Bone and Joint Specialists E-Newsletter Archive
Subscapularis Tendon Tears
by Dr. Richard Bartholomew
The subscapularis muscle/tendon unit is known to play a major role in shoulder function and subscapularis tendon tears are attracting increasing recognition and interest. These subscapularis lesions are often partial tears that are easily missed, unlike complete tears, which are usually obvious. With the advancement of arthroscopic techniques and instrumentation these tears are now readily identified and repaired. Sometimes a partial subscapularis tear is incidentally visualized during other arthroscopic procedures. The subscapularis must be repaired to restore its tenodesis effect, to balance the force couple at the glenohumeral joint, and to prevent tear propagation.
The subscapularis was often only treated when it was a complete tear, and by traditional open methods. New instrumentation and techniques have been devised to treat the subscapularis via arthroscopic methods. This can be done at the same time that other pathology is treated. A better understanding of coracoid morphology also leads us to believe that a prominent or hooked coracoid causes subscapularis tearing (similar to the acromion process with supra/infraspinatous tears), therefore a coracoplasty is often performed as well. The biceps tendon is often injured in conjunction with the subscapularis because of its close proximity to the subscapularis. The medial sling of the biceps (as it lies in the intertubercular groove) is composed of the coracohumeral ligament and superior glenohumeral ligament. This often tears in conjunction with the subscapularis, thus a tenodesis or tenotomy is usually performed at the same time.Dr. Bartholomew treats painful shoulder conditions such as bursitis, tendonitis, calcium deposition, advanced arthritis, rotator cuff tears and frozen shoulder.
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