A group of four muscles, known as the rotator cuff muscles, control the movement of the upper arm and shoulder. The subscapularis muscle is the strongest muscle of this group that is located on the front side of the upper arm. It keeps the muscle stable and helps in inward rotation of the arm. This muscle also prevents the head of the humerus from slipping out of the shoulder socket. About two- thirds of this muscle is made up of tendons which makes it prone to injuries, particularly in athletes who indulge in swimming, playing tennis or throwing actions. Damage to the tendon that supports this muscle is termed as Subscapularis Tendon Tears.
Causes
- Repeated arm movement that involves lifting or throwing actions
- Inefficient warm ups before playing a sport
- Overuse injuries
- Playing a sport or training when the muscles are strained or injured
- Inherent mechanical problems in the shoulder joint
- Tendinitis- prolonged use of the muscles leads to degeneration
- Falling on the shoulder to break a fall
- Forceful forward or backward movement of the arm
- Slipping out of the biceps tendon from its grove and cutting across the subscapularis tendon
Symptoms
- Pain in the front part of the shoulder, which may get aggravated with upper arm or body movement
- Decreased movement of the joint
- Lifting, twisting and rotation of the arm may be painful
- Weakness of internal rotation
- Anterior shoulder swelling
- Tenderness in the affected part of the joint
- The shoulder may hurt when touched
Diagnosis
- Bear-hug test
- Gerber’s Lift Test
- Belly-press Test
- Ultrasound
- MRI Scan
Treatment
- The preferred mode of treatment in elderly patients is physical therapy for this condition.
- Arthroscopic surgery may be recommended in people who are physically active. During the procedure, the tendon is replaced or treated as per the severity of the condition
- Pec Major Transfer- This surgical procedure is adopted in case of chronic tears. The Pectoralis major muscle is transferred in place of the subscapularis as it has the capability to perform the same function
- Sufficient rest is required for the affected shoulder and all activities that cause stress to the joint need to be avoided
- Injecting cortisones into the affected part may provide immediate relief
- Post-surgery, physical therapy and gradual mobility training may be helpful in regaining movement and strength
- The operated arm may be immobilized using a sling for a few days or weeks
