Subscapularis Tear

What is Subscapularis Tear?

The subscapularis muscle is one of the four rotator cuff muscles, being the largest and strongest one of the group. Situated in front of the shoulder, the subscapularis brings 53% of the total rotator cuff strength, having several key roles in the dynamics of the arm. First of all, the subscapularis is the main muscle involved in the turning of the arm inward and it is also responsible for any lifting movement you will be doing across your chest.

This muscle is often used by people who practice different types of sports, including swimming, racquetball and throwing spears or weights. The tear of the subscapularis muscle is less common then the tear of the other rotator cuff muscles, such as the supraspinatus, infraspinatus or suprascapularis. However, when it happens for the subscapularis to tear, then it is going to be extremely painful and it will also affect the tendon of the biceps, dislocating it from its normal position. The problem is indeed made worse by a painful and weak biceps tendon.

Symptoms of Subscapularis Tear

These are the most common symptoms that appear in the situation of a subscapularis tear:

• When torn, the subscapularis can impinge on the coracoid process, leading to pain and loss of mobility
• Pain and weakness in the shoulder – the areas where these symptoms are felt are the front of the shoulder and the upper arm, especially when the biceps tendon is affected
• Movement aggravates the pain felt in the shoulder – the pain becomes worse when the patient is trying to reach for something, by lifting the affected arm overhead
• Tenderness
• Swelling
• Warmth
• Redness
• Loss of strength – this is especially noticeable if the patient is trying to rotate the shoulder and the arm inwards (this being the primary function of the subscapularis)
• The subscapularis tear will allow for more degrees of outward rotation of the shoulder than normal range of movement.
• Each movement of the shoulder will be accompanied by crackling sounds
• The biceps tendon is weak, painful and sometimes inflamed. The symptoms are made worse when the patient is trying to bend the elbow or lift the arm, putting the already weakened biceps to work
• Recurrent shoulder dislocations can occur because of the weakened rotator cuff muscle

Causes of Subscapularis Tear

These are the most common causes that can lead to the appearance of the subscapularis tear:

• Trauma – fall or accident, especially car accidents in which there is a direct impact with a solid object or work accidents where the shoulder joint is in full impact with a solid object or surface, leading to the partial or full tear of the subscapularis muscle.
• New injury to the shoulder and arm
• Previous injuries of the rotator cuff muscles
• Poor physical condition, especially in terms of strength and flexibility
• Inadequate warm up before playing a sport
• Not using adequate protection equipment during practice
• After surgery – both arthroscopic surgery and the surgery for shoulder replacement can lead to a tear in the subscapularis muscle
• Shoulder dislocation
• Occupation – handling heavy equipment can lead to a tear in the subscapularis muscle, especially if the shoulder joint is stretched beyond its normal range of mobility
• Shoulder joint forceful movements in sports such as baseball, football, volleyball or tennis
• Direct impact on shoulder joint and scapula in sports such as wrestling, football, soccer, boxing and rugby
• Repeated shoulder joint movements when lifting weights, beating the drums or conducting an orchestra

Treatment

These are the most common courses of treatment undertaken for subscapularis tear:

• Anti-inflammatory medication and oral corticosteroids for pain
• Muscle relaxers, such as Baclofen, for muscle spasms
• Manual therapy for tissue manipulation
• Massage therapy – this is especially recommended after the surgery done in the area, as there will be an increased need for the built-up lymph to be properly drained, thus allowing the area to recover as soon as possible.
• Physical therapy – this is recommended prior to surgery for a period of six to eight weeks but also after the surgery, after the initial critical period of four weeks. In partial tear, physical therapy might be enough in order to guarantee recovery. In full tears, passive and active stretching exercises combined with anti-inflammatory medication can guarantee the best recovery.
• The purpose of the anti-inflammatory drugs is to relieve pain, so that the patient can concentrate on rebuilding the strength of the muscle.
• Cortisone injections – these are applied exactly to the affected area, helping the injured tendon and muscle to faster recover.

Surgery

These are four main types of surgical interventions for subscapularis tear:

• Arthroscopic repair in case of partial or full subscapularis tears – the rupture site is visualized with the help of an arthroscopic camera and it is then sutured with the help of professional arthroscopic equipment.
• Open surgery is recommended for larger tears, allowing for the injured tendon or muscle to be properly sutured.
• Shoulder joint replacement is recommended in case of large tears associated with other problems.
• Muscle transfer – this operation is indicated in cases of tears that are old and chronic, being too large even for direct repair. A piece of the big pectoral muscle is transferred to the affected area.

Sling immobilization after surgery, for at least four weeks

Recovery time for Subscapularis tear

Depending on how extensive the tear was, the patient diagnosed with subscapularis tear can return to full functioning and activity in somewhere between six and twelve months. It is important to understand that he will have to wear a sling for for weeks after the surgery and that after twelve weeks after the physical therapy will concentrate on muscle strengthening. After a period of sixteen weeks, the patient will be allowed to practice different sports to increase mobility and flexibility, including these three choices: tennis, golf or swimming.