Non-insertional tendinopathy of the subscapularis

Subscapularis tendon tear classification and diagnosis: A systemic review and meta-analysis

Background

In the current study, we performed a systematic review and meta-analysis regarding the comparison of accuracy, sensitivity, and specificity of the techniques in diagnosing SSC tendon tears. Also, we performed a systematic review of the classification of SSC tendon tears.

Methods

English language, peer-reviewed journal publications from the first date available to March 2022 were extracted by searching PubMed and Web of Science databases. A forest plot was used to graphically show the results of pooled sensitivity, specificity, and accuracy of different diagnostic modalities.

Results

There were six studies on using MRI to diagnose subscapularis tendon tears, five studies on MRI, four studies on clinical examination, one on ultrasonography, and one on CT arthrography. Pooled sensitivity values for MRI, MRA, clinical examination, ultrasonography, and CT arthrography were 0.71 (CI: 0.54; 0.87), 0.83 (0.77; 0.88), 0.49 (0.31; 0.67), 0.39 (0.29; 0.51), and 0.90 (0.72–0.97), respectively. The pooled specificity values for MRI, MRA, clinical examination, ultrasonography, and CT arthrography were 0.93 (CI: 0.89; 0.96), 0.86 (0.75; 0.93), 0.89 (0.73; 0.96), 0.93 (0.88; 0.96), and 0.90 (0.69; 0.98), respectively. The pooled diagnostic accuracy values for MRI, MRA, clinical examination, ultrasonography, and CT arthrography were 0.84 (CI: 0.80; 0.88), 0.85 (0.77; 0.90), 0.76 (0.66; 0.84), 0.76 (0.70; 0.81), and 0.90 (0.78; 0.96), respectively.

Conclusion

According to our systematic review and meta-analysis, MR arthrography was the most accurate in diagnosing subscapularis tears. MR arthrography was the most sensitive, and MRI and ultrasonography were the most specific in detecting subscapularis tears.

Interstitial Tear of the Subscapularis Tendon, Arthroscopic Findings and Technique of Repair

Tears of the subscapularis tendon have been significantly recognized as a source of shoulder pain and dysfunction in the past decade, thanks to arthroscopic evaluation of the shoulder and biomechanical and anatomical studies of the tendon. Current classification of subscapularis tendon tear is based on insertion site of the tendon. Recently, a classification for non-insertional types of subscapularis tendon tear has been published. Interstitial tear of subscapularis tendon has not been described in classifications available in the literature. This report describes significant interstitial tear of the subscapularis tendon. This tear looks normal in superior, bursal and articular sides. Then its specific arthroscopic findings as "Air bag sign" and repair technique of the pathology is explained.

Recovery of subscapularis and shoulder function following arthroscopic treatment of isolated anterior and combined anterosuperior rotator cuff lesions

BACKGROUND

The purpose of the study was to evaluate the recovery of the subscapularis and shoulder function dependent on the type of lesion and type of surgical treatment, when compared to the non-affected contralateral shoulder. We hypothesized that regardless of type of lesion and performed surgical intervention, a significant muscle insufficiency as compared to the healthy contralateral side will remain.

PATIENTS AND METHODS

Sixty-eight patients (14 females and 54 males) with an anterior or anterosuperior cuff lesion at an average age of 55.7 ± 11.7 years (range 20-80 years) were prospectively evaluated up to 24 months. Intraoperatively, the lesions were classified according to current systems and treated by debridement or reconstruction. Pre- and postoperatively, the Constant Score (CS) as well as the belly-press angle (BPA) and back-to-hand distance (BHD) on the affected and on the contralateral shoulder was noted.

RESULTS

29.4% had an isolated subscapularis lesion whereas 69.1% had concomitant supraspinatus pathology. In 17 patients an arthroscopic debridement and in 51 patients an arthroscopic repair were performed. Postoperatively, all patients revealed a significant improvement of the CS, BPA and BHD (p < 0.05) independent of the type of lesion or the surgical intervention. However, reconstruction of the subscapularis tendon resulted in significant differences of CS, BPA and BHD (p < 0.05) compared to the contralateral shoulder.

CONCLUSION

Reconstruction of subscapularis lesions cannot provide full subscapularis function since a residual subscapularis insufficiency remains, other than in patients with small partial tears treated with debridement alone.