Overview
The subscapularis tendon is a part of the rotator cuff. It is one of four tendons that come together to form the rotator cuff. The four tendons come from four muscles that start at the scapula. These muscles are called the subscapularis, supraspinatus, infraspinatus, and teres minor. The subscapularis tendon is the largest part of the rotator cuff, located in the front part of the shoulder, and is the largest and most powerful muscle of the four.
When an injury occurs to the subscapularis tendon, the shoulder is in pain, weakens, and often the biceps tendon next to it can be affected. Most common in male patients between the age of 30 to 50, subscapularis tears often occur from work-related or sport-related injuries. As we get older, strenuous activity or sudden trauma can tear the subscapularis tendon.
Subscapularis tears can often be misdiagnosed. Historical medical literature refers to the subscapularis tendon as “the forgotten tendon.” More than half of subscapularis tendon injuries seen only during arthroscopy, a minimally-invasive surgical procedure, were not reported on standard preoperative MRI’s. As technology advanced and subscapularis tears were more understood, high-quality MRI’s such as the ones used by Dr. Stowell’s office have helped confirm the diagnosis before surgery. Dr. Stowell will perform a complete examination of all four tendons to accurately diagnose your tear. Pain in the front of your shoulder that persists after an injury should prompt you to seek a full medical evaluation by Dr. Stowell of your subscapularis as he is adept at identifying the prime cause of pain and weakness in your shoulder.
Subscapularis Diagram
A subscapularis tear is a type of shoulder injury that involves a tear or rupture of the subscapularis muscle, which is located on the front of the shoulder blade.
Treatment
Nonsurgical treatment options are first considered. If the tear is not severe, Dr. Stowell may suggest one or more of the following:
- Rest
- Activity modification
- At-home exercises
- Anti-inflammatory medication
- Physical therapy
- Corticosteroid injection
Physical therapy can help preserve and even extend your arm’s range of motion. Diligent adherence to our in-house physical therapy program can reduce pain while strengthening muscles to relieve stress from the subscapularis tendon. Cortisone is a corticosteroid that Dr. Stowell can inject in conjunction with physical therapy to help with short-term pain relief and help fight inflammation. If Dr. Stowell recommends surgery, corticosteroid injections may be avoided.
If your tear is significant and not responding to conservative treatment options, Dr. Stowell may recommend an outpatient procedure using an arthroscopic technique. During surgery, Dr. Stowell may use special sutures and surgical tapes to securely fix the tendon to the bone with anchors. He will also check the labrum and biceps tendon for any related issues that may need to be addressed.
After surgery, patients are sent home with a sling and pillow brace to wear for about six weeks of recovery. Ice packs to the shoulder can help ease swelling and discomfort after surgery. Dr. Stowell will give you specific post-op pain management instructions before you go home on the day of surgery.
The physical therapy team will care for you conservatively for the first six weeks, permitting simple range-of-motion activities. Usually, it takes about six weeks for the bone and tendon to begin to grow back together. Too much movement can lead to the tendon pulling out of the sutures and tapes. For the next three months, the PT team will provide a strengthening program to build flexibility and strength, and to help relieve a significant amount of scar tissue buildup at the site of repair. A full recovery is expected by six months; however, depending on the patient, it could take up to a year to perform optimally.