Are you dealing with pain or discomfort around the front of your shoulder? Does this discomfort worsen when you try to rotate your arm internally? If so, you may be dealing with an injury to your subscapularis muscle. Your subscapularis is the largest muscle in your rotator cuff, connecting from your shoulder blade to your humerus. Although it is typically strong and stable, acute injury or degenerative wear and aging can lead to minor or major tears in this muscle, leading to painful symptoms and increasing your risk of a more serious shoulder injury like a dislocation. In today’s blog, we take a closer look at why subscapularis tears develop and how a specialist like Dr. Holloway can help you overcome these injuries so that you can continue to move your arms and shoulders with ease.
Causes And Symptoms Of Subscapularis Tears
Subscapularis tears tend to develop for different reasons based on an individual’s age. In younger adults, subscapularis tears are almost always the result of acute trauma. Falling with an outstretched arm or a significant blow to the shoulder region can lead to tearing in the subscapularis muscle. In older adults, the tear tends to develop as a result of natural degeneration and muscle weakening. Acute trauma or repetitive strain can also play a role in these tears, but oftentimes the stress needed to damage the subscapularis is much less in older adults who have experienced significant degeneration as a result of the aging process.
Subscapularis tears can also be tied to shoulder impingement. If an issue like a bone spur or inflammation leads to increased pressure or compression on the subscapularis muscle, microdamage can continue until a larger tear develops. These tears tend to be most common near the end of the tendon that connects to the humerus.
Symptoms of a subscapularis tear include:
- General shoulder pain or discomfort
- A clicking sound when rotating your arm
- Shoulder or arm weakness
- Increased discomfort when turning your arm inward or lifting your arm
- Difficulty reaching behind your back
- Shoulder tenderness
If you’re dealing with any of these symptoms, make it a point to connect with a shoulder specialist like Dr. Holloway. Subscapularis won’t fully heal without proactive treatment, so take the first step by having your shoulder assessed and a comprehensive treatment plan developed.
Diagnosing And Treating Subscapularis Tears
The diagnostic process begins with the doctor reviewing your medical history and asking about your symptoms. They will likely ask when symptoms first developed and how the issue is affecting your daily activities. From there, they’ll begin a physical assessment of the area and may have you attempt to perform some simple movements to see which actions can be performed and which ones prove difficult. Certain tests like the lift-off test and the bear hug test can prove incredibly helpful at identifying issues with the subscapularis muscle. Although your specialist will likely have a good idea that a subscapularis tear is to blame, they may wish to learn more about its size and positioning with an imaging test like an MRI.
If a subscapularis tear is confirmed, your doctor will walk you through your treatment options. For smaller tears, conservative care can usually help the patient make a full recovery. Although your specific course of care will vary, odds are you will pursue a combination of non-surgical treatments like activity modification, icing, heat packs, pain medications or anti-inflammatories and physical therapy. Many patients can make a full recovery by pursuing these treatments for 6-12 weeks.
Larger tears respond best to surgical treatment. The operation can be performed arthroscopically, meaning that a couple small incisions will be made before a tiny camera is inserted so that the surgeon can perform the correction by visualizing the surgical site on a screen in the operating room without needing to make a large incision. Specialized tools are used to suture the tear so that healing can effectively run its course.
Following surgery, you can expect to wear a shoulder brace for the first 4-6 weeks in order to minimize the stress on your subscapularis muscle. Following that period, you’ll pursue many of the previously listed conservative care techniques, with a heavy emphasis on physical therapy. Because the muscles and soft tissues in the shoulder will be weakened as a result of the surgery and prolonged inactivity, it is imperative that you gradually work to strengthen them so that they can get back to handling normal movements and stress patterns. Most patients will be able to transition back to most normal daily activities within 3-6 months after surgery, but a return to more intense shoulder activities can take up to 12 months or longer. We’re confident that we can develop a rehabilitation plan to help you hit the shorter end of these recovery timelines.
For more information about subscapularis tears or rotator cuff injuries, reach out to Dr. Holloway and his team today at (865) 410-7887.
