The forelock sign: A new arthroscopic finding in partial subscapularis tears

Area of Science:

• Orthopedic surgery
• Shoulder arthroscopy
• Rotator cuff pathology

Background:

• Partial tears of the subscapularis tendon can be challenging to diagnose.
• The forelock sign and air bag sign are potential diagnostic indicators for subscapularis tears.
• Understanding the incidence of these signs is crucial for accurate diagnosis and treatment.

Purpose of the Study:

• To identify the forelock sign in partial subscapularis tears.
• To compare the incidence of the forelock sign with the air bag sign.
• To evaluate the association of these signs with other shoulder pathologies.

Main Methods:

• 120 patients with isolated subscapularis or supraspinatus tears underwent shoulder arthroscopy.
• Patients were divided into four groups based on tear type.
• Surgical video records were analyzed to assess the forelock sign, air bag sign, long head of biceps tendon (LHBT) integrity, and Lafosse classification.

Main Results:

• The forelock sign was present in 60% of subscapularis tears (group 1), significantly more frequent than in other groups (OR 10.46).
• The air bag sign was observed in only 10% of subscapularis tears.
• Pathology of the long head of biceps tendon (LHBT) was significantly associated with subscapularis tears (p<0.01).

Conclusions:

• The forelock sign is a frequent and consistent finding in partial subscapularis tears.
• The air bag sign is rare in subscapularis tears.
• While LHBT disorders are associated with subscapularis tears, the forelock sign does not predict LHBT condition or tear classification.