Improving the detection of subscapularis tears using a specific transverse CT arthrography image

Area of Science:

• Orthopedic Surgery
• Diagnostic Imaging
• Musculoskeletal Radiology

Background:

• Subscapularis (SSC) tendon tears are frequently underestimated, leading to impaired shoulder internal rotation and function.
• Accurate preoperative diagnosis of SSC tears is crucial for effective treatment planning.

Purpose of the Study:

• To compare a combined clinical and radiological preoperative index of suspicion for SSC tears against arthroscopic findings.
• To evaluate the accuracy of the surgeon's versus the radiologist's index of suspicion for detecting SSC tears.

Main Methods:

• Prospective study of 50 patients undergoing shoulder arthroscopy.
• Preoperative assessment included four clinical tests and CT arthrography analysis by the surgeon.
• Surgeon's radiological and blended clinical-radiological suspicion indexes were compared with arthroscopy results and radiologist's findings.

Main Results:

• The prevalence of subscapularis (SSC) tendon tears was 58%.
• The surgeon's blended clinical and radiological index of suspicion closely matched his radiological index.
• Both of the surgeon's suspicion indexes were higher than the radiologist's index.

Conclusions:

• Multiple clinical tests are recommended for detecting SSC tears due to their complementary nature in activating different muscle portions.
• Surgeons should augment clinical examinations with analysis of the specific image below the coracoid process as a reference for SSC tear origins.