The subscapularis tendon is a vital part of the rotator cuff and is responsible for shoulder movements in overhead sports such as swimming, tennis, or other racquet sports. Injuries to this tendon, whether through tendonitis or acute trauma resulting in a tear, can significantly impact shoulder function in sports. This blog outlines the clinical assessment, rehabilitation strategies, and surgical options for a subscapularis tendon tear and tendonitis.
What is the Subscapularis Muscle and Tendon?
The subscapularis muscle is the largest rotator cuff muscle, sitting at the front of the shoulder. It is also the strongest cuff muscle, providing over 50% of the total cuff length. The subscapularis muscle turns the arm inwards and is vital in lifting movements across the chest.
The subscapularis tendon attaches to the upper arm bone. A torn subscapularis tendon can occur by itself or be associated with other rotator cuff tendon tears. Tears arise due to trauma when the arm is forced into external rotation or extension. However, in people over the age of 50, tears can occur without trauma.
Some cases of a torn subscapularis tendon lead to instability of the biceps tendon at the front of the shoulder.
Clinical Assessment of a Subscapularis Tendon Tear
Active individuals often present with front shoulder pain, weakness, and difficulty with activities requiring internal rotation, such as reaching behind their back. In cases of acute tears, there may be a history of trauma, such as a fall or heavy lifting. Chronic overuse injuries often have a gradual onset of symptoms associated with repetitive overhead activities.
A sports doctor’s assessment of the shoulder reveals a weakness in internal rotation and an increase in passive external rotation. Special tests, such as the Lift-Off test (inability to lift the hand from the back) or the Belly Press Test (weakness or pain when pressing the hand against the tummy), are positive. Generally, there is tenderness at the front of the shoulder.
We usually use ultrasound or MRI scans to detect a torn subscapularis tendon or tendonitis. Imaging is also helpful in detecting injuries to the other rotator cuff tendons or the biceps tendon.
Treatment Options
Generally, we reserve non-surgical treatment for subscapularis tendonitis and partial tears. NSAIDs can help reduce pain and inflammation. Physiotherapy starts with isometric exercises and progresses to isotonic exercises targeting the rotator cuff and scapular stabilising muscles.
Sometimes, shoulder injections are used to help rehab. Cortisone injections may be considered for severe inflammation but should be used cautiously to avoid tendon weakening and tearing. Although the evidence remains mixed, platelet-rich plasma (PRP) injections are gaining attention for promoting tendon healing. We use PRP injections for partial tears of the subscapularis tendon.
Surgical Options
Surgical intervention may be necessary when conservative treatment fails or in cases of significant tears. Most surgeons perform keyhole surgery. However, open repair is often performed for larger or retracted tears.
Other Frequently Asked Questions about a Torn Subscapularis Tendon:
Is surgery needed for subscapularis tendon injury?
We think that surgery should be reserved for full-thickness subscapularis tendon tears.
How is the subscapularis tendon injured in sports?
Ususally, tendon injuries occur with forced shoulder external rotation or extension. Sometimes, shoulder dislocations may cause full-thickness tendon partial full-thickness tear.
Do interstitial subscapularis tears need surgery?
Generally, no. Interstitial tears involve the centre of the tendon and are partial tears. We usually advise conservative treatment incorporating physiotherapy, oral NSAIDs, and shoulder injections.
Final Word from Sportdoctorlondon about Subscapularis Tendon Tear
Subscapularis tendon injuries can significantly impair shoulder function, but most patients achieve good outcomes with a comprehensive approach. Accurate diagnosis, individualised rehabilitation, and, when needed, timely surgical intervention are key to successful management. If you’re experiencing persistent shoulder pain or dysfunction, consult a sports medicine specialist for an evaluation.
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