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$Autologous Microfractured and Purified Adipose Tissue for Arthroscopic Management of Osteochondral Lesions of the Talus$

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Lesser tuberosity avulsions in adolescents.

Lorenzo Nardo¹, Benjamin C Ma², Lynne S Steinbach³

¹Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus, San Francisco, CA 94143-0628 USA.

HSS Journal : the Musculoskeletal Journal of Hospital for Special Surgery

|September 30, 2014

Summary

Subscapularis tendon avulsions are rare shoulder injuries in adolescents, often misdiagnosed. Early recognition and appropriate treatment, surgical or conservative, lead to good outcomes with full recovery of shoulder function.

Keywords:

MRI rotator cuff shoulder subscapularis trauma

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Area of Science:

Orthopedic Surgery
Sports Medicine
Pediatric Traumatology

Background:

Subscapularis tendon avulsions of the lesser tuberosity are uncommon injuries.
These injuries are frequently misdiagnosed as osteochondromas or neoplastic processes due to their characteristic appearance.
Acute diagnosis is often missed, leading to delayed treatment and management challenges.

Purpose of the Study:

To review the clinical experience with adolescent subscapularis tendon avulsions of the lesser tuberosity.
To highlight diagnostic challenges and treatment outcomes in this specific patient population.
To emphasize the importance of recognizing this injury in young athletes.

Main Methods:

Retrospective review of six male adolescent patients (12-15 years) presenting with shoulder pain after trauma.
Evaluation of clinical data including range of motion, strength tests, and pain assessment.
Review of pre- and post-treatment imaging studies (X-ray, MRI).
Analysis of treatment strategies, including surgical repair with suture anchors and conservative management.

Main Results:

All six cases were diagnosed with subscapularis tendon avulsion of the lesser tuberosity after initial misdiagnosis in two instances of simulated exostosis.
Five patients underwent surgical repair, while one received conservative treatment.
All patients achieved good outcomes, with full recovery of shoulder strength and motion.

Conclusions:

A high index of suspicion for lesser tuberosity avulsions is crucial in adolescents with anterior shoulder pain and loss of internal rotation post-trauma.
An osseous fragment or exostosis on the inferomedial humeral head should prompt consideration of subscapularis tendon avulsion, not osteochondroma or neoplasm.
Prompt and accurate diagnosis is key to successful management and functional recovery in these injuries.