The subscapularis tendon is a vital part of the rotator cuff, driving the shoulder movements used in overhead sports such as swimming, tennis, and other racquet sports. Injury to it — whether tendonitis or an acute tear — can significantly affect shoulder function. This guide covers the assessment, rehabilitation, and surgical options for a subscapularis tendon tear and tendonitis.
What is the subscapularis muscle and tendon?
The subscapularis is the largest and strongest of the four rotator cuff muscles, sitting at the front of the shoulder. It turns the arm inwards and is vital for lifting and for movements across the chest.
The subscapularis tendon attaches to the upper arm bone. A tear can occur on its own or alongside other rotator cuff tears. Tears usually arise from trauma — when the arm is forced into external rotation or extension — though in people over 50 they can occur without any injury. Some subscapularis tears also lead to instability of the biceps tendon at the front of the shoulder.
Clinical assessment of a subscapularis tendon tear
Active people usually present with front shoulder pain, weakness, and difficulty with tasks that need internal rotation — such as reaching behind the back. Acute tears often follow trauma, like a fall or heavy lift, while chronic overuse injuries come on gradually with repetitive overhead activity.
On examination, we find weakness of internal rotation and increased passive external rotation. Specific tests are usually positive:
- Lift-off test — an inability to lift the hand away from the back
- Belly-press test — weakness or pain when pressing the palm into the stomach
There’s usually tenderness at the front of the shoulder.
Ultrasound or MRI confirms a subscapularis tear or tendonitis, and also detects any injury to the other rotator cuff tendons or the biceps tendon. Ultrasound has the advantage of a dynamic assessment — testing the tendon as the shoulder moves.
Treatment options
Non-surgical treatment
We reserve non-surgical treatment for subscapularis tendonitis and partial tears. NSAIDs reduce pain and inflammation. Physiotherapy starts with isometric exercises and progresses to isotonic strengthening of the rotator cuff and the scapular stabilising muscles.
Shoulder injections sometimes support rehabilitation. A cortisone injection may help severe inflammation, but we use it cautiously, since cortisone can weaken the tendon. PRP injections, while the evidence is still mixed, are increasingly used to support healing — we use PRP for partial subscapularis tears.
Surgical treatment
Surgery may be needed when conservative treatment fails, or for a significant (full-thickness) tear. Most surgeons perform keyhole surgery, though open repair is often used for larger or retracted tears.
Frequently asked questions about a torn subscapularis tendon
Does a subscapularis tendon tear need surgery?
Not always. We reserve surgery for full-thickness tears. Tendonitis and partial tears usually settle with physiotherapy, anti-inflammatories, and — where helpful — a guided injection. A full-thickness tear, particularly in an active person, is more likely to need surgical repair.
How is the subscapularis tendon injured in sport?
Most often by a forced external rotation or extension of the shoulder. A shoulder dislocation can also tear the tendon. In people over 50, degenerative tears can occur without any specific injury.
Do interstitial subscapularis tears need surgery?
Generally no. Interstitial tears involve the middle of the tendon and are partial. We usually advise conservative treatment — physiotherapy, oral NSAIDs, and, where needed, a shoulder injection.
What’s the difference between subscapularis tendonitis and a tear?
Tendonitis is inflammation and early degeneration of the tendon, causing pain but preserving most of its strength. A tear is a structural break in the tendon fibres — partial or full-thickness — and tends to cause more weakness, especially of internal rotation. Ultrasound or MRI distinguishes them, which guides whether treatment is rehabilitation or surgery.
How long does recovery take?
Tendonitis and partial tears often settle over a few months of rehabilitation. A surgically repaired full-thickness tear takes longer — typically several months in a graded programme that protects the repair early while rebuilding strength.
Final word from Sport Doctor London about a subscapularis tendon tear
A subscapularis tendon injury can significantly impair shoulder function, but most people do well with the right approach. Accurate diagnosis, an individualised rehabilitation programme, and — where needed — timely surgery are the keys to a good outcome.
If you have persistent front-shoulder pain or weakness, Dr Masci can assess you in London, including dynamic ultrasound in clinic. Contact the team here or call +44 (0) 203 488 0350.
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