What is a subscapularis disruption?
Subscapularis disruption is characterized by pain and weakness of the shoulder due to partial or complete tearing of the subscapularis muscle and tendon from the upper arm (humerus). The subscapularis is one of the four rotator cuff muscles that surround the ball of the shoulder (humeral head) and is the muscle in the front of the humeral head. It is the strongest of the four cuff muscles.
The muscle attaches directly to the humerus in the lower 25 percent and via a tendon for the rest. The main function of the subscapularis is to help maintain the humeral head in the center of the socket and provide strength for rotating the arm inward. This is an uncommon injury. It may occur as part of a rotator cuff tear.
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How does subscapularis disruption occur?
- Violent outer rotation of the shoulder or arm
- Hyperextension of the shoulder
- Direct blow to the shoulder or a fall
- Resumption of activity too soon after shoulder surgery (especially shoulder stabilization surgery)
- Shoulder dislocation
What increases the risk?
- Contact sports, such as football, wrestling or basketball
- Previous injury to rotator cuff
- Poor physical conditioning (strength and flexibility)
- Inadequate warm-up before practice or play
- Inadequate protective equipment
- Shoulder dislocation
- Surgery that requires moving the subscapularis
What are the symptoms of subscapularis disruption?
- Pain around the shoulder, often in the front of the shoulder and upper arm
- Pain that is worse with shoulder function, especially when reaching overhead or lifting
- Occasionally, tenderness, swelling, warmth or redness over the front of the shoulder
- Loss of strength, especially on inward rotation of the shoulder and arm
- Increased outward rotation of the shoulder
- Crepitation (crackling sound) when the shoulder is moved
- Biceps tendon pain and inflammation (in the front of the shoulder), worse with bending the elbow or lifting
- Recurrent shoulder dislocation (if rupture is associated with or caused by initial dislocation)
How is subscapularis disruption treated?
Non-operative treatment is indicated for most patients, who are able to successfully resume all pre-injury activities. Non-operative treatment consists of medication and ice to relieve the pain and stretching and strengthening exercises. These all can be carried out at home, although referral to a physical therapist or athletic trainer may be prescribed.
Operative treatment: Surgery to reattach the tendon to the humerus is usually recommended. Surgery performed after 6 months has a poorer result than if performed within the first 3 months following injury. Surgery is performed through an open incision.
What are the complications from treatment?
Possible complications of operative treatment include:
- Surgical complications not specifically associated with shoulder repair/reconstruction, such as pain, bleeding (uncommon), infection (<1percent), nerve injury (uncommon), stiffness, problems with anesthesia, and inability to return to previous level of pre-injury activity.
When can you return to your sport/activity?
Surgery is performed through an open incision. Return to full activity usually requires six to 12 months.
How can a subscapularis disruption be prevented?
- Appropriately warm up and stretch before practice or competition
- Maintain appropriate conditioning:
- Cardiovascular fitness
- Shoulder flexibility
- Strength and endurance
- Use proper technique
