The rotator cuff is a series of four muscles that run along the scapula (shoulder blade), around the glenoid (shoulder socket), and attach to the humeral head (ball) by their tendons. The subscapularis muscle runs along the underside of the scapula and attaches to the anterior (front) portion of the humeral head. Injury or degeneration (wear and tear) can result in a tear of the subscapularis tendon.
What Is a Subscapularis Rotator Cuff Tear?
The muscles of the rotator cuff work to keep the humeral head (ball) centered in the glenoid (socket) as the arm moves. The subscapularis muscle is critical for internal rotation of the humerus (arm bone) and stability of the shoulder joint.
A tear of the subscapularis tendon can result from injury or degeneration (wear and tear). Rotator cuff tears can cause weakness and pain. The resulting dysfunction also affects the ability to keep the humeral head centered on the glenoid, which can cause additional irritation and pain in the shoulder.
Causes and Risk Factors
Causes of subscapularis rotator cuff tears include:
- Direct injury to the shoulder, such as falling on an outstretched arm or getting the arm caught and forced backward
- Aging or degeneration (wear and tear) of the tendon with normal use
- Shoulder dislocation in patients older than age 40
Risk factors include:
- Contact sports or throwing sports
- Weightlifting and bodybuilding
- Heavy or repetitive overhead labor
- Previous injury to the rotator cuff, including impingement
- Poor physical conditioning, including strength and flexibility
- Inadequate warm-up before activities
- Increasing age
Symptoms
Common signs and symptoms include:
- Pain along the upper arm between the shoulder and elbow
- Pain that increases when reaching out and overhead
- Aching pain at rest or at night while trying to sleep
- Loss of strength
- Limited shoulder motion, especially when reaching behind for a back pocket or bra clasp
- Crepitus (a crackling sound) when moving the shoulder
Treatment
Treatment depends on the patient’s medical health and demands (activity level), the presence of arthritis, and whether the tear can be repaired.
For large, possibly irreparable tears, elderly patients with low demands, or patients who are poor surgical candidates because of other health conditions, restricting activity to prevent symptoms combined with physical therapy to optimize the function of the remaining intact rotator cuff muscles is the most appropriate initial treatment.
For irreparable tears that have not improved with initial activity restriction and physical therapy, arthroscopic surgery to debride (clean up), partially repair the rotator cuff, or transfer a muscle to replace the subscapularis may help relieve symptoms and regain function. Reverse total shoulder replacement may be appropriate for some irreparable tears.
For all other symptomatic rotator cuff tears, surgery is usually recommended to repair the rotator cuff tendon back to the arm bone. Surgery may be performed arthroscopically or with an open incision. Dr. Chudik can perform arthroscopic surgery to reattach the torn rotator cuff tendon to the bone.
Recovery and Outcomes
Symptoms may improve by avoiding or limiting aggravating activities and performing physical therapy exercises to strengthen the remaining intact rotator cuff muscles to compensate for the tear. However, rotator cuff tears do not heal with conservative treatment and will tend to get larger and more painful with time. Eventually, an untreated rotator cuff tear may become nonfunctional and irreparable, sometimes within months.
Surgery is often needed to repair the rotator cuff tear, alleviate pain, and restore function. Outcomes for arthroscopic rotator cuff repair are generally good, but larger and older tears do not have as good of an outcome.
Recovery usually requires six to eight weeks in a sling followed by four to six months of physical therapy.
Potential complications include:
- Intermittent pain that may progress to constant pain as the tear progresses
- Shoulder stiffness or loss of motion
- Persistent weakness
- Worsening of symptoms if treated without surgery
- Inability to return to the same level of function even if the tendon is repaired
- Arthritis or rotator cuff arthropathy
- Surgical risks, including infection, bleeding, injury to nerves, shoulder stiffness, weakness, re-tearing of the rotator cuff tendon, and persistent pain
When to See Dr. Chudik
For evaluation and treatment of a subscapularis rotator cuff tear, call 630-324-0402, schedule an appointment online, or email contactus@chudikmd.com.