Subscapularis Tendon Tear

The biggest rotator cuff muscle in the shoulder is called the subscapularis muscle; it is key to shoulder strength, especially when weight lifting or moving the arm inward. Around two thirds of the subscapularis is comprised of tendon, and if the tendon becomes torn then the injury and pain can be significantly more serious than other rotator cuff tears. This is due to the largeness of the muscle and also the tendency of the injury to affect the biceps tendon.

Symptoms

Pain will be present in the front of the shoulder, particularly during arm movement. Motions likely to cause pain include lifting the arm over the shoulders, such as in tennis, cricket or swimming, and during inward rotation of the arm against weight or pressure. Any weight lifting will also be affected. If you can identity the location of the tendon insertion, this area will be painful to the touch.

Causes

Tears to the subscapularis tendon can either be chronic or acute. Chronic tears are often provoked due to repetitive overhead movements of the arm over time, such as used by bowlers in cricket and similar sports, and players of racquet sports. Overuse can greatly contribute to this, which is usually caused through ineffectual warm ups, overexertion, or training when muscles are weakened or fatigued. The other leading cause is a mechanical problem in the shoulder structure.

Acute tears are regularly caused by a single instance of moving the arm upwards against pressure. This can occur as a result of heavy weight lifting, or in landing from an accidental fall, for example falling onto the shoulder in an attempt not to damage one's head or body. Such a fall or impact will be noticeably harsh, as it can take a lot of force to tear the tendon, especially in younger athletes.

Sometimes the injury may be linked to tendinitis, which is often caused over long periods due to degeneration of the muscle or repeated damage from regular activities.

Medical Treatment

Cease all demanding shoulder activity and consult a doctor as soon as possible. While physical therapy can be sufficient for those who are older or far less active, injections and surgery are both commonplace among injured parties who lead a healthy, active lifestyle due to the severity of subscapularis tears. More surgery will be required if the biceps have also been affected. If the tear is not caught early, or is deemed to be too big, it may be ineffective to treat it normally. More major treatment may follow as a result; if this is required then a doctor can talk you through it. During recovery, physical therapy and gradual mobility training (such as stretching and strengthening the area) may be prescribed in order to maintain and build up movement again in the joint.