Department of Surgery, Section of Orthopaedic Surgery, McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta, CanadaDepartment of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
Arthroscopic image of a right shoulder, viewed through a posterior glenohumeral portal, demonstrating a full-thickness subscapularis tendon tear and the resulting comma sign. SSc = subscapularis tendon, HH = humeral head, G = glenoid, BT = long head of the biceps tendon.
Arthroscopic images of a left shoulder, viewed through a posterior glenohumeral portal with a 30° arthroscope (Fig. 2-A) and a 70° arthroscope (Fig. 2-B), demonstrating an intact subscapularis tendon. SSc = subscapularis, HH = humeral head, BT = long head of the biceps tendon, M = medial sling.
Arthroscopic images of right shoulders, demonstrating a full-thickness upper subscapularis tear with a medially dislocated biceps tendon (Fig. 3-A), a full-thickness subscapularis tendon tear with minimum retraction (Fig. 3-B), and a full-thickness subscapularis tendon tear with medial retraction (Fig. 3-C). SSc = subscapularis, HH = humeral head, BT = long head of the biceps tendon, M = medial sling, LT = lesser tuberosity, RI = rotator interval.
↵* SR = single row, DR = double row, SB = suture bridge, TO = transosseous, RCT = rotator cuff tear, SSc = subscapularis, IASS = intra-articular subscapularis, Constant = Constant-Murley score, VAS = visual analog scale, ASES = American Shoulder and Elbow Surgeons shoulder score, DASH = Disabilities of the Arm, Shoulder and Hand score, SSV = subjective shoulder value, UCLA = University of California at Los Angeles shoulder score, SST = simple shoulder test, JOA = Japanese Orthopaedic Association score, NR = not reported.
Diagnostic arthroscopy should include arthroscopic assessment of the subscapularis tendon
Acute traumatic subscapularis tears should be considered for urgent repair within 3 months
Chronic or degenerative subscapularis tears may be considered for elective repair following failure of nonoperative treatment for 3-6 months
↵* Grade A indicates good evidence (Level-I studies with consistent findings) for or against recommending intervention. Grade B indicates fair evidence (Level-II or III studies with consistent findings) for or against recommending intervention. Grade C indicates conflicting or poor-quality evidence (Level-IV or V studies with consistent findings) for or against recommending intervention. Grade I indicates that there is insufficient or conflicting evidence not allowing a recommendation for or against intervention.