AANA Lab Course 1002 -3rd Annual Fellows/Chief Residents-Subscapularis Repair

Subscapularis Repair_ Technique-Xinning Li, M.D.

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This document outlines the epidemiology, anatomy, evaluation, and arthroscopic surgical repair technique for subscapularis tendon tears, authored by Dr. Xinning Li. Subscapularis tears, often underdiagnosed "forgotten" tendon injuries, occur in 3.5% to 20.8% of cases in cadaver studies and have a prevalence of around 31% in arthroscopic rotator cuff repairs. They are frequently seen alongside large rotator cuff tears, with repair reducing retear rates significantly.<br /><br />Anatomically, the subscapularis is the largest and most powerful rotator cuff muscle, contributing about 50% of rotator cuff strength. It has two attachment parts: a superior two-thirds tendon that interdigitates with the supraspinatus tendon and an inferior one-third muscular attachment. Its insertion is on the lesser tuberosity, near the biceps groove, contributing to biceps stability. The tendon is partly visible arthroscopically on the intra-articular superior third, with the inferior part covered by the capsule.<br /><br />Subscapularis tears mainly result from degeneration or trauma. Symptoms include anterior shoulder pain and weakness, with clinical tests like lift-off, belly-press, and bear hug offering 54-77% diagnostic accuracy. Imaging with MRI, ultrasound (75% sensitivity, 90% specificity), and X-rays help confirm diagnosis.<br /><br />Management depends on patient age, injury cause, and tear size. Conservative treatment is for atraumatic or older patients, while younger or traumatic cases benefit from surgery. Arthroscopic repair involves patient positioning in the beach chair, specific shoulder rotations for visualization, use of anchors, and suture techniques (vertical mattress and lasso loop). Biceps tenotomy or tenodesis may be done simultaneously. Postoperative rehab includes 6 weeks in a sling with abduction pillow, restricted internal and external rotation, passive ROM starting at 4 weeks, and strengthening at 2-3 months, with full activity return expected by 9-12 months.

Keywords

Subscapularis tendon tears

Rotator cuff anatomy

Arthroscopic repair technique

Shoulder pain diagnosis

MRI and ultrasound imaging

Rotator cuff strength

Biceps stability

Clinical tests for subscapularis

Postoperative rehabilitation

Surgical management of tendon tears