One of four muscles that make up the rotator cuff, the Subscapularis muscle originates at the subscapular fossa and inserts onto the lesser tubercle of the humerus. The largest and strongest of the rotator cuff muscles, the Subscapularis muscle consists of 60% tendon and 40% muscle. The Subscapularis muscle turns the arm inward and allows one to lift and rotate the arm. Subscapularis tears commonly occur from overuse, trauma, and age. Most trauma injuries occur from sporting events, falls, and motor vehicle accidents.
Symptoms of a Subscapularis tear
Most patients suffering from a tear of the subscapularis muscle complain or pain in the front of the shoulder. The shoulder may also make clicking or popping noises or feelings when rotating or moving the arm. The subscapularis muscle may tear alone or in tandem with other muscles of the rotator cuff, symptoms may vary depending on which muscles tear and how severely. The most commonly reported symptoms of a tear of the subscapularis muscle include:
- Pain and/or weakness of the arm or shoulder
- Increased pain when lifting the arm
- Difficulty reaching for items
- Pain underneath the collarbone
Causes of subscapularis tears
Older people may suffer a tear of the subscapularis muscle due to arthritis or degeneration that occurs with age. In younger individuals, subscapularis tears typically occur due to injury or trauma. Sporting events commonly cause tears to the subscapularis muscle along with the other muscles of the rotator cuff. Traumatic events like falls or car accidents also often cause tears of the subscapularis muscle.
Diagnosing and Treating Subscapularis tears
When suspecting an injury to the shoulder, patients should seek out the expertise of a board certified shoulder physician. First the physician conducts a physical examination and goes over medical history with the patient. The doctor may perform a variety of physical “tests” including the lift-off test, bear hug test, and belly press test. If the doctor suspects a tear to the subscapularis or any shoulder muscle, the physician orders an MRI to confirm the suspicion. The doctor may also perform an ultrasound.
If the physician finds a tear in the subscapularis muscle, treatments depends on the size of the tear and the patients lifestyle. With a small tear in an older individual with a relatively sedentary lifestyle, the treating doctor may recommend conservative treatments. Conservative treatments typically include non-steroidal anti-inflammatory medications, physical therapy, and potentially steroid injections.
In a younger patient, highly active patient, or a patients with a full thickness tear of the muscle, the physician most likely recommends surgery to repair the tear. In most cases, the surgeon performs the surgery arthroscopically, but in certain instances the surgeon may need to make a larger incision.
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