[Ruptures of the subscapular tendon. A diagnostic problem?]

Isolated ruptures of the subscapularis tendon are rare injuries which are often missed initially. After recent treatment of 3 patients treated in our clinic typical courses and pitfalls are demonstrated. Due to the traumatic genesis of subscapularis tendon ruptures, lesions of the rotator cuff must be excluded generally by an adequate diagnostic concept. Conventional x-rays of the shoulder in 2 views to exclude a bony lesion, clinical and ultrasound examination are seen as a standard because these methods will allow the correct diagnosis in most cases. Typical clinical signs for a subscapularis lesion are the "lift-off-test" and the "napoleon sign." The ultrasound examination should be done statically and dynamically by comparing the injured with the uninjured shoulder. The typical view in case of a subscapularis tendon rupture is a thinned tendon overlying the humeral head. In our opinion nuclear magnetic resonance imaging should not be the first diagnostic procedure. It should be reserved for such cases with unclear clinical and ultrasound results.