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Subscapularis Deficiency

Rupture of the subscapularis after an anterior open instability repair causes significant functional disability, which may or may not be associated with recurrence of instability.

Often such tears go unrecognized when patients present postoperatively with weakness and pain but no clear evidence of recurrent instability. A high index of suspicion and a careful physical examination is necessary in order to detect this problem.

When a subscapularis rupture occurs, repair poses a significant surgical challenge and risk for the surrounding neurovascular structures. Unless it is detected and addressed quickly, the subscapularis muscle and tendon are often retracted and adherent to the surroundings structures.

The axillary nerve, musculocutaneous nerve, and brachial plexus are at risk. This problem is best avoided by meticulous repair of the tendon. If subscapularis rupture occurs, successful revision repair is often possible with direct repair of the tendon. In chronic cases, tendon transfer of the pectoralis is necessary as previously described .

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