Subscapularis Tendon Tears - Causes, Symptoms, Diagnosis, and Treatment

Introduction

The shoulder joint is one of the most flexible and mobile joints in the human body. However, this flexibility also makes it susceptible to various tendon injuries, including tears of the tendons that support and stabilize the joint. One such injury is the subscapularis tendon tear. This article will explore the factors behind subscapularis tendon tears, elucidating the symptoms and various treatment options available for this commonly encountered shoulder condition.

What Is Subscapularis Tendon Tears?

Subscapularis tendon tears are injuries that occur in the subscapularis tendon, a key component of the rotator cuff in the shoulder. The subscapularis tendon connects the subscapularis muscle to the upper arm bone, allowing internal rotation of the shoulder and providing stability during various arm movements. These tears can result from overuse, acute trauma, age-related degeneration, or shoulder impingement. Symptoms include shoulder pain, weakness, and restricted range of motion. Depending on the severity, treatment may involve rest, physical therapy, corticosteroid injections, or surgical repair. Timely identification and proper treatment are crucial to facilitate healing and regain optimal shoulder function.

What Are the Causes of Subscapularis Tendon Tears?

• Overuse or Repetitive Movements: Engaging in repetitive overhead motions or activities that involve the shoulder can put a strain on the subscapularis tendon over time, leading to wear and tear.

• Acute Trauma: A sudden and forceful impact to the shoulder, such as a fall or a direct blow, can cause a tear in the subscapularis tendon.

• Age-related Degeneration: As a person ages, the tendons in the shoulder can naturally degenerate and weaken, making them more susceptible to tears.

• Chronic Impingement: Impingement syndrome occurs when the space between the acromion (part of the shoulder blade) and the rotator cuff narrows, causing compression of the tendons. Chronic impingement can lead to tendon damage, including tears in the subscapularis tendon.

• Shoulder Instability: Instability in the shoulder joint can put extra stress on the tendons, including the subscapularis, increasing the risk of tears.

• Muscle Imbalances: When there is a weakness or muscle imbalances around the shoulder, it can create abnormal stresses on the subscapularis tendon, potentially leading to tears.

• Sports and Physical Activities: Certain sports and physical activities that involve repetitive shoulder movements or forceful motions, such as throwing, swimming, or weightlifting, can increase the risk of subscapularis tendon tears.

• Rotator Cuff Tears: Tears in other rotator cuff tendons, such as the supraspinatus or infraspinatus, can alter shoulder mechanics and place additional stress on the subscapularis tendon, potentially leading to a tear.

• Poor Posture: Prolonged poor posture, especially with rounded shoulders, can lead to abnormal loading on the shoulder and contribute to subscapularis tendon injuries.

• Genetic Factors: In some cases, individuals may have a genetic predisposition to developing tendon problems, including subscapularis tears.

What Are the Symptoms of Subscapularis Tendon Tears?

• Shoulder Pain: Pain is a common symptom of subscapularis tendon tears. The pain may be felt deep within the shoulder joint and can worsen with movement, especially when rotating the arm inward.

• Weakness: Individuals with a subscapularis tendon tear may experience weakness in the affected shoulder. This weakness can make it challenging to perform certain movements, such as lifting or reaching.

• Limited Range of Motion: There could be limitations in the range of motion of the shoulder, particularly when trying to rotate the arm inward or move it away from the body. Activities like reaching behind the back or lifting objects overhead may be especially difficult.

• Shoulder Instability: Tendon tears can lead to shoulder instability, where the joint feels loose or as if it might pop out of place.

• Catching or Clicking Sensation: Some people with subscapularis tendon tears may experience a catching or clicking sensation in the shoulder when moving it.

• Pain at Night: Tendon tears can cause pain at rest, particularly during sleep, making it challenging to find a comfortable sleeping position.

• Muscle Atrophy: In severe cases where the tear is substantial or chronic, there may be muscle wasting (atrophy) of the subscapularis muscle.

How to Diagnose Subscapularis Tendon Tears?

1. Medical History and Physical Examination: The initial step involves the doctor obtaining a comprehensive medical history, inquiring about the symptoms, recent injuries, or activities, as well as assessing the pain level. Subsequently, a physical examination will be conducted to evaluate the shoulder range of motion, strength, and areas of tenderness.

2. Imaging Studies:

• MRI (Magnetic Resonance Imaging): MRI is a valuable tool for evaluating soft tissues like tendons. It can provide detailed images of the subscapularis tendon and surrounding structures, helping to identify tears or other abnormalities.

• Ultrasound: Ultrasound imaging may also be used to visualize the subscapularis tendon. It is less expensive than an MRI and can be used dynamically during specific shoulder movements to assess the tendon's function.

3. Diagnostic Arthroscopy: In some cases, especially if other diagnostic methods are inconclusive, the doctor may recommend arthroscopic surgery. In this procedure, a miniature camera is introduced into the shoulder joint, enabling the doctor to directly observe the subscapularis tendon and evaluate its condition.

What Are the Treatment of Subscapularis Tendon Tears?

• Conservative Treatment: For minor tears or partial tears, non-surgical or conservative treatments may be recommended. Possible treatment options encompass periods of rest, activity modification, physical therapy, and anti-inflammatory medications, all aimed at alleviating pain and reducing inflammation. Physical therapy can help strengthen the surrounding muscles, improve shoulder mechanics, and restore range of motion.

• Corticosteroid Injections: In some cases, corticosteroid injections may be used to help reduce inflammation and relieve pain around the affected tendon. Typically, these injections are complemented by physical therapy to enhance outcomes and effectiveness.

• Surgical Repair: For more severe tears or cases where conservative treatments have not been effective, surgical intervention may be necessary. The surgical approach will depend on the extent and location of the tear. The surgeon may repair the torn tendon directly or reattach it to the bone using various techniques.

• Arthroscopic Surgery: In many cases, subscapularis tendon tears can be repaired arthroscopically. Arthroscopic surgery involves using small incisions and specialized tools, including a tiny camera, to visualize and repair the damaged tendon. This minimally invasive approach typically results in faster recovery and less post-operative pain compared to traditional open surgery.

• Open Surgery: In certain complex cases or when the tear is extensive, open surgery may be required. Open surgery necessitates a larger incision, granting the surgeon improved access to the affected area and facilitating repair.

• Rehabilitation: Irrespective of the selected treatment, successful recovery hinges on the importance of rehabilitation and physical therapy. A structured rehabilitation program helps improve strength, flexibility, and stability in the shoulder joint. Following the post-operative rehabilitation plan diligently is crucial for regaining full function and preventing re-injury.

Conclusion

In conclusion, subscapularis tendon tears represent a significant and often underdiagnosed shoulder pathology that can lead to significant functional impairment and pain. These tears are frequently associated with other rotator cuff injuries, making accurate diagnosis and prompt treatment essential for successful patient outcomes. Advances in diagnostic imaging, such as MRI and ultrasound, have improved our ability to detect and assess subscapularis tendon tears. Non-surgical interventions like physical therapy and anti-inflammatory medications may be effective for partial tears and less severe cases, but surgical repair remains the gold standard for significant tears and cases with persistent symptoms. Postoperative rehabilitation plays a crucial role in restoring strength, range of motion, and functional abilities. As research and clinical experience continue to evolve, a better understanding of the optimal treatment approaches for subscapularis tendon tears will further enhance patient care and outcomes. Early detection, accurate diagnosis, and a comprehensive, individualized treatment plan are vital in addressing this complex shoulder condition effectively.