Isolated Traumatic Rupture of the Subscapularis Tendon

Russell J. Clark, MD, Jeffrey Marchessault, MD, Phillip S. Sizer, Jr., MEd, PT, and James Slauterbeck, MD

Disclosures

J Am Board Fam Med. 2002;15(4) 

In This Article

Abstract and Introduction

Abstract

Background: Although rotator cuff tears are well documented in the literature, there have been relatively few reported cases of isolated subscapularis tears. To our knowledge, no case has been reported that describes an isolated subscapularis tear in a woman without anterior shoulder dislocation or bony avulsion.
Methods: This report outlines the case of a healthy 46-year-old woman with no history of shoulder problems who sustained injury to her right shoulder while hanging a light fixture. We highlight several key points to early diagnosis and underscore operative management for a successful outcome.
Results and Conclusions: Isolated subscapularis tendon ruptures are uncommon in women. Increased vigilance during the history and physical examination is necessary to detect these injuries. Subscapularis tendon ruptures are commonly mistaken for degenerative rotator cuff tears or subacromial impingement syndrome. The lift-off test can isolate a subscapularis injury. Pertinent radiographic and magnetic resonance imaging findings are described.

 

Introduction

Rotator cuff tears are well documented in the literature and typically involve the tendons of the supraspinatus, infraspinatus, and teres minor.[1,2,3] Until recently there have been few reported cases of subscapularis tears. These tears typically occur with simultaneous damage to other muscles of the rotator cuff and are commonly discovered at the time of surgery. Subscapularis injuries are also frequently found in association with avulsion of the lesser tuberosity and anterior dislocation of the shoulder.[4,5,6]

The occurrence of isolated traumatic rupture to the subscapularis tendon, without avulsion or anterior shoulder dislocation, is relatively rare.[7] In the previous 10 years an increasing number of such injuries has been documented, all of which occurred in men.[8,9,10] To our knowledge, no case has been reported that describes an isolated subscapularis tear without anterior shoulder dislocation or bony avulsion in a woman. This case report highlights several key points to early diagnosis and underscores operative management for successful outcomes.

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