Introduction
The subscapularis is a muscle present in the shoulder that helps in the internal rotation of the arm. During the internal rotation of the arm, the palm will be facing behind the body. A subscapularis is a group of muscles that help to attach the upper arm to the shoulder. They are considered to be the largest muscle among the rotator cuff muscles. The rotator cuff muscle plays a role in the rotation movement of the arm. Read the article to know more.
What Is Meant by Subscapularis Pain?
The subscapularis is a rotator cuff muscle that helps rotate the arms internally. This is one of the largest rotator cuff muscles. The subscapularis muscle gets torn due to any injury or overuse of the muscle, resulting in pain. The aging process can also cause this. The extent of the tear helps to determine what treatment is required. This tear occurs mainly near the tendon, where it gets attached to the humerus.
What Are the Causative Factors of Subscapularis Pain?
Some common causes of subscapularis tear, which causes pain, are:
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In the case of older people, subscapularis tear occurs due to aging factors and some underlying conditions, such as arthritis and degenerative conditions caused by aging.
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In the case of young patients, subscapularis tear is caused by some trauma or injury to the muscle or overuse of the muscle. Injury or trauma occurs when the arm is over-extended.
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Trauma due to sporting events usually results in a tear of the subscapularis muscle.
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When other rotator cuff muscles exert pressure over the subscapularis muscle, it is known as shoulder impingement. This can also result in tears of the subscapularis tear.
What Are the Symptoms Associated With Subscapularis Pain?
The most common symptom that a person may experience when the subscapularis muscle gets torn is shoulder pain and a clicking sound in the affected shoulder. Other common symptoms are
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Weakness of shoulder and arm.
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The pain caused by subscapularis tears can worsen when the person lifts the arm.
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The pain aggravates during the night.
These symptoms are very similar to the other injuries caused in other rotator cuff muscles. Some unique symptoms related to subscapularis tear are
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Weakness of biceps.
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The person finds it difficult to reach out to the back pocket.
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Pain is present below the collarbone.
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The affected arm rotates outward even without movement from the person.
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The pain gets enhanced when the person lifts the arm above the shoulder level.
How Is Subscapularis Pain Diagnosed?
Shoulder pain should be consulted with the doctor as soon as possible. Initially, the doctor performs a physical examination and hears out the symptoms experienced by the person. Some of the physical tests performed to diagnose the condition are:
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Lift-off Test: During this test, the doctor asks the patient to place their hand on the lower back and then lift the hands. If the patient cannot perform this test, it is a sign that they may be affected by subscapularis tears.
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Bear Hug Test: The person will be asked to place the affected arm over the other shoulder. The doctor tried to pull the arm off the shoulder by moving the arm outwards in a rotation motion. If the person cannot hold the shoulder and finds it difficult to hold it stably, it can be suspected that the person is affected by a subscapularis tear.
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Belly Press Test: Using only the hand and not the wrist or elbow, the person is asked to press down while placing the hands over the stomach. If this causes pain, the person is affected by subscapular tears. By performing these tests, if the doctor suspects a subscapular tear, the doctor may suggest an MRI (Magnetic Resonance Imaging) and an ultrasound to confirm the condition.
How Is Subscapularis Pain Managed?
The treatment of subscapularis depends on the extent of the tear. Treatment also depends on the lifestyle of the person. If the tear occurs in older people with a sedentary lifestyle, conservative treatment, including icing, heat, and medications, may improve the condition. This includes a recommendation of NSAIDs (non-steroidal anti-inflammatory drugs) and physical therapy. If this does not help, then a steroidal injection can be given.
When the subscapularis pain occurs in very young and active patients and where the tear is huge, the doctors usually recommend surgery to treat the tear. Mostly, the surgeon does the surgery arthroscopically, a surgical procedure performed on a joint in which the treatment is done using an arthroscope.
How Is Surgery Performed to Manage Subscapularis Pain?
Usually, surgery is performed when the tear is huge and causes disability due to injury or when the tear does not improve with the help of conservative treatment. Surgery is usually performed arthroscopically, where the doctor introduces a camera into the shoulder through a small incision, and this camera helps to guide the surgery. During the surgical procedure, small instruments are used through small incisions. If the space near the surgery is insufficient for arthroscopy to enter, a traditional surgical procedure is performed where a larger incision is made in the arm. This helps the doctors have a better view and use the instruments more freely.
Post-surgery, the patient should be in complete rest without any arm movements for about six weeks, after which physical therapy can be introduced, and the range of motions can improve slowly. The person can resume exercise to strengthen the shoulder after ten weeks. During the recovery phase, the person should avoid activities that can increase stress or can cause damage to the shoulder. This can worsen the condition.
What Are the Complications of Subscapularis Pain?
In the case of muscle atrophy, which occurs due to aging, a small tear, when not treated properly, can become a huge one. A tear that occurs in the subscapularis muscles can also cause damage to other rotator cuff muscles. This is caused because once the muscle is torn, the other muscles are under stress to compensate for the torn muscle.
Conclusion
Subscapularis tear is a condition that occurs when the muscle responsible for the internal rotation of the arm gets damaged, injured, or overextended. This results in severe pain. This condition can be treated through conservative methods, but in some active young individuals with huge tears, surgery is a better option.
