Current concepts review in the management of subscapularis tears

Chellamuthu, Girinivasan; Sundar, Shyam; Rajan, David V.

doi:10.1016/j.jcot.2022.101867

Cited by 5 publications

(4 citation statements)

References 110 publications

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“…The belly-press test or bear-hug test is based on the examiner's subjective sensation or observation (weakness or accessory movement), but the modified belly-press test is based on measuring the angle of the wrist after the patient presses the belly with the palms of the hands, which is the BPA. 9 This study hypothesized that differences in test methods would cause differences in interobserver reliability. The results showed that the interobserver reliability of the BPA was higher than that of bear-hug test.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Performance of Belly-Press Angle in Predicting the Severity of Subscapularis Tear

Kim,

Park

et al. 2023

Am J Sports Med

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Background: Neglected partial subscapularis tears often cause functional impairment even after repair of the supraspinatus and infraspinatus tear is done. Numerous physical examinations for detecting partial subscapularis tears have been described in previous studies. Purpose: To analyze the relationship between the preoperative clinical features and the severity of a partial subscapularis tear and to provide diagnostic clues for patients requiring subscapularis repair. Study Design: Cohort study (Diagnosis); Level of evidence, 2. Methods: This retrospective study included 286 patients who underwent arthroscopic shoulder surgery between 2020 and 2022. Preoperative clinical features, including range of motion, functional scores, muscle strength ratio, modified belly-press test (measuring belly-press angle), and bear-hug test, were collected. Magnetic resonance imaging (MRI) evaluation was done according to the Yoo and Rhee classification. Types of subscapularis tear, supraspinatus lesion, and biceps lesion were recorded during arthroscopic surgery. A comparison of preoperative clinical features between the no-repair group (type 2A or less) and surgical repair group (type 2B or more) was done. The optimal cutoff value of the belly-press angle was determined and the diagnostic performance of the belly-press angle, bear-hug test, and MRI were evaluated using the receiver operating characteristic curve. Results: Among 286 patients, 189 (66.1%) had subscapularis tears with type 2A or more. There was a significant difference in muscle strength ratio of the belly-press ( P < .001), belly-press angle ( P < .001), and bear-hug test ( P < .001) between the no-repair group (type 2A or less) and the surgical repair group (type 2B or more). With a belly-press angle of 15° as a new cutoff value, the modified belly-press test showed 67.6% sensitivity, 73.9% specificity, and 69.6% accuracy in detecting type 2B or higher subscapularis tear. Conclusion: Patients with type 2A and 2B subscapularis tears (according to the Yoo and Rhee classification) showed differences in belly-press strength ratio, belly-press angle, and bear-hug test. The cutoff value of the 15° belly-press angle showed an accuracy of 69.6% in detecting subscapularis tears with type 2B or higher.

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Section: Discussionmentioning

confidence: 99%

Diagnostic Performance of Belly-Press Angle in Predicting the Severity of Subscapularis Tear

Kim,

Park

et al. 2023

Am J Sports Med

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“…Intratendinous SSC (inSSC) tears occurred concurrently with intact biceps pulley or rotator interval [7][8][9][10][11][12]. Walch et al [12] noted that these tears were not immediately visualised intra-operatively, and thus coined the term "hidden lesion."…”

Section: Introductionmentioning

confidence: 99%

“…Intratendinous SSC (inSSC) tears occurred concurrently with intact biceps pulley or rotator interval [7–12]. Walch et al [12] noted that these tears were not immediately visualised intra‐operatively, and thus coined the term “hidden lesion.” Denard et al [13] introduced that occult tears of SSC were hidden by intact medial sling and that the SSC footprint could be fully visualised only using the 70° arthroscope.…”

Section: Introductionmentioning

confidence: 99%

“…Chae et al [15] described these tears as concealed inSSC tears which related to instability of long head of the biceps tendon (LHBT). So far, there are few studies that describe the clinical, radiological and arthroscopic characteristics of this lesion [7,15]. In addition, the clinical signs such as bear-hug test, internal rotation resistance test at 90° abduction and external rotation (IRRT90°) test and radiographic techniques such as magnetic resonance imaging (MRI) may also be non-deterministic in these lesions of SSC [16][17][18][19].…”

Section: Introductionmentioning

confidence: 99%

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The prevalence, classification, radiological and arthroscopic findings of intratendinous subscapularis tears

Lin

Zhang

Cui

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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PurposeTo investigate the clinical characteristics of intratendinous subscapularis (inSSC) tears. MethodsRetrospectively, 69 patients with arthroscopically confirmed inSSC tears were identified from 2018 to 2019. Preoperatively and at final follow‐up, thorough physical examination was performed and clinical outcomes (American Shoulder and Elbow Surgeons [ASES] score; University of California, Los Angeles [UCLA] score; visual analogue scale [VAS] for pain; and Simple Shoulder Test [SST]) were recorded. Features of pre‐operative magnetic resonance image (MRI) such as high signalling within the tendon substance, communication to the bicipital groove and long head of biceps tendon (LHBT) lesions were investigated. Characteristics of arthroscopic view were investigated. Bear‐hug and internal rotation resistance test at 90° abduction and external rotation (IRRT90°) test were used to assess the SSC strength. ResultsThe mean follow‐up was 2.4 (2–3) years. The prevalence of arthroscopically confirmed inSSC tears was 69/675 (10.2%) among arthroscopic rotator cuff repairs. Pre‐operative physical examination found positive IRRT90° and bear‐hug test in 41/60 (68.3%) and 42/69 (60.8%) patients, respectively. The Cohen kappa coefficient was interpreted to be substantial for the evaluation of all MRI parameters. According to the conditions of LHBT, inSSC tears were classified into 3 types: type I: without LHBT subluxation and tear; type II: with LHBT subluxation or tears and type III: with LHBT dislocation. At final follow‐up, mean ASES, UCLA, VAS, and SST scores improved significantly from mean of 50.6 ± 14.7, 19.4 ± 3.07, 6.2 ± 2.0, and 6.1 ± 2.5 to mean of 90.7 ± 9.5, 32.2 ± 1.8, 1.4 ± 1.2 and 9.8 ± 2.2, respectively (P < 0.001). Bilateral symmetric strength was found by bear‐hug and IRRT90° test in all patients postoperatively. ConclusionUnderstanding features of pre‐operative MRI, physical examination and arthroscopic view is helpful to identify inSSC tears. Arthroscopic repair yielded satisfactory clinical outcomes in patients with inSSC tears. Level of evidenceLevel IV.

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Arthroscopic management of isolated partial‐thickness rotator cuff tears

Longo,

Marino,

Lalli

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeThe aim of the present study is to provide a comprehensive review on the surgical outcomes following arthroscopic treatments of partial‐thickness rotator cuff tears (PT‐RCTs) and to compare the postoperative American Shoulder and Elbow Surgeons (ASES) score following in situ transtendon repair and tear completion, followed by repair.MethodsMedline, EMBASE, Scopus, CINAHL and CENTRAL bibliographic databases were searched. Papers including patients with PT‐RCTs of any grade who underwent treatment using debridement, in situ transtendon repair, tear completion and repair or bioinductive collagen implants were reviewed. Primary PT‐RCTs were the sole indication for surgery. Primary postoperative outcomes assessed included the ASES score, the Absolute Constant–Murley score, the Simple Shoulder Test, the Visual Analogue Scale, the University of California‐Los Angeles Shoulder Scale, the Western Ontario Rotator Cuff Score, range of motion, complications and revisions. A meta‐analysis of comparative studies compared the postoperative ASES score between patients treated with in situ transtendon repair versus tear completion repair.ResultsTwenty‐eight studies were included. The ASES score was reported by four comparative studies with contrasting results. The heterogeneity was high (I2 = 86%), and effect sizes ranged from −0.49 in favour of the tear completion and repair technique to an effect size of +1.07 favouring in situ transtendon repair. The overall effect size of 0.02 suggests an equivalence between the two techniques in terms of the ASES score. Two studies with a total sample size of 111 patients reported on debridement, and four studies with a total sample size of 155 patients reported on bioinductive collagen implants.ConclusionDebridement alone is suitable for Ellman grades I‐II PT‐RCTs. In situ transtendon and tear completion repair techniques yield similar postoperative outcomes. Bioinductive collagen implants hold promise but lack long‐term efficacy data. High‐quality comparative studies are needed to determine the best treatment for PT‐RCTs.Level of EvidenceLevel IV.

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Current concepts review in the management of subscapularis tears

Cited by 5 publications

References 110 publications

Diagnostic Performance of Belly-Press Angle in Predicting the Severity of Subscapularis Tear

Diagnostic Performance of Belly-Press Angle in Predicting the Severity of Subscapularis Tear

The prevalence, classification, radiological and arthroscopic findings of intratendinous subscapularis tears

Arthroscopic management of isolated partial‐thickness rotator cuff tears

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