Subscapularis Tendon Rupture - Everything You Need To Know - Dr. Nabil Ebraheim
Dr. Ebraheim’s educational animated video describes the condition and treatment of subscapularis tendon rupture, the signs and symptoms, etiology, anatomy, diagnosis, and the treatment.
The subscapularis muscle is a large muscle that originates on the anterior surface of the scapula and lies in front of the shoulder. The subscapularis muscle is the largest of four rotator cuff muscles and it provides about 50% of the total cuff strength. The subscapularis muscle inserts into the lesser tuberosity, while the other rotator cuff muscles have an insertion into the greater tuberosity. The biceps tendon lies in the groove and is held in place by the transverse humeral ligament.
Ultrasound examination
Usually the probe is placed transversely over the bicipital groove to identify the groove and the biceps tendon while the arm is in a neutral position. The arm is then externally rotated to view the subscapularis tendon.
Function of the subscapularis muscle is internal rotation and acts as a dynamic stabilizer of the humeral head.
The subscapularis muscles is supplied by the upper and lower subscapular nerve. The upper and lower subscapular nerves originate from the posterior cord of the brachial plexus.
Causes
•Anterior shoulder dislocation.
•A fall on an outstretched arm during abduction is usually the mechanism of injury.
•May occur following anterior shoulder surgery
•In traumatic situations a subscapularis tendon avulsion can be associated with avulsion of the lesser tuberosity.
•A subscapularis tear may be associated with a rotator cuff tear.
Tears are rare and can be either chronic or acute. Patient will have pain, anterior shoulder swelling, decreased range of motion and weakness of internal rotation. Patient will also have an increase in passive external rotation.
Diagnosis of a subscapularis tear could be difficult and may be missed. With complete rupture of the subscapularis tendon, the transverse humeral ligament will become torn, causing medial dislocation of the biceps tendon from its groove.
Clinical diagnostic tests for subscapularis tendon rupture.
Lift-off test
The patient places the hand behind their back at the lumbar level and lifts the hand away from the back with an intact subscapularis tendon. If the patient is unable to lift the handoff of the lower back, then a tear of the subscapularis tendonis suspected.
Lift-off lag test.
The examiner will hold the patient’s hand away from the back at the lumbar region and let go. Patient will be unable to keep the hand away from the back if the tendon is torn.
Belly press test
The patient presses the palm of the hand against the abdomen with the wrist in a neutral position. This is an example of an intact subscapularis tendon. A positive sign for the belly-press test occurs if the patient is unable to press his belly without wrist volar flexion or the elbow falling posteriorly.
Belly-off test
The shoulder is placed in flexion and maximum internal rotation. The examiner positions the patients hand on the belly while holding the flexed elbow. If the tendon is ruptured the patient will not be able to maintain this position and the hand will lift off of the abdomen when the examiner let go.
Tear can be diagnosed by MRI or ultrasound.
Treatment
Complete tear
Surgical repair. Repair may be either open or arthroscopic. Biceps tenodesis during repair is associated with improved outcomes. Biceps tenodesis is usually done if the biceps is involved in the process, otherwise subluxation of the biceps will stress and fail the repair.
For Chronic muscle tear, Pectoral major muscle transfer is the procedure of choice.
Пікірлер: 55
I prefer hearing the man himself narrating these priceless lectures. He phonetically stresses the important points. I'm a doctor 30 years into my practice and wish I had these back in the day. The best ortho content on the web hands down.
@xavierrichard8274
2 жыл бұрын
instaBlaster...
@jiayinglee
2 жыл бұрын
same
@fireblade9781
Жыл бұрын
@@jiayinglee same
I am a fan of Prof. Ebraheims videos /but only in his original voice/. They are extremely useful.
This video is brilliant! If you have a loved one who might have with this condition resulting from a frozen shoulder procedure or previous rotator cuff injury, it's pure validation.
I think I may have a similar injury but have not been able to get my physician's cooperation through my health plan for a diagnosis yet. This happened two years ago already this last spring, or about 26 months ago. Wish you a complete healing and successful treatment.
thanks
Subscapularis tendon rupture is usually a diagnostic challenge. This video is very helpful to deal with this situation. Thanks!
@outerrealm
Жыл бұрын
yeah, what little you could see through this idiot's logo plastered across the image. As if he has patent rights on the human rotator cuff
I fractured my shoulder and I've been trying to figure out what exactly is wrong with my arm this video was more helpful than all the doctors videos and therapist videos thank you so much
Phenomenal. Great ultrasound imaging.
Great video! All your videos are fantastic. I love the humor!
This is fantastic. Educational for remember the forgottenimagines after finisf the carreer
Excellent video..
@nebraheim great
Very good teaching presentation 👌
I believe mine is associated with a rotor cuff tear, 63 retired truckdriver shoveling and throwing heavy wet snow. Sometime s winter sucks! Good vid , now I know what it showed on my MRI. And yes it hurt s all the time , hoping for repair!
love the video
Your videos are the best! Thank you so much. :-)
@NYOrthoRN thanks
Best video!
@1darrenknight thanks
@TCMAUMEE thanks
sometimes
@fj783 thanks
Thank you. I have this, and the video helped me to understand. I will be having my 2nd surgery to repair this problem.
@youtubebrowser1730
4 жыл бұрын
why second surgery bro. please reply as i have complete tear of subcapularis. its almost two months i have not done surgery. i am afraid of surgery. i dont know what to do
@Kencio26
Жыл бұрын
@@youtubebrowser1730 just tore the subscapularis. How did you do? Are you fine? i‘m an athlete and need to get back to shape
@Kencio26
Жыл бұрын
Just tore it yesterday, was able to get MRI today, results tomorrow. Will update if you want
@ELF3945 thanks
I am currently 4 weeks out of surgery as well. Had to wait for surgery 2 yrs after injury :(
Salam.thank you
A great informational video. i had a fit this year and as i result of it when i fell, i have snapped the subscapularis tendon and after my MRI scan last week i have learnt it is totally detached and i am awaiting a consultation with a specialist. Surgery is going to be required and i cannot do the lift off test, lift off lag test or the belly press. thanks again Andy
@adamzuker8757
5 жыл бұрын
kebabster75 hey! I had my sub scapulars tendon repair and biceps tenodesis 6 weeks ago I was wondering... how is your pain while preforming belly press or lift off Did it improve?
@thefutureh
3 жыл бұрын
@@adamzuker8757 how is your shoulder now ?
5 weeks ago i had surgary for Subscapularis Tendon
i was 2 years after injury as well ..
3.56 - I don't think the shoulder is in flexion here. You probably meant elbow. But I like the video. Thanks :-)
Hi can I please listen to this in another voice?
same thing i've been feling since childhood............can raprture of rotatary cuff is completely cure able?
@Meanoldwoman2013
6 жыл бұрын
Yes, you get it operated on. Nothing else will work but for a temporary measure.
@hamza12345679 thanks
2 broken toes 2 broken fingers no curve in neck spine two bad knees and now a fucked up tendon? Why I still live in America?
I enjoyed the skeleton humor at the end! ;-)
@HI4Deb
8 жыл бұрын
+Maroon Medio You got the WRONG Debbie Ingram sir.... There is more than one of us in the Twin Cities!!!
thanks
@Bonemd2015 thanks
thanks
thanks