Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 27, Issue 1, pp 277–288 | Cite as

A novel diagnostic method to predict subscapularis tendon tear with sagittal oblique view magnetic resonance imaging

  • Jae Woo Shim
  • Chae Hyun Pang
  • Seul Ki Min
  • Jeung Yeol Jeong
  • Jae Chul YooEmail author



To find novel measurement guidelines correlating with known tear size on two sagittal oblique views (en-face view and Y-view).


From a series of arthroscopic rotator cuff repair cases between 2012 and 2015, 50 patients were randomly selected from each of six subscapularis tear classifications. Due to rarity of type IV lesions, 272 shoulders were included. En-face view and Y-view in sagittal plane MRI were selected. Image evaluation was retrospectively performed by two researchers independently. In en-face view, anatomical line connecting the coracoid tip to the glenoid base designated as the base-to-tip line was used for thickness measurement and classification. Grading according to base-to-tip line, overlapped segment of base-to-tip line, thickness of subscapularis, and fluid accumulation were measured. In Y-view, a tangent line was drawn through the scapular spine and the coracoid. Parallel lines were then made. Grading according to tangent line, vertical length, cephalic width, caudal width, and fluid accumulation was measured.


In en-face view, grading according to base-to-tip line and overlapped segment of base-to-tip line showed differences in subscapularis tendon tear types IIB, III, and IV compared to the normal group. Thickness of subscapularis showed differences in types III and IV. No significant difference was observed in fluid accumulation. In Y-view, grading according to tangent line, vertical length, cephalic width, and fluid accumulation showed significant differences in types III and IV. Caudal width in Y-view was significantly different only in type IV.


Several measurement parameters in two additional views in sagittal–oblique MRI (en-face view and Y-view) showed different degrees of subscapularis tendon tears. Grading of base-to-tip line is easy to use and helps diagnose partial subscapularis tear.

Level of evidence



Arthroscopy Magnetic resonance imaging Subscapularis tendon Rotator cuff 



There is no funding source.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

Ethical approval for this study was granted following review by Samsung Medical Center Institutional Review Board. (reference number SMC 2016-12-070).

Informed consent

IRB waived the requirement for informed patient consent.


  1. 1.
    Adams CR, Brady PC, Koo SS, Narbona P, Arrigoni P, Karnes GJ, Burkhart SS (2012) A systematic approach for diagnosing subscapularis tendon tears with preoperative magnetic resonance imaging scans. Arthroscopy 28:1592–1600CrossRefPubMedGoogle Scholar
  2. 2.
    Arai R, Sugaya H, Mochizuki T, Nimura A, Moriishi J, Akita K (2008) Subscapularis tendon tear: an anatomic and clinical investigation. Arthroscopy 24:997–1004CrossRefPubMedGoogle Scholar
  3. 3.
    Bartl C, Salzmann GM, Seppel G, Eichhorn S, Holzapfel K, Wortler K, Imhoff AB (2011) Subscapularis function and structural integrity after arthroscopic repair of isolated subscapularis tears. Am J Sports Med 39:1255–1262CrossRefPubMedGoogle Scholar
  4. 4.
    Bennett WF (2001) Subscapularis, medial, and lateral head coracohumeral ligament insertion anatomy. Arthroscopic appearance and incidence of “hidden” rotator interval lesions. Arthroscopy 17:173–180CrossRefPubMedGoogle Scholar
  5. 5.
    Codman EA (1934) Rupture of the supraspinatus tendon and other lesions in or about the subacromial bursa. In: The shoulder. Thomas Todd, Boston, pp 262–312Google Scholar
  6. 6.
    Colas F, Nevoux J, Gagey O (2004) The subscapular and subcoracoid bursae: descriptive and functional anatomy. J Shoulder Elbow Surg 13:454–458CrossRefPubMedGoogle Scholar
  7. 7.
    Deutsch A, Altchek DW, Veltri DM, Potter HG, Warren RF (1997) Traumatic tears of the subscapularis tendon. Clinical diagnosis, magnetic resonance imaging findings, and operative treatment. Am J Sports Med 25:13–22CrossRefPubMedGoogle Scholar
  8. 8.
    Goutallier D, Postel JM, Bernageau J, Lavau L, Voisin MC (1994) Fatty muscle degeneration in cuff ruptures. Pre- and postoperative evaluation by CT scan. Clin Orthop Relat Res 304:78–83Google Scholar
  9. 9.
    Iannotti JP, Zlatkin MB, Esterhai JL, Kressel HY, Dalinka MK, Spindler KP (1991) Magnetic resonance imaging of the shoulder. Sensitivity, specificity, and predictive value. J Bone Joint Surg Am 73:17–29CrossRefPubMedGoogle Scholar
  10. 10.
    Ide J, Tokiyoshi A, Hirose J, Mizuta H (2008) An anatomic study of the subscapularis insertion to the humerus: the subscapularis footprint. Arthroscopy 24:749–753CrossRefPubMedGoogle Scholar
  11. 11.
    Kappe T, Sgroi M, Reichel H, Daexle M (2018) Diagnostic performance of clinical tests for subscapularis tendon tears. Knee Surg Sports Traumatol Arthrosc 26:176–181CrossRefPubMedGoogle Scholar
  12. 12.
    Lafosse L, Jost B, Reiland Y, Audebert S, Toussaint B, Gobezie R (2007) Structural integrity and clinical outcomes after arthroscopic repair of isolated subscapularis tears. J Bone Joint Surg Am 89:1184–1193CrossRefPubMedGoogle Scholar
  13. 13.
    Lin L, Yan H, Xiao J, He Z, Luo H, Cheng X, Ao Y, Cui G (2016) The diagnostic value of magnetic resonance imaging for different types of subscapularis lesions. Knee Surg Sports Traumatol Arthrosc 24:2252–2258CrossRefPubMedGoogle Scholar
  14. 14.
    McGarvey C, Harb Z, Smith C, Houghton R, Corbett S, Ajuied A (2016) Diagnosis of rotator cuff tears using 3-Tesla MRI versus 3-Tesla MRA: a systematic review and meta-analysis. Skelet Radiol 45:251–261CrossRefGoogle Scholar
  15. 15.
    Melis B, Nemoz C, Walch G (2009) Muscle fatty infiltration in rotator cuff tears: descriptive analysis of 1688 cases. Orthop Traumatol Surg Res 95:319–324CrossRefPubMedGoogle Scholar
  16. 16.
    Morrison DS, Ofstein R (1990) The use of magnetic resonance imaging in the diagnosis of rotator cuff tears. Orthopedics 13:633–637PubMedGoogle Scholar
  17. 17.
    Naimark M, Zhang AL, Leon I, Trivellas A, Feeley BT, Ma CB (2016) Clinical, radiographic, and surgical presentation of subscapularis tendon tears: a retrospective analysis of 139 patients. Arthroscopy 32:747–752CrossRefPubMedGoogle Scholar
  18. 18.
    Nakagaki K, Ozaki J, Tomita Y, Tamai S (1995) Function of supraspinatus muscle with torn cuff evaluated by magnetic resonance imaging. Clin Orthop Relat Res 318:144–151Google Scholar
  19. 19.
    Pfirrmann CW, Zanetti M, Weishaupt D, Gerber C, Hodler J (1999) Subscapularis tendon tears: detection and grading at MR arthrography. Radiology 213:709–714CrossRefPubMedGoogle Scholar
  20. 20.
    Rowshan K, Hadley S, Pham K, Caiozzo V, Lee TQ, Gupta R (2010) Development of fatty atrophy after neurologic and rotator cuff injuries in an animal model of rotator cuff pathology. J Bone Joint Surg Am 92:2270–2278CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Ryu HY, Song SY, Yoo JC, Yun JY, Yoon YC (2016) Accuracy of sagittal oblique view in preoperative indirect magnetic resonance arthrography for diagnosis of tears involving the upper third of the subscapularis tendon. J Shoulder Elbow Surg 25:1944–1953CrossRefPubMedGoogle Scholar
  22. 22.
    Scheibel M, Tsynman A, Magosch P, Schroeder RJ, Habermeyer P (2006) Postoperative subscapularis muscle insufficiency after primary and revision open shoulder stabilization. Am J Sports Med 34:1586–1593CrossRefPubMedGoogle Scholar
  23. 23.
    Sela Y, Eshed I, Shapira S, Oran A, Vogel G, Herman A, Perry Pritsch M (2015) Rotator cuff tears: correlation between geometric tear patterns on MRI and arthroscopy and pre- and postoperative clinical findings. Acta Radiol 56:182–189CrossRefPubMedGoogle Scholar
  24. 24.
    Smith TO, Daniell H, Geere JA, Toms AP, Hing CB (2012) The diagnostic accuracy of MRI for the detection of partial- and full-thickness rotator cuff tears in adults. Magn Reson Imaging 30:336–346CrossRefPubMedGoogle Scholar
  25. 25.
    Tung GA, Yoo DC, Levine SM, Brody JM, Green A (2001) Subscapularis tendon tear: primary and associated signs on MRI. J Comput Assist Tomogr 25:417–424CrossRefPubMedGoogle Scholar
  26. 26.
    Tuoheti Y, Itoi E, Minagawa H, Wakabayashi I, Kobayashi M, Okada K, Shimada Y (2005) Quantitative assessment of thinning of the subscapularis tendon in recurrent anterior dislocation of the shoulder by use of magnetic resonance imaging. J Shoulder Elbow Surg 14:11–15CrossRefPubMedGoogle Scholar
  27. 27.
    Vidt ME, Santago AC II, Tuohy CJ, Poehling GG, Freehill MT, Kraft RA, Marsh AP, Hegedus EJ, Miller ME, Saul KR (2016) Assessments of fatty infiltration and muscle atrophy from a single magnetic resonance image slice are not predictive of 3-dimensional measurements. Arthroscopy 32:128–139CrossRefPubMedGoogle Scholar
  28. 28.
    Ward JRN, Lotfi N, Dias RG, McBride TJ (2018) Diagnostic difficulties in the radiological assessment of subscapularis tears. J Orthop 15:99–101CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Warner JJ, Higgins L, Parsons IM, Dowdy P (2001) Diagnosis and treatment of anterosuperior rotator cuff tears. J Shoulder Elbow Surg 10:37–46CrossRefPubMedGoogle Scholar
  30. 30.
    Yoo JC, Rhee YG, Shin SJ, Park YB, McGarry MH, Jun BJ, Lee TQ (2015) Subscapularis tendon tear classification based on 3-dimensional anatomic footprint: a cadaveric and prospective clinical observational study. Arthroscopy 31:19–28CrossRefPubMedGoogle Scholar
  31. 31.
    Zanetti M, Gerber C, Hodler J (1998) Quantitative assessment of the muscles of the rotator cuff with magnetic resonance imaging. Invest Radiol 33:163–170CrossRefPubMedGoogle Scholar

Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2018

Authors and Affiliations

  1. 1.Department of Orthopedic Surgery, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulSouth Korea
  2. 2.Department of Orthopedic Surgery, Dong-Tan Sacred Heart HospitalHallym University School of MedicineHwasungSouth Korea

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