Dr. Kevin Yip

Dr Kevin Yip
Orthopaedic Surgeon
MBBS(UK), FRCS(EDIN), FAM(SING), FHKCOS(ORTHO)

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Injury of the Subscapularis Tendon

Injury of the subscapularis tendon

The subscapularis muscle (which originates on the inner surface of the scapula, runs anterior to the shoulder joint, and is inserted high into the anterior aspect of the head of the humerus) is the most important internal rotator of the upper arm. Its tendon can be affected by partial or total ruptures. A partial rupture, which is most common, may heal with thickening of the tendon as a result. A complete rupture is uncommon but can occur in conjunction with dislocation of the shoulder joint.
Throwers and athletes whose sports require repetitive overhead activity most commonly suffer from injury and degeneration of the subscapularis tendon. Such sports include baseball, American football
(quarterbacks), racket sports, javelin, team handball, wrestling, weightlifting, and goalkeeping. Tennis players and volleyball players make a similar movement when serving or smashing, but they keep the elbow joint bent until it is extended at the moment of impact. About 25% of top-level tennis players examined had symptoms of overuse of the subscapularis tendon in one study.

Symptoms and diagnosis

– Internal rotation is limited.
– Pain is felt on moving the shoulder joint, particularly when the arm is held above the horizontal plane and is turned inwards.
– Pain is initiated by rotating the arm inwards against resistance. Another application is the ‘lift-off’ test.
– Tenderness is found when direct pressure is applied against the tendon and the tendon attachment anterior to the shoulder.
– The power of the arm is impaired during movements involving inward rotation.

Treatment

The athlete should:
– start active mobility training;
– avoid pain-causing situations;
– apply local heat and use a heat retainer after the acute phase;
– see a doctor if pain is severe.

The doctor may:
– advise active flexibility training.
– prescribe anti-inflammatory medication;
– arrange physiotherapy with flexibility training and heat treatment;
– when symptoms are chronic, administer a steroid injection around but not in the tendon, followed by a few days of rest;
– recommend surgery in chronic cases. If focal pathological changes can be verified, surgery (often arthroscopic) may be indicated.

Healing and complications

With appropriate treatment, the injured athlete can, in most cases, resume training after 1–3 weeks. If signs of injury in the subscapularis tendon reappear, the athlete should rest from sporting activity until symptoms resolve and consult a doctor. Otherwise, the injury may become chronic and force the athlete to interrupt training for several months or even give up the sport completely.

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