The Subscapularis is the largest of the rotator cuff muscles. It has a tendon attachment that is separate from the rest of the rotator cuff. Subscapularis tendon tears can lead to pain, significant weakness and even the total loss of shoulder elevation. Despite the importance of the Subscapularis, partial or even complete Subscapularis tendon tears are often missed, leading to suboptimal surgical results. During arthroscopic shoulder examination, Subscapularis tendon tears have to be intentionally looked for separately.
Often Subscapularis tears are part of massive rotator cuff tears. Fortunately, Subscapularis tendon tears can be repaired arthroscopically at the same time as the other rotator cuff tendon tears.
The Subscapularis is a major stabilizer of the biceps tendon and Subscapularis tears almost always lead to biceps tendon subluxation. Therefore, the first step is to perform a biceps tenodesis to eliminate the biceps tendon as a problem. The Subscapularis is then repaired arthroscopically.
Arthroscopic Subscapularis Repair
After Arthroscopic Subscapularis Repair, keep the small arthroscopy portals clean and dry for 48 hours. Before 48 hours, bathing is fine; just keep the shoulder above water and don’t get the dressings wet. After 48 hours, the wounds can get wet in the shower, then blot them dry. Don’t submerge the wounds under water until the stitches are removed, which usually occurs at the first post-operative visit at 2 weeks. The elbow, wrist, forearm and hand can be moved early on to prevent stiffness. During Shoulder Arthroscopy, fluid is placed into the shoulder. This fluid will leak out over the first 2-3 days, and is not blood.
Following surgery, Subscapularis Tendon Repairs need to be protected for at least 6-12 weeks. Because all Rotator Cuff Tendons are heal slowly, the post-operative course following a Subscapularis Tendon Repair is highly inconvenient. An abduction pillow, a sling with a pillow on it that is nearly-universally hated, is worn for 6-8 weeks, except when showering. It is slept in. Nobody likes it, but helps prevent Rotator Cuff re-injury and increases the Rotator Cuff’s blood supply. No active shoulder elevation (i.e. using the operated shoulder to lift its arm) is allowed for 6-8 weeks. Normally, a home motion program is begun after the first follow-up appointment at 2 weeks. Therapy is used as needed; it’s better if motion can be initially regained without the help of a therapist. Physical therapy is used when a patient has trouble regaining motion on their own. Some people need a lot of therapy, some hardly any. No lifting anything heavier than a telephone or one pound for 3 months.
Most people do very well following Arthroscopic Subscapularis Repair and can return to heavy work or sports at 6-12 months. It takes about 1-1.5 years before the shoulder feels “as good as it’s going to get”. Those who wait too long may develop atrophy of the Rotator Cuff’s muscles, leading to worse results. However, when all is said and done, most patients who obey the restrictions and perform their home exercises are much improved and extremely happy with the improvements in their pain relief, strength and shoulder function following Arthroscopic Subscapularis Repair.