Dr. Kevin Yip

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

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Subscapularis Tendon Rupture

SYMPTOMS

There is acute or gradual onset of exercise-induced pain and weakness on internal rotation with the shoulder in a neutral position, and difficulty in reaching the lower back with the hand.

AETIOLOGY

The onset can be dramatic and relate to an anterior shoulder dislocation caused by heavy tackling, for example in rugby.

CLINICAL FINDINGS

Active forward flexion and external rotation is usually painful. Gerber’s lift-off test is positive. There is tenderness on palpation in the anterior shoulder joint. Palm-up tests and SLAP tests are usually vaguely positive. Since this injury often affects many structures, a thorough clinical examination of these must also be undertaken.

INVESTIGATIONS

This is a clinical though difficult diagnosis. Arthroscopy can confirm. X-rays should be taken in different planes to rule out fracture. MRI is helpful.

TREATMENT

If there is a complete tear, surgical refixing is usually required but partial tears can be treated with progressive rehabilitation. Distal partial flap tears can cause impingement and require a thorough vaporation.

REFERRALS

Refer to Dr Kevin Yip (+65 9724 1219) senior consultant orthopaedic surgeon to determine the diagnosis and for consideration of surgery. In almost all cases, a thorough rehabilitation programme, including specific treatment, thoraco-scapular control training, strength, flexibility and posture training is required.

EXERCISE PRESCRIPTION

Most sports and activities are possible but secondary symptoms due to
compensatory movements are common and must be addressed. Swimming is usually difficult. The specific rehabilitation should aim to achieve over time a full range of controlled motion, good posture and thoraco-scapular control.

EVALUATION OF TREATMENT OUTCOMES

Normal clinical symptoms and signs. Gerber’s lift-off test should be negative. Functional strength, control and flexibility should be comparable with the other shoulder.

DIFFERENTIAL DIAGNOSES

A number of shoulder injuries can cause similar symptoms but Gerber’s
lift-off test is seldom positive if the subscapularis is not affected.

PROGNOSIS

Excellent-Poor, depending on the severity of the injury

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