspinatus tears were present in 69% of cases. Associated findings included medial dislocation (n = 4) or subluxation (n = 3) of biceps tendon, biceps tendinopathy (n = 2), superior labral tear (n = 5), and effusions of superior subscapularis recess (n = 6), subcoracoid bursa (n = 2), or both (n = 5). One or more associated signs were present in 94% of cases.

Conclusion: Subscapularis tear is frequently missed on MRI. Recognizing that primary signs of tear may be limited to the cranial third of the subscapularis tendon and identifying associated signs should facilitate diagnosis.