Skip to main content
SpringerLink
Log in

Subscapularis Tears

  • Chapter
  • First Online:
Arthroscopy

  • 2733 Accesses

Abstract

The subscapularis (SSC) muscle is the largest and strongest muscle of the rotator cuff. It allows active internal rotation of the humerus, provides anterior stability of the shoulder, and is involved in maintaining balanced force couples of the glenohumeral joint in the transverse plane [1, 2]. Anatomic studies reported different shapes for its insertion on the lesser tuberosity: comma, Nevada state, ear, and trapezoid [3–8]. It has been shown that the superior two-thirds of the SSC insertion are tendinous, while the inferior third is muscular and directly attached to the humerus through a thin membranous structure. The upper part of its insertion extends in a thin tendinous slip, which is attached to the fovea capitis of the humerus [3]. The size of its footprint widely varies between 25 and 51 mm in mean length and 9.5 and 18.1 mm in mean width [3–8].

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 149.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 199.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 279.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Burkhart SS, Lo IKY. Arthroscopic rotator cuff repair. J Am Acad Orthop Surg. 2006;14:333–46.

    Article  PubMed  Google Scholar 

  2. Longo UG, Berton A, Marinozzi A, et al. Subscapularis tears. Med Sports Sci. 2012;57:114–21. doi:10.1159/000328886.

    Article  Google Scholar 

  3. Arai R, Sugaya H, Mochizuki T, et al. Subscapularis tendon tear: an anatomic and clinical investigation. Arthroscopy. 2008;24:997–1004. doi:10.1016/j.arthro.2008.04.076.

    Article  PubMed  Google Scholar 

  4. Curtis AS, Burbank KM, Tierney JJ, et al. The insertional footprint of the rotator cuff: an anatomic study. Arthroscopy. 2006;22:609.e1. doi:10.1016/j.arthro.2006.04.001.

    Article  PubMed  Google Scholar 

  5. D’Addesi LL, Anbari A, Reish MW, et al. The subscapularis footprint: an anatomic study of the subscapularis tendon insertion. Arthroscopy. 2006;22:937–40. doi:10.1016/j.arthro.2006.04.101.

    Article  PubMed  Google Scholar 

  6. Ide J, Tokiyoshi A, Hirose J, Mizuta H. An anatomic study of the subscapularis insertion to the humerus: the subscapularis footprint. Arthroscopy. 2008;24:749–53. doi:10.1016/j.arthro.2008.02.009.

    Article  PubMed  Google Scholar 

  7. Richards DP, Burkhart SS, Tehrany AM, Wirth MA. The subscapularis footprint: an anatomic description of its insertion site. Arthroscopy. 2007;23:251–4. doi:10.1016/j.arthro.2006.11.023.

    Article  PubMed  Google Scholar 

  8. Yoo JC, Rhee YG, Shin SJ, et al. Subscapularis tendon tear classification based on 3-dimensional anatomic footprint: a cadaveric and prospective clinical observational study. Arthroscopy. 2015;31:19–28. doi:10.1016/j.arthro.2014.08.015.

    Article  PubMed  Google Scholar 

  9. Gerber C, Hersche O, Farron A. Isolated rupture of the subscapularis tendon. J Bone Joint Surg Am. 1996;78:1015–23.

    CAS  PubMed  Google Scholar 

  10. Bennett WF. Arthroscopic repair of isolated subscapularis tears: a prospective cohort with 2- to 4-year follow-up. Arthroscopy. 2003;19:131–43. doi:10.1053/jars.2003.50053.

    Article  PubMed  Google Scholar 

  11. Burkhart SS, Tehrany AM. Arthroscopic subscapularis tendon repair: technique and preliminary results. Arthroscopy. 2002;18:454–63. doi:10.1053/jars.2002.30648.

    Article  PubMed  Google Scholar 

  12. Lafosse L, Jost B, Reiland Y, et al. Structural integrity and clinical outcomes after arthroscopic repair of isolated subscapularis tears. J Bone Joint Surg Am. 2007;89:1184–93. doi:10.2106/JBJS.F.00007.

    PubMed  Google Scholar 

  13. Lanz U, Fullick R, Bongiorno V, et al. Arthroscopic repair of large subscapularis tendon tears: 2- to 4-year clinical and radiographic outcomes. Arthroscopy. 2013;29:1471–8. doi:10.1016/j.arthro.2013.06.004.

    Article  PubMed  Google Scholar 

  14. Bennett WF. Subscapularis, medial, and lateral head coracohumeral ligament insertion anatomy. Arthroscopic appearance and incidence of “hidden” rotator interval lesions. Arthroscopy. 2001;17:173–80.

    Article  CAS  PubMed  Google Scholar 

  15. Li XX, Schweitzer ME, Bifano JA, et al. MR evaluation of subscapularis tears. J Comput Assist Tomogr. 1999;23:713–7.

    Article  CAS  PubMed  Google Scholar 

  16. Warner JJ, Higgins L, Parsons IM, Dowdy P. Diagnosis and treatment of anterosuperior rotator cuff tears. J Should Elb Surg. 2001;10:37–46. doi:10.1067/mse.2001.112022.

    Article  CAS  Google Scholar 

  17. Kim TK, Rauh PB, McFarland EG. Partial tears of the subscapularis tendon found during arthroscopic procedures on the shoulder: a statistical analysis of sixty cases. Am J Sports Med. 2003;31:744–50.

    PubMed  Google Scholar 

  18. Lo IKY, Burkhart SS. The etiology and assessment of subscapularis tendon tears: a case for subcoracoid impingement, the roller-wringer effect, and TUFF lesions of the subscapularis. Arthroscopy. 2003;19:1142–50. doi:10.1016/j.arthro.2003.10.024.

    Article  PubMed  Google Scholar 

  19. Le Huec JC, Schaeverbeke T, Moinard M, et al. Traumatic tear of the rotator interval. J Should Elb Surg. 1996;5:41–6.

    Article  Google Scholar 

  20. Deutsch A, Altchek DW, Veltri DM, et al. Traumatic tears of the subscapularis tendon. Clinical diagnosis, magnetic resonance imaging findings, and operative treatment. Am J Sports Med. 1997;25:13–22.

    Article  CAS  PubMed  Google Scholar 

  21. Gerber C, Krushell RJ. Isolated rupture of the tendon of the subscapularis muscle. Clinical features in 16 cases. J Bone Joint Surg (Br). 1991;73:389–94.

    CAS  Google Scholar 

  22. Haas JC, Meyers MC. Rock climbing injuries. Sports Med. 1995;20:199–205.

    Article  CAS  PubMed  Google Scholar 

  23. Symeonides PP. The significance of the subscapularis muscle in the pathogenesis of recurrent anterior dislocation of the shoulder. J Bone Joint Surg (Br). 1972;54:476–83.

    CAS  Google Scholar 

  24. Neviaser RJ, Neviaser TJ. Recurrent instability of the shoulder after age 40. J Should Elb Surg. 1995;4:416–8.

    Article  CAS  Google Scholar 

  25. DePalma AF, Cooke AJ, Prabhakar M. The role of the subscapularis in recurrent anterior dislocations of the shoulder. Clin Orthop Relat Res. 1967;54:35–49.

    Article  CAS  PubMed  Google Scholar 

  26. Walch G, Nové-Josserand L, Boileau P, Levigne C. Subluxations and dislocations of the tendon of the long head of the biceps. J Should Elb Surg. 1998;7:100–8.

    Article  CAS  Google Scholar 

  27. Gerber C, Sebesta A. Impingement of the deep surface of the subscapularis tendon and the reflection pulley on the anterosuperior glenoid rim: a preliminary report. J Should Elb Surg. 2000;9:483–90. doi:10.1067/mse.2000.109322.

    Article  CAS  Google Scholar 

  28. Collin P, Matsumura N, Lädermann A, et al. Relationship between massive chronic rotator cuff tear pattern and loss of active shoulder range of motion. J Should Elb Surg. 2014;23:1195–202. doi:10.1016/j.jse.2013.11.019.

    Article  Google Scholar 

  29. Lin L, Yan H, Xiao J, et al. Internal rotation resistance test at abduction and external rotation: a new clinical test for diagnosing subscapularis lesions. Knee Surg Sports Traumatol Arthrosc. 2015;23:1247–52. doi:10.1007/s00167-013-2808-1.

    Article  PubMed  Google Scholar 

  30. Roy J-S, Braën C, Leblond J, et al. Diagnostic accuracy of ultrasonography, MRI and MR arthrography in the characterisation of rotator cuff disorders: a systematic review and meta-analysis. Br J Sports Med. 2015;49:1316–28. doi:10.1136/bjsports-2014-094148.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Garavaglia G, Ufenast H, Taverna E. The frequency of subscapularis tears in arthroscopic rotator cuff repairs: a retrospective study comparing magnetic resonance imaging and arthroscopic findings. Int J Should Surg. 2011;5:90–4. doi:10.4103/0973-6042.91000.

    Article  Google Scholar 

  32. Adams CR, Schoolfield JD, Burkhart SS. Accuracy of preoperative magnetic resonance imaging in predicting a subscapularis tendon tear based on arthroscopy. Arthroscopy. 2010;26:1427–33. doi:10.1016/j.arthro.2010.02.028.

    Article  PubMed  Google Scholar 

  33. Adams CR, Brady PC, Koo SS, et al. A systematic approach for diagnosing subscapularis tendon tears with preoperative magnetic resonance imaging scans. Arthroscopy. 2012;28:1592–600. doi:10.1016/j.arthro.2012.04.142.

    Article  PubMed  Google Scholar 

  34. Foad A, Wijdicks CA. The accuracy of magnetic resonance imaging and magnetic resonance arthrogram versus arthroscopy in the diagnosis of subscapularis tendon injury. Arthroscopy. 2012;28:636–41. doi:10.1016/j.arthro.2011.10.006.

    Article  PubMed  Google Scholar 

  35. Vinson EN, Wittstein J, Garrigues GE, Taylor DC. MRI of selected abnormalities at the anterior superior aspect of the shoulder: potential pitfalls and subtle diagnoses. AJR Am J Roentgenol. 2012;199:534–45. doi:10.2214/AJR.12.8789.

    Article  PubMed  Google Scholar 

  36. Furukawa R, Morihara T, Arai Y, et al. Diagnostic accuracy of magnetic resonance imaging for subscapularis tendon tears using radial-slice magnetic resonance images. J Should Elb Surg. 2014;23:e283–90. doi:10.1016/j.jse.2014.03.011.

    Article  Google Scholar 

  37. Shi LL, Mullen MG, Freehill MT, et al. Accuracy of long head of the biceps subluxation as a predictor for subscapularis tears. Arthroscopy. 2015;31:615–9. doi:10.1016/j.arthro.2014.11.034.

    Article  PubMed  Google Scholar 

  38. Omid R, Lee B. Tendon transfers for irreparable rotator cuff tears. J Am Acad Orthop Surg. 2013;21:492–501. doi:10.5435/JAAOS-21-08-492.

    Article  PubMed  Google Scholar 

  39. Nelson GN, Namdari S, Galatz L, Keener JD. Pectoralis major tendon transfer for irreparable subscapularis tears. J Should Elb Surg. 2014;23:909–18. doi:10.1016/j.jse.2013.12.035.

    Article  Google Scholar 

  40. Shin JJ, Saccomanno MF, Cole BJ, et al. Pectoralis major transfer for treatment of irreparable subscapularis tear: a systematic review. Knee Surg Sports Traumatol Arthrosc. 2014. doi:10.1007/s00167-014-3229-5.

    Google Scholar 

  41. Burkhart SS, Lo IK, Brady PC. Burkhart’s view of the shoulder: a cowboy’s guide to advanced shoulder arthroscopy. Philadelphia: Lippincott Williams and Wilkins; 2006.

    Google Scholar 

  42. Pfirrmann CW, Zanetti M, Weishaupt D, et al. Subscapularis tendon tears: detection and grading at MR arthrography. Radiology. 1999;213:709–14. doi:10.1148/radiology.213.3.r99dc03709.

    Article  CAS  PubMed  Google Scholar 

  43. Goutallier D, Postel JM, Bernageau J, et al. Fatty muscle degeneration in cuff ruptures. Pre- and postoperative evaluation by CT scan. Clin Orthop Relat Res. 1994;304:78–83.

    Google Scholar 

  44. Lo IKY, Burkhart SS. The comma sign: an arthroscopic guide to the torn subscapularis tendon. Arthroscopy. 2003;19:334–7. doi:10.1053/jars.2003.50080.

    Article  PubMed  Google Scholar 

  45. Ticker JB, Burkhart SS. Why repair the subscapularis? A logical rationale. Arthroscopy. 2011;27:1123–8. doi:10.1016/j.arthro.2011.03.001.

    Article  PubMed  Google Scholar 

  46. Denard PJ, Lädermann A, Burkhart SS. Arthroscopic management of subscapularis tears. Sports Med Arthrosc. 2011;19:333–41. doi:10.1097/JSA.0b013e31822d41c6.

    Article  PubMed  Google Scholar 

  47. Burkhart SS, Brady PC. Arthroscopic subscapularis repair: surgical tips and pearls A to Z. Arthroscopy. 2006;22:1014–27. doi:10.1016/j.arthro.2006.07.020.

    Article  PubMed  Google Scholar 

  48. Lo IKY, Burkhart SS, Parten PM. Surgery about the coracoid: neurovascular structures at risk. Arthroscopy. 2004;20:591–5.

    Article  PubMed  Google Scholar 

  49. Mall NA, Chahal J, Heard WM, et al. Outcomes of arthroscopic and open surgical repair of isolated subscapularis tendon tears. Arthroscopy. 2012;28:1306–14. doi:10.1016/j.arthro.2012.02.018.

    Article  PubMed  Google Scholar 

  50. Gerhardt C, Bartl C, Voigt C, et al. Recovery of subscapularis and shoulder function following arthroscopic treatment of isolated anterior and combined anterosuperior rotator cuff lesions. Arch Orthop Trauma Surg. 2015. doi:10.1007/s00402-015-2334-3.

    Google Scholar 

  51. Visonà E, Paladini P, Merolla G, et al. Strength recovery after arthroscopic anterosuperior cuff repair: analysis of a consecutive series. Musculoskelet Surg. 2015;99 Suppl 1:37–42. doi:10.1007/s12306-015-0369-9.

    Article  Google Scholar 

  52. Flury MP, John M, Goldhahn J, et al. Rupture of the subscapularis tendon (isolated or in combination with supraspinatus tear): when is a repair indicated? J Should Elb Surg. 2006;15:659–64. doi:10.1016/j.jse.2005.07.013.

    Article  Google Scholar 

  53. Ide J, Tokiyoshi A, Hirose J, Mizuta H. Arthroscopic repair of traumatic combined rotator cuff tears involving the subscapularis tendon. J Bone Joint Surg Am. 2007;89:2378–88. doi:10.2106/JBJS.G.00082.

    Article  PubMed  Google Scholar 

  54. Bartl C, Kouloumentas P, Holzapfel K, et al. Long-term outcome and structural integrity following open repair of massive rotator cuff tears. Int J Should Surg. 2012;6:1–8. doi:10.4103/0973-6042.94304.

    Article  Google Scholar 

  55. Denard PJ, Jiwani AZ, Lädermann A, Burkhart SS. Long-term outcome of arthroscopic massive rotator cuff repair: the importance of double-row fixation. Arthroscopy. 2012;28:909–15. doi:10.1016/j.arthro.2011.12.007.

    Article  PubMed  Google Scholar 

  56. Di Schino M, Augereau B, Nich C. Does open repair of anterosuperior rotator cuff tear prevent muscular atrophy and fatty infiltration? Clin Orthop Relat Res. 2012;470:2776–84. doi:10.1007/s11999-012-2443-z.

    Article  PubMed  PubMed Central  Google Scholar 

  57. Schnaser E, Toussaint B, Gillespie R, et al. Arthroscopic treatment of anterosuperior rotator cuff tears. Orthopedics. 2013;36:e1394–400. doi:10.3928/01477447-20131021-20.

    Article  PubMed  Google Scholar 

  58. Grueninger P, Nikolic N, Schneider J, et al. Arthroscopic repair of massive cuff tears with large subscapularis tendon ruptures (lafosse III/IV): a prospective magnetic resonance imaging-controlled case series of 26 cases with a minimum follow-up of 1 year. Arthroscopy. 2015;31:2173–82. doi:10.1016/j.arthro.2015.05.012.

    Article  PubMed  Google Scholar 

  59. Bartl C, Salzmann GM, Seppel G, et al. Subscapularis function and structural integrity after arthroscopic repair of isolated subscapularis tears. Am J Sports Med. 2011;39:1255–62. doi:10.1177/0363546510396317.

    Article  PubMed  Google Scholar 

  60. Denard PJ, Burkhart SS. A new method for knotless fixation of an upper subscapularis tear. Arthroscopy. 2011;27:861–6. doi:10.1016/j.arthro.2010.11.010.

    Article  PubMed  Google Scholar 

  61. Denard PJ, Lädermann A, Burkhart SS. Double-row fixation of upper subscapularis tears with a single suture anchor. Arthroscopy. 2011;27:1142–9. doi:10.1016/j.arthro.2011.02.033.

    Article  PubMed  Google Scholar 

  62. Gilmer BB, Crall TS, Guttmann D. Knotless arthroscopic repair of subscapularis tendon tears using looped suture. Arthrosc Tech. 2015;4:e267–71. doi:10.1016/j.eats.2015.02.009.

    Article  PubMed  PubMed Central  Google Scholar 

  63. Kim D-Y, Yoo Y-S, Lee S-S, et al. Arthroscopic percutaneous repair of anterosuperior rotator cuff tear including biceps long head: a 2-year follow-up. Clin Orthop Relat Res Surg. 2012;4:284–92. doi:10.4055/cios.2012.4.4.284.

    Article  Google Scholar 

  64. Lorbach O, Trennheuser C, Kieb M, et al. Reconstruction of 25 and 50 % subscapularis tears: a single anchor with a double-mattress suture is sufficient for the reconstruction. Knee Surg Sports Traumatol Arthrosc. 2015. doi:10.1007/s00167-015-3767-5.

    Google Scholar 

  65. Park YB, Park YE, Koh KH, et al. Subscapularis tendon repair using suture bridge technique. Arthrosc Tech. 2015;4:e133–7. doi:10.1016/j.eats.2014.11.013.

    Article  PubMed  PubMed Central  Google Scholar 

  66. Kim S-J, Jung M, Lee J-H, et al. Arthroscopic repair of anterosuperior rotator cuff tears: in-continuity technique vs. disruption of subscapularis-supraspinatus tear margin: comparison of clinical outcomes and structural integrity between the two techniques. J Bone Joint Surg Am. 2014;96:2056–61. doi:10.2106/JBJS.N.00293.

    Article  PubMed  Google Scholar 

  67. Ide J, Karasugi T, Okamoto N, et al. Functional and structural comparisons of the arthroscopic knotless double-row suture bridge and single-row repair for anterosuperior rotator cuff tears. J Should Elb Surg. 2015;24:1544–54. doi:10.1016/j.jse.2015.03.015.

    Article  Google Scholar 

  68. Edwards TB, Walch G, Sirveaux F, et al. Repair of tears of the subscapularis. J Bone Joint Surg Am. 2005;87:725–30. doi:10.2106/JBJS.D.02051.

    Article  PubMed  Google Scholar 

  69. Adams CR, Schoolfield JD, Burkhart SS. The results of arthroscopic subscapularis tendon repairs. Arthroscopy. 2008;24:1381–9. doi:10.1016/j.arthro.2008.08.004.

    Article  PubMed  Google Scholar 

  70. Kreuz PC, Remiger A, Erggelet C, et al. Isolated and combined tears of the subscapularis tendon. Am J Sports Med. 2005;33:1831–7. doi:10.1177/0363546505277118.

    Article  PubMed  Google Scholar 

  71. Maqdes A, Abarca J, Moraiti C, et al. Does preoperative subscapularis fatty muscle infiltration really matter in anterosuperior rotator cuff tears repair outcomes? A prospective multicentric study. Orthop Traumatol Surg Res. 2014;100:485–8. doi:10.1016/j.otsr.2014.02.010.

    Article  CAS  PubMed  Google Scholar 

  72. Toussaint B, Audebert S, Barth J, et al. Arthroscopic repair of subscapularis tears: preliminary data from a prospective multicentre study. Orthop Traumatol Surg Res. 2012;98:S193–200. doi:10.1016/j.otsr.2012.10.004.

    Article  CAS  PubMed  Google Scholar 

  73. Nové-Josserand L, Hardy M-B, Leandro Nunes Ogassawara R, et al. Clinical and structural results of arthroscopic repair of isolated subscapularis tear. J Bone Joint Surg Am. 2012;94, e125. doi:10.2106/JBJS.K.00008.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedics, Catholic University, Rome, Italy

    Maristella F. Saccomanno MD & Giuseppe Milano MD

  2. Service of Shoulder Surgery, “A. Gemelli” University Hospital, Rome, Italy

    Giuseppe Milano MD

Authors
  1. Maristella F. Saccomanno MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Giuseppe Milano MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Maristella F. Saccomanno MD .

Editor information

Editors and Affiliations

  1. San Donato Milanese, Milano, Italy

    Pietro Randelli

  2. Lyon, France

    David Dejour

  3. Academic Med Ctr, Orthopedic Surger, Univ of Amsterdam, Amsterdam, The Netherlands

    C. Niek van Dijk

  4. Istituto Clinico Humanitas, Rozzano, Milan, Italy

    Matteo Denti

  5. Dept Orthopedic Surgery & Sports Meds, Ctr Hospitalier Clinique d’Eich, Luxemburg, Luxembourg

    Romain Seil

Rights and permissions

Reprints and permissions

Copyright information

© 2016 ESSKA

About this chapter

Cite this chapter

Saccomanno, M.F., Milano, G. (2016). Subscapularis Tears. In: Randelli, P., Dejour, D., van Dijk, C., Denti, M., Seil, R. (eds) Arthroscopy. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-49376-2_45

Download citation

  • DOI: https://doi.org/10.1007/978-3-662-49376-2_45

  • Published:

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-662-49374-8

  • Online ISBN: 978-3-662-49376-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation