Injuries to the subscapularis may be overlooked when patients initially present with a shoulder problem. In the past, the medical literature sometimes referred to as “the forgotten tendon.” Your subscapularis tear might very well be forgotten too - or misdiagnosed, if a complete examination of all four tendons of the rotator cuff is not performed.
A significant subscapularis injury is present in less than 20% of all rotator cuff tears. Even when there is a tear, many of them involve a small area of the tendon that is compensated by the healthy muscles and tendons around the shoulder. Anterior shoulder pain that persists after an injury should trigger a full evaluation of the subscapularis.
In addition to understanding the mechanism of injury, a careful and unique set of examination tests that are different from the tests for the other parts of the rotator cuff are necessary to fully assess the subscapularis.
Ten years ago, Dr. Romeo and others reported that more than half of subscapularis tendon injuries seen at the time of arthroscopy were not reported on standard preoperative MRI's. However, as the technology improved, and the potential of a subscapularis injury was better understood, high-quality MRI's provide the information needed to help confirm this diagnosis before going to the operating room.
Of course, at the time of arthroscopic rotator cuff repair surgery, Dr. Romeo inspects all four tendons of the rotator cuff, including the subscapularis, to ensure that the tendon is in its normal position and functioning properly. As a recognized leader in the management of rotator cuff conditions, Dr. Romeo is adept at identifying if a subscapularis tear is the prime cause of pain, restricted motion, and limited function.