Subscapularis tears: hidden and forgotten no more

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Subscapularis tears: hidden and forgotten no more Julia Lee, MD, Dave R. Shukla, MB, BCh, BAO, Joaquín Sánchez-Sotelo, MD, PhD JSES Open Access Volume 2, Issue 1, Pages 74-83 (March 2018) DOI: 10.1016/j.jses.2017.11.006 Copyright © 2017 The Author(s) Terms and Conditions

Figure 1 Subscapularis physical examination maneuvers. (A) Lift-off test. (B) Belly-press test. (C) Bear hug test. JSES Open Access 2018 2, 74-83DOI: (10.1016/j.jses.2017.11.006) Copyright © 2017 The Author(s) Terms and Conditions

Figure 2 Applying the 4-step magnetic resonance imaging evaluation by Adams et al.1 (A) Axial image showing the biceps tendon in the groove with an obvious retracted tear of the subscapularis tendon. (B) Sagittal image showing grade 2 fatty infiltration of the subscapularis muscle. (C) Sagittal image showing a bare lesser tuberosity. JSES Open Access 2018 2, 74-83DOI: (10.1016/j.jses.2017.11.006) Copyright © 2017 The Author(s) Terms and Conditions

Figure 3 Medial dislocation of the long head of the biceps tendon. JSES Open Access 2018 2, 74-83DOI: (10.1016/j.jses.2017.11.006) Copyright © 2017 The Author(s) Terms and Conditions

Figure 4 Manipulation methods for better arthroscopic subscapularis visualization. (A) Flexion and internal rotation of affected extremity. (B) “Posterior lever push,” whereby a posteriorly directed force is placed on the proximal humerus. JSES Open Access 2018 2, 74-83DOI: (10.1016/j.jses.2017.11.006) Copyright © 2017 The Author(s) Terms and Conditions

Figure 5 Lafosse classification of subscapularis tears and treatment algorithm. JSES Open Access 2018 2, 74-83DOI: (10.1016/j.jses.2017.11.006) Copyright © 2017 The Author(s) Terms and Conditions

Figure 6 Intraoperative images of a subscapularis tear. (A) Traction on the subscapularis reveals the poor-quality tendon associated with a tear. (B) Tear in continuity seen in subscapularis tendon. (C) Intraoperative fixation of tendon with retrograde passing of sutures for horizontal mattress suture fixation. (D) Final picture of re-established rolled border. JSES Open Access 2018 2, 74-83DOI: (10.1016/j.jses.2017.11.006) Copyright © 2017 The Author(s) Terms and Conditions

Figure 7 Arthroscopic fixation of type I and type II tears. (A) Type I tear. (B) Fixation of type I tear. (C) Type II tear. (D) Fixation of type II tear. JSES Open Access 2018 2, 74-83DOI: (10.1016/j.jses.2017.11.006) Copyright © 2017 The Author(s) Terms and Conditions

Figure 8 Arthroscopic fixation of type III and type IV tears. (A-C) Type III tear. Note the disruption of the superior tendinous portion in (A) and continuity of the muscle portion in (B). (C) Fixation of type III tear. (D-F) Type IV tear. (D) Before mobilization of tendon. (E) After mobilization of tendon; note how far back the tendon is retracted. (F) Suture fixation of the tendon with multiple anchors. JSES Open Access 2018 2, 74-83DOI: (10.1016/j.jses.2017.11.006) Copyright © 2017 The Author(s) Terms and Conditions