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Related Experiment Video

Updated: Jan 30, 2026

The Modified Single-working Portal Technique Using Lasso-loop Stitch with Needle for Arthroscopic Subscapularis Repair
04:01

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Subscapularis tears: hidden and forgotten no more.

Julia Lee1, Dave R Shukla1, Joaquín Sánchez-Sotelo1

  • 1Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN, USA.

JSES Open Access
|January 25, 2019
PubMed
Summary

Subscapularis tendon tears are increasingly diagnosed and repaired using arthroscopy. Accurate diagnosis relies on history, physical exams, and advanced imaging, guiding surgical repair strategies.

Keywords:
Arthroscopic rotator cuff repairIrreparable subscapularisRotator cuff imagingRotator cuff tearShoulder tendon transferSubscapularis physical examinationSubscapularis tear

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Area of Science:

  • Orthopedics
  • Sports Medicine
  • Shoulder Surgery

Background:

  • The subscapularis tendon was historically overlooked, with partial tears often missed.
  • Advancements in understanding anatomy, biomechanics, imaging, and arthroscopy have improved diagnosis and treatment rates.
  • The subscapularis is the largest rotator cuff muscle, crucial for internal shoulder rotation.

Purpose of the Study:

  • To review the diagnosis and arthroscopic repair of subscapularis tendon tears.
  • To highlight the importance of clinical examination and advanced imaging in identifying these injuries.
  • To present the Lafosse classification as a guide for surgical management.

Main Methods:

  • Review of current literature on subscapularis tendon anatomy, biomechanics, and pathology.
  • Emphasis on diagnostic methods including patient history, physical examination (bear hug, lift-off, belly-press tests), and advanced imaging.
  • Discussion of arthroscopic repair techniques, including portal selection and tendon mobilization based on tear severity.

Main Results:

  • Improved diagnostic capabilities lead to higher rates of subscapularis tear identification.
  • Arthroscopic repair is effective for most diagnosed tears.
  • The Lafosse classification system aids in tailoring surgical approaches for different tear types.

Conclusions:

  • Accurate diagnosis of subscapularis tendon tears is achievable through thorough clinical evaluation and advanced imaging.
  • Arthroscopic repair is the standard treatment, with techniques adapted to tear size and complexity using classifications like Lafosse.
  • Management strategies range from direct repair to tendon transfer or reverse arthroplasty for severe cases with instability.