What is Subscapularis Tendon Injury

Subscapularis tendon injury is a tear in the strong cord of tissue (tendon) that connects one of the shoulder muscles (subscapularis muscle) to the top of the upper arm bone (humerus).

The subscapularis muscle starts at the inside of the shoulder blade (scapula) and attaches to the humerus. The subscapularis muscle is one of four muscles that make up the rotator cuff in the shoulder. It helps to rotate the shoulder inward and stabilize the shoulder.

Subscapularis tears can be partial or complete tears. These injuries cause shoulder pain and weakness, and, in severe cases, shoulder instability. Subscapularis tears may also involve tearing of a different muscle in the rotator cuff (supraspinatus muscle), injury to the biceps tendon, or both.

What are the causes?

Subscapularis tears are commonly caused by gradual wear and tear from overuse. Gradual wear and tear can result from:

• Participating in sports or activities that involve overhead arm movements.
• Aging.

Subscapularis tears can also be caused by a sudden (acute) injury, which can result from:

• Falling on an outstretched arm.
• Forcefully pulling or thrusting your arm upward, especially with unexpected resistance.
• The shoulder joint moving out of place (dislocation).

What increases the risk?

This condition may be more likely to develop in:

• Men, especially men who are age 40 and older.
• Baseball players, especially pitchers.
• Tennis players.
• Rowers.
• Weight lifters.
• Painters and carpenters.

What are the signs or symptoms?

Shoulder pain is the main symptom of this condition. If your condition is caused by an acute injury, pain may be sudden and severe. If your condition is caused by overuse, pain may get worse with activity and get better with rest.

Other signs and symptoms may include:

• Pain with shoulder movement.
• Pain at night when lying on your arm or when your arm is unsupported.
• Stiffness and limited range of motion.
• Weakness.

How is this diagnosed?

This condition is diagnosed based on:

• Your symptoms.
• Your medical history.
• A physical exam. Your health care provider may check your shoulder strength and range of motion. This may include having you put your hand behind your back and try to hold your hand away from your back (lift-off test).
• Imaging tests, such as MRI or CT scan.

How is this treated?

Treatment for this condition may include:

• Avoiding activities that cause shoulder pain.
• NSAIDs to help reduce pain and swelling.
• Physical therapy to improve your strength and range of motion.
• One or more shots (injections) of medicines to numb the area and reduce inflammation (steroids).
• Surgery to repair the tendon. This may be done if:
  • Nonsurgical treatments have not helped after 6 weeks.
  • You have had a recent acute injury.
  • You have a large tear.
  • You have a lot of shoulder weakness.
  • You are an active person or athlete who needs complete shoulder function.

After surgery, treatment includes keeping your arm still while it heals (immobilization) and physical therapy.

Follow these instructions at home:

Managing pain, stiffness, and swelling

• If directed, put ice on the injured area.
  • Put ice in a plastic bag.
  • Place a towel between your skin and the bag.
  • Leave the ice on for 20 minutes, 2–3 times a day.

Driving

• Ask your health care provider when it is safe for you to drive.
• Do not drive or operate heavy machinery while taking prescription pain medicine.

Activity

• Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
• Do exercises as told by your health care provider.

General instructions

• Do not use any tobacco products, such as cigarettes, chewing tobacco, or e-cigarettes. Tobacco can delay healing. If you need help quitting, ask your health care provider.
• Take over-the-counter and prescription medicines only as told by your health care provider.
• Keep all follow-up visits as told by your health care provider. This is important.

How is this prevented?

• Warm up and stretch before being active.
• Cool down and stretch after being active.
• Give your body time to rest between periods of activity.
• Be safe and responsible while being active to avoid falls.
• Maintain physical fitness, including strength and flexibility.

Contact a health care provider if:

• You continue to have pain after 6 weeks of treatment.
• You have pain or other symptoms that get worse.

Subscapularis Tendon Injury Rehabilitation

Ask your health care provider which exercises are safe for you. Do exercises exactly as told by your health care provider and adjust them as directed. It is normal to feel mild stretching, pulling, tightness, or discomfort as you do these exercises, but you should stop right away if you feel sudden pain or your pain gets worse. Do not begin these exercises until told by your health care provider.

Stretching and range of motion exercises

These exercises warm up your muscles and joints and improve the movement and flexibility of your shoulder. These exercises also help to relieve pain, numbness, and tingling.

Exercise A: Pendulum

1. Stand near a wall or a surface that you can hold onto for balance.
2. Bend at the waist and let your left / right arm hang straight down. Use your other arm to keep your balance.
3. Relax your arm and shoulder muscles, and move your hips and your trunk so your left / right arm swings freely. Your arm should swing because of the motion of your body, not because you are using your arm or shoulder muscles.
4. Keep moving so your arm swings in the following directions, as told by your health care provider:
   1. Side to side.
   1. Forward and backward.
   1. In clockwise and counterclockwise circles.

Repeat __________ times, or for __________ seconds per direction. Complete this exercise __________ times a day.

Exercise B: Flexion, seated

1. Sit in a stable chair so your left / right forearm can rest on a flat surface. Your elbow should rest at a height that keeps your upper arm next to your body.
2. Keeping your left / right shoulder relaxed, lean forward at the waist and slide your hand forward until you feel a stretch in your shoulder. You can move your chair farther back to increase the stretch, if needed.
3. Hold for __________ seconds.
4. Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.

Strengthening exercises

These exercises build strength and endurance in your shoulder. Endurance is the ability to use your muscles for a long time, even after they get tired.

Exercise C: Shoulder extension, prone

1. Lie on your abdomen on a firm surface so your left / right arm hangs over the edge.
2. Hold a __________ weight in your left / right hand so your palm faces in toward your body. Your arm should be straight.
3. Squeeze your shoulder blade down toward the middle of your back.
4. Slowly raise your arm behind you, up to the height of the surface that you are lying on. Keep your arm straight.
5. Hold for __________ seconds.
6. Slowly return to the starting position and relax your muscles.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise D: Internal rotation, isometric

1. Stand or sit in a doorway, facing the door frame.
2. Bend your left / right elbow and place the inside of your wrist against the door frame. Only your wrist should be touching the frame. Keep your upper arm at your side.
3. Gently press your wrist against the door frame, as if you are trying to push your arm toward your abdomen.
4. Avoid shrugging your shoulder while you press your wrist into the door frame. Keep your shoulder blade tucked down toward the middle of your back.
5. Hold for __________ seconds.
6. Slowly release the tension, and relax your muscles completely before you repeat the exercise.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise E: External rotation

1. Lie down on your left / right side.
2. Place a small pillow or rolled-up towel under your left / right upper arm.
3. Bend your left / right elbow to an “L” shape (90 degrees) so your hand is palm-down on your abdomen.
4. Squeeze your shoulder blade back toward your spine.
5. Keeping your upper arm against the pillow or towel:
   1. Move (pivot) your forearm and your hand away from your abdomen and toward the ceiling.
   1. Keep your elbow bent at 90 degrees.
6. Hold for __________ seconds.
7. Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise F: Scapular retraction

1. Sit in a stable chair without arm rests, or stand.
2. Secure an exercise band to a stable object in front of you so the band is at shoulder height.
3. Hold one end of the exercise band in each hand.
4. Squeeze your shoulder blades together and move your elbows slightly behind you. Do not shrug your shoulders while you do this.
5. Hold for __________ seconds.
6. Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.