BACKGROUND: Our purpose was to investigate (1) the difference in external rotation range of motion (ROM) limitation between the two recommended subscapularis-splitting techniques (mid-split versus upper 2/3rd -lower 1/3rd split) and (2) the differences in elevation ROM, internal rotation ROM, the functional outcomes and the internal rotation strength between the two techniques in the Latarjet-Walch procedure.
METHODS: We conducted a prospective cohort study of patients with recurrent shoulder instability treated by the Latarjet-Walch procedure between January 2021 and January 2022. After a priori calculation of sample size, 32 patients were divided into two groups according to the type of intraoperative subscapularis split [upper 2/3rd -lower 1/3rd level split (LS group, n=19) versus mid-level split (MS group, n=13)] performed in the Latarjet-Walch procedure.
RESULTS: The final ER1 (external rotation with the arm adducted) deficit (as compared to opposite normal shoulder) was not significantly different between the LS (9° ± 8°) and the MS (10° ± 8°, p=0.8) groups. The final ER2 (external rotation with the elbow abducted @ 90°) deficit was not significantly different between that of the LS (14° ± 12°) and the MS groups (12° ± 9°, p=0.5). Only in the MS group were the final ER1 deficit (p=0.03) and the final ER2 deficits (p=0.05) significantly better (smaller) than the corresponding baseline values. The Rowe scores (p=0.2) and the shoulder subjective value (p=0.7) were not significantly different between the two groups. There were no postoperative subluxations in either group. However, 3 patients tested positive in apprehension testing in the LS group compared to none in the MS group, the difference being statistically insignificant. The internal rotation strength was 95% of the normal, unaffected shoulder in the LS group and 93% of the normal in the MS group (p=0.6). Computed tomography (CT) scan evaluation showed that the transverse diameter index of subscapularis (upper subscapularis diameter / lower subscapularis diameter) was not different in the MS (0.9 ± 0.1) and the LS (0.9 ± 0.1, p=0.3) groups.
CONCLUSIONS: We found no difference in final external rotation limitation between the upper 2/3rd - lower 1/3rd versus mid-level subscapularis split techniques. The functional outcomes, the internal rotation strength, subscapularis transverse diameter index, and fatty infiltration in the CT scan were similar in both groups.

UNASSIGNED: An intramuscular abscess of the subscapularis is a rare phenomenon but important pathology for surgeons to be aware of because clinical deterioration can be rapid and diagnosis difficult. The presentation often mimics other common shoulder pathologies with subacute shoulder pain and stiffness. Early diagnosis, antibiotics and surgical drainage are critical to reduce the spread and joint destruction.
UNASSIGNED: A search of PubMed and Google Scholar databases identified cases of subscapular intramuscular abscess. Data collected about each case included patient demographics, presentation, pathology, surgical treatment and outcome. The authors report one additional subscapular abscess case.
UNASSIGNED: Data from 17 cases of subscapular abscess were found, 16 in the literature and one case described by the authors. Sixteen of 17 cases (94.1%) presented with shoulder pain and reduced range of motion worsening over a mean of 6.7 days prior to presentation. Surgical approaches utilised included a posterior inferomedial approach, deltoid-pectoral approach and one posterior inferolateral approach.
UNASSIGNED: From the limited data available regarding subscapular intramuscular abscess, the authors make the following recommendations: (1) Empirical antibiotics covering Staphylococcus aureus +/- methicillin-resistant Staphylococcus aureus, (2) drainage is indicated in all cases; and (3) tendon-sparing approaches can access an abscess in most locations within the subscapular space.

BACKGROUND: Reverse shoulder arthroplasty is an established procedure for patients with rotator cuff tear arthropathy. However, the refixation of the subscapularis tendon remains a controversial and frequently discussed topic. This prospective randomized study was conducted to evaluate the clinical benefit of the subscapularis refixation after reverse shoulder arthroplasty.
METHODS: Fifty patients (f: 36, m:14) were randomized and assigned to either the \"repaired\" (rep) or the \"not repaired\" (nrep) cohort. Intraoperatively, the subscapularis tendon was reattached in the rep-cohort with four tendon-to-tendon sutures, whereas no refixation was performed in the nrep-cohort. The Constant-Murley Score (CS) and the range of motion was evaluated preoperatively as well as 12 and 36 months postoperatively. The Subjective Shoulder Value (SSV) and the Lift-off test were performed 36 months postoperatively. The postoperative subscapularis integrity was assessed sonographically.
RESULTS: Twelve months postoperatively the rep-cohort presented better results in the CS (rep: 71 vs. nrep: 66, p: 0.037). The normalized CS was 80% in the rep-cohort and 75% in the nrep-cohort (p: 0.114). At our last follow-up after 36 months we did not find significant differences between the rep-cohort and the nrep-cohort in the CS (rep: 76 vs. nrep: 75, p: 0.285) and normalized CS (rep: 91% vs. nrep: 91%, p: 0.388). Concerning internal rotation (in points) the rep-cohort achieved better results than the nrep-cohort (rep: 7.3 vs. nrep: 6.6, p: 0.040). Flexion (rep: 145° vs. nrep: 151°, p: 0.826), abduction (rep: 135° vs. nrep: 137° p: 0.816), external rotation (rep: 34° vs. nrep: 37°, p: 0.817) and the SSV (rep: 81% vs. nrep: 77%, p: 0.398) presented no significant differences between the cohorts. The ultrasound examination after 36 months displayed an intact tendon in 70%.
CONCLUSIONS: While the subscapularis refixation effects the postoperative internal rotation positively, there were no differences in mid-term follow-up concerning the overall results after rTSA. Further, the external rotation is not affected by the refixation of the subscapularis tendon.

UNASSIGNED: Subscapularis repair has recently garnered significant interest. A thorough understanding of the tendon\'s anatomy is essential for precise and safe repair. Our objectives were to describe the anatomy of the subscapularis insertion, define its landmarks, and analyze nearby structures to guide arthroscopic repair.
UNASSIGNED: We conducted an anatomical study, dissecting 12 shoulders. We evaluated the distance from the footprint to the axillary nerve, the dimensions, and shape of the footprint, and its relationship with the humeral cartilage.
UNASSIGNED: The distance to the axillary nerve was 32 mm (standard deviation [SD], 3.7 mm). The craniocaudal length of the footprint was 37.3 mm (SD, 4.6 mm). Its largest mediolateral thickness was 16 mm (SD, 2.2 mm), wider at the top and narrower distally. The distance between the footprint and the cartilage varied, being 3.2 mm (SD, 1.2 mm) in the upper part, 5.4 mm (SD, 1.8 mm) in the medium, and 15.9 mm (SD, 2.9 mm) in the lower part.
UNASSIGNED: When performing a repair of the subscapularis tendon, the distance to the cartilage should be carefully evaluated as it varies proximally to distally, and the shape of the footprint (wider proximally, tapered distally) should be considered for implant positioning. The distance to the axillary nerve is approximately 30 mm. Anterior visualization guarantees direct control of all landmarks and allows accurate implant positioning with safe tendon release.

UNASSIGNED: The pathology of and mechanisms underlying muscle degeneration remain unclear. We aimed to quantitatively evaluate the natural changes in fatty infiltration and muscle atrophy in patients with chronic rotator cuff tears using 3-dimensional 2-point Dixon magnetic resonance imaging.
UNASSIGNED: Thirty patients with nonoperatively observed rotator cuff tears without tear extension were evaluated using multiple magnetic resonance imaging examinations with a minimum interval of 2 years. The fatty infiltration ratio (%fat) and muscle volume of the rotator cuff muscles were compared between the 2 examinations in those with supraspinatus (SSP) tear <2 cm (<2 cm SSP group), SSP tear ≥2 cm (≥2 cm SSP group), and massive tear (massive group). The SSP) infraspinatus, and teres minor (ISP + TM), and subscapularis muscles were evaluated.
UNASSIGNED: The massive group showed a significantly greater %fat than the <2 and ≥2 cm SSP groups in the SSP (P = .002) and ISP + TM muscles (P < .001). The total muscle volume did not differ among the 3 groups for all rotator cuff muscle components. The %fat values did not change in any rotator cuff components during the follow-up period in all groups. The total muscle volume in the massive group significantly decreased in the SSP (P = .018) and ISP + TM muscles (P = .013).
UNASSIGNED: The present results indicate that fatty infiltration of the torn muscle occurs in the early phase after a rotator cuff tear, whereas muscle atrophy appears to progress gradually in chronic rotator cuff tears. Early intervention before muscle degeneration should be considered if the tear involves the infraspinatus tendon.

UNASSIGNED: Minimal Clinically Important Difference (MCID) and Patient-Acceptable Symptomatic State (PASS) have emerged as patient-based treatment assessments. However, these have not been investigated in patients undergoing arthroscopic isolated subscapularis repair (AISR). The primary purpose of this study was to determine the MCID and PASS for commonly used patient-reported outcomes in individuals who underwent AISR. The secondary purpose was to assess potential associations between preoperative and intraoperative patient characteristics and the MCID and PASS.
UNASSIGNED: A retrospective analysis was conducted on prospectively collected data for patients who underwent primary AISR between 2011 and 2021 at a single institution, with minimum 2-year postoperative follow-up. Functional outcomes were assessed using the American Shoulder and Elbow Surgeons (ASES) score, Subjective Shoulder Value (SSV), and Visual Analog Scale (VAS) pain scale. The MCID was determined using the distribution-based method, while PASS was evaluated using area under the curve analysis. To investigate the relationship between preoperative variables and the achievement of MCID and PASS thresholds, Pearson and Spearman coefficient analyses were employed for continuous and noncontinuous variables, respectively.
UNASSIGNED: A total of 77 patients with a mean follow-up of 58.1 months were included in the study. The calculated MCID values for VAS pain, ASES, and SSV were 1.2, 10.2, and 13.2, respectively. The PASS values for VAS pain, ASES, and SSV were 2.1, 68.8, and 68, respectively. There was no significant correlation between tear characteristics and the likelihood of achieving a MCID or PASS. Female sex, worker\'s compensation status, baseline VAS pain score, and baseline ASES score, exhibited weak negative correlations for achieving PASS for VAS pain and ASES.
UNASSIGNED: This study defined the MCID and PASS values for commonly used outcome measures at short-term follow-up in patients undergoing AISR. Tear characteristics do not appear to impact the ability to achieve a MCID or PASS after AISR. Female sex, worker\'s compensation claim, and low baseline functional scores have weak negative correlations with the achievement of PASS for VAS pain and ASES scores.

Most subscapularis and serratus anterior muscles lie between the scapula and the thoracic cage. Evaluation of this area in patients with scapulothoracic dyskinesis, snapping scapular syndrome, or interscapular pain can provide valuable information to clinicians. However, ultrasound scanning of pathologies in this area is hindered by anatomical limitations. In this study, we described a simple patient setup position and scanning method for ultrasound evaluation and guided intervention of the subscapularis and serratus anterior muscles between the scapula and thoracic cage.

Introduction Pre-operative diagnosis of subscapularis tears remains a difficult challenge. Ultrasound has been shown to be ineffective at directly detecting subscapularis tears. It has been widely accepted that medial subluxation of the long head of biceps tendon (LHBT) is associated with full-thickness subscapularis tears. The aims of this study are to assess whether LHBT subluxation on ultrasound scanning has any predictive value for subscapularis tears and to determine the relationship between LHBT subluxation and subscapularis tears at arthroscopy. Methods Pre-operative ultrasound and arthroscopic findings for patients undergoing arthroscopic rotator cuff repair at our institution between March 2011 and January 2016 were analysed. The accuracy of LHBT subluxation on ultrasound and at arthroscopy as a predictor of subscapularis tears at arthroscopy was calculated. The correlation between LHBT subluxation and subscapularis tears was determined. A standardised technique was used for ultrasound scans, and the grade of the sonographer was recorded. Results Three hundred fifty-nine rotator cuff repairs were performed. Twenty-four patients had a subluxed LHBT. Ultrasound was poorly sensitive (50%), and a subluxed LHBT on ultrasound only correlated very weakly with subscapularis tears at arthroscopy (R = 0.268, p<0.001). At arthroscopy, 92 patients had full-thickness subscapularis tears. Of these, only 16 patients (17%) had a subluxed/dislocated LHBT. Of the 24 patients with a subluxed LHBT, eight had no subscapularis tears. Thus, LHBT subluxation/dislocation only correlated weakly with full-thickness subscapularis tears (R=0.252, p<0.001). Conclusion Due to their close anatomical relationship, traditional teaching suggests subscapularis tears are associated with medial LHBT subluxation. Our data indicate that, contrary to popular belief, the two are only weakly correlated. In our series, the majority of patients with subscapularis tears (83%) had their LHBT in-groove. The authors therefore recommend high vigilance during arthroscopy for the diagnosis and repair of subscapularis tears, regardless of pre-operative ultrasound findings and the intra-operative position of the LHBT.

UNASSIGNED: Few studies have reported clinical outcomes and tendon healing rates after arthroscopic isolated subscapularis (SSC) repair (AISR).
UNASSIGNED: The primary purpose of this study was to evaluate clinical outcomes and tendon healing after AISR. It was hypothesized that AISR would result in satisfactory clinical outcomes along with a high rate of tendon healing at the midterm follow-up. The secondary purpose was to assess the influence of tear size and muscle atrophy on SSC tendon healing and patient-reported outcomes. It was hypothesized that both would be negatively correlated with healing but would have no effect on clinical outcomes .
UNASSIGNED: Case series; Level of evidence, 4.
UNASSIGNED: A retrospective analysis was conducted on prospectively collected data for 77 patients who underwent primary AISR between 2011 and 2021 at a single institution, with a minimum 2-year postoperative follow-up for all patients. Functional outcomes were assessed using the American Shoulder and Elbow Surgeons (ASES) score, the Subjective Shoulder Value (SSV), and the visual analog scale for pain. Repair techniques and concomitant procedures were also collected. SSC tendon healing was evaluated via ultrasound at the final follow-up. Linear regression analysis was performed to determine factors affecting SSC healing.
UNASSIGNED: The mean follow-up was 58.1 ± 3.3 months. ASES scores significantly improved from 41.5 to 81.6, and the SSV improved from 38.2 to 80.5 (P < .01 for both). Among the 40 patients (51.9%) who underwent postoperative ultrasound, 87.5% showed complete tendon healing. There were no significant differences in outcome scores between healed and unhealed tendons. Increased muscle atrophy and larger tears were correlated with failure of SSC healing (β = -0.285 [P = .015] and β = -0.157 [P = .045], respectively).
UNASSIGNED: Improved clinical outcomes and an overall high rate of tendon healing were seen at the midterm follow-up after AISR. Smaller tear sizes with less muscle atrophy were correlated with improved tendon healing. However, even when the tendon incompletely healed, the procedure improved functional outcomes.

UNASSIGNED: This study aimed to investigate which indirect parameters on preoperative MRI were the principal predictors of subscapularis tendon tears (STTs) requiring surgical repair.
UNASSIGNED: Preoperative MRI scans of 86 patients were retrospectively reviewed for visual assessment of the STT, pathology of the long head of the biceps tendon (LHBT), posterior decentering (PD) of the humeral head, humeral rotation, fatty degeneration, and subscapularis muscle atrophy. To evaluate atrophy, visual grading using the anatomical line connecting the coracoid tip to the glenoid base, designated as the base-to-tip line (BTL), and thickness measurements were performed in the en-face view.
UNASSIGNED: Arthroscopically, 31 patients (36%) exhibited Lafosse type III or IV STT and underwent surgical repair. LHBT pathology (p = 0.002), PD of the humeral head (p = 0.012), fatty degeneration (p < 0.001), and BTL grade (p = 0.003) significantly correlated with STT. In the multivariate analysis, PD of the humeral head (p = 0.011, odds ratio [OR] = 5.14) and fatty degeneration (p = 0.046, OR = 2.81) were independent predictors of STT.
UNASSIGNED: PD of the humeral head and fatty degeneration of the subscapularis can help to diagnose clinically significant STT. Interpretation of these findings may contribute to the planning of an optimal surgical strategy.
UNASSIGNED: 본 연구의 목적은 수술 전 MRI의 다양한 간접 소견 중 어떤 소견이 외과적 치료가 필요한 견갑하건 파열을 예측하는 데 가장 주요한 것인지 조사하는 것이다.
UNASSIGNED: 총 86명의 환자를 대상으로 수술 전 MRI 영상을 후향적으로 분석하였다. 견갑하건 파열의 직접평가, 이두박근 장두의 병리, 상완골두의 후방위, 상완골 회전, 견갑하근의 지방변성과 위축을 평가하였다. En-face 보기에서 부리돌기의 끝과 관절오목의 기저를 연결한 base-to-tip line (이하 BTL)을 이용한 육안 등급 및 두께 측정을 통해서 위축을 평가하였다.
UNASSIGNED: 관절경 시술에서 31명(36%)의 환자가 Lafosse type III 또는 IV의 견갑하건 파열을 보여, 재건수술을 받았다. 이두박근 장두의 병리(p = 0.002), 상완골두의 후방위(p = 0.012), 견갑하근의 지방 변성(p < 0.001), BTL 등급(p = 0.003)은 견갑하건 파열과 유의한 상관관계가 있었다. 다변량 분석에서 상완골두의 후방위(p = 0.011, odds ratio [이하 OR] = 5.14)와 견갑하근의 지방변성(p = 0.046, OR = 2.81)은 견갑하건 파열의 독립적인 예측인자였다.
UNASSIGNED: 상완골두의 후방위와 지방변성은 견갑하건 파열 진단에 도움이 될 수 있다. 이러한 결과를 판독하는 것은 최적의 수술 전략을 계획하는 데 기여할 수 있다.