Subscapularis Tears

The subscapularis muscle is the largest and strongest muscle of the rotator cuff. It plays an essential role in the stability and function of the shoulder. Tears of the subscapularis tendon are more frequent than previously estimated. The worldwide use of arthroscopy in rotator cuff surgery has allowed to recognize the true prevalence of subscapularis lesions, as it permits to visualize the articular side where partial tears are usually localized. Subscapularis tears are generally non-traumatic, arising from intrinsic degeneration, subcoracoid and/or anterosuperior impingement. Clinical presentation is usually characterized by history of pain, typically located anteriorly, and difficulty in lifting movements across the chest, or twisting inwards that hinders activities of daily life. Special tests for the diagnosis of subscapularis tears include the lift-off, belly-press, and bear-hug tests. Imaging of the subscapularis tendon may involve plain radiography, magnetic resonance and ultrasound scanning, but MRI better characterizes subscapular tears and coexistent shoulder pathology. The management of subscapularis tears is aimed at restoring the integral role of this muscle in the shoulder. Operative management is indicated for most patients because it is the only one to allow restoration of subscapularis function. Arthroscopic repair can be safely and successfully performed. It requires tendon mobilization to reach the lesser tuberosity. If this is not possible, its footprint can be medialized up to 5-7 mm. Arthroscopic results are encouraging. At intermediate follow-up, improvement in functional scores and patient satisfaction has been reported. Outcomes are comparable to that of open repair, with a very low complication rate and no major intraoperative complications.