Subscapularis tendon rupture in an 8-year-old boy: a case report

Since falling off a motorcycle 2 years earlier, an 8-year-old, right-hand-dominant boy reported anterior shoulder pain and weakness. After being evaluated by his family physician and completing a course of physical therapy with no symptomatic improvement, he was seen at our institution. Physical examination was remarkable for diminished strength with internal rotation (4/5). In addition, bellypress and lift-off tests were positive, suggesting a lesion of the subscapularis. Magnetic resonance imaging of the shoulder showed a full-thickness subscapularis tendon tear and a supraspinatus tendon signal that could have represented a partial-thickness tear vs supraspinatus tendinosis. The patient underwent right shoulder diagnostic arthroscopy with debridement of a partial-thickness articular-sided tear of the supraspinatus tendon followed by open repair of the subscapularis tendon rupture. This case illustrates a traumatic subscapularis tendon injury that is rare in this age group. A few other traumatic subscapularis injuries have been reported in children, but they all demonstrated bony avulsion of the lesser tuberosity.