Higher Upper Subscapularis Goutallier Grade and Coracohumeral Distance Narrowing Are Predictive of Subscapularis Tears in Patients Undergoing Arthroscopic Rotator Cuff Repair

Editorial Commentary: Subtle Degenerative Tears That So Commonly Involve the Upper Third of the Subscapularis Are Oftentimes Missed

Subtle degenerative tears that so commonly involve the upper third of the subscapularis are oftentimes missed. However, there are physical examination, imaging, and arthroscopic findings that are highly suggestive of subscapularis tearing. Positive belly-press and bear hug tests, a thinner and longer subscapularis tendon, subscapularis muscle, belly loss of bulk or fatty infiltration, narrow coracohumeral distance, and biceps pathology are indicative. Artificial intelligence-based predictive algorithms can estimate the likelihood of subscapularis tearing based on a combined analysis of these and other features. Improved outcomes should logically be expected for those shoulders with subscapularis tears that are identified and repaired. Finally, some research suggests that debridement remains an alternative to repair; however, pending future research, debridement is not the author's preferred treatment.