Subscapularis Tears

Tears of the subscapularis tendon are more common that thought, mostly associated with other shoulder injuries. These tears can be either traumatic or degenerative. Patients with these tears complain of anterior shoulder pain, and a combination of clinical tests are useful to detect it. Ultrasound and magnetic resonance imaging help identify and grade the tear, the gold standard being arthroscopic findings. The Lafosse classification helps understand the severity of the tears and plan treatment options. Conservative management consisting mainly of physiotherapy is reserved for low-activity patients, usually with comorbidities, or low-grade, marginal tears. Surgical management includes options such as debridement, direct repair (arthroscopic or open), tendon transfers, anterior capsule reconstruction, or reverse arthroplasty. Postoperative rehabilitation is needed and takes up to 6 months. Outcomes of subscapularis repair are usually good to excellent, with a retear rate up to 12.9%.