Subscapularis Tendon Tears: Arthroscopic Management

Chapter 26

Subscapularis Tendon Tears

Arthroscopic Management

Patrick J. Denard, and Stephen S. Burkhart


Tears of the subscapularis are present in nearly 30% of all arthroscopic shoulder procedures and approximately 50% of rotator cuff repairs. Repair of a torn subscapularis tendon is critically important to restoring anatomy and therefore to achieving the best functional outcome possible. The subscapularis is critical to maintaining overhead elevation and serves as the attachment for the anterior rotator cable. Repair is therefore critical to achieving balanced force couples. Additionally, for tears extending into the supraspinatus, repair of the upper subscapularis decreases the stress on the adjacent repair of the supraspinatus.


Repair of the subscapularis tendon begins with proper recognition. Once recognized, a systematic approach can be used to arthroscopically repair all subscapularis tendon tears regardless of the degree of retraction or fatty degeneration.

Patient History

Patient Examination


Treatment Options

Surgical Anatomy

Surgical Indications

Surgical Technique Setup


Possible Pearls

Possible Pitfalls


Surgical Exposure/Portals

  1. • Posterior portal: used as a viewing portal. Our standard posterior viewing portal is placed 4 to 5 cm inferior (caudal) to the posterior border of the acromion and 3 to 4 cm medial to the posterolateral corner of the acromion.
  2. • Anterosuperolateral (ASL) portal: used as the working portal. This is established off the anterolateral border of the acromion, guided by an 18-gauge spinal needle in an outside-in technique. Placement should allow a 5-degree to 10-degree angle of approach to the lesser tuberosity and should be parallel to the subscapularis tendon. An 8.25-mm threaded clear cannula (Arthrex Inc., Naples, FL) is placed in this portal.
  3. • Anterior portal: used for anchor placement. This is also created with a spinal needle as a guide and is placed 4 to 5 cm inferior to the anterior acromion, just lateral to the coracoid tip. The angle of insertion is often toward the patient’s jaw. This is typically a percutaneous portal.

Short Description of the Surgical Exposure

A standard diagnostic arthroscopy is performed with a 30-degree arthroscope viewing through a posterior portal. A bare lesser tuberosity footprint is indicative of a tear. Following are several tips improve visualization: (1) the arm is placed in abduction and internal rotation to view the subscapularis insertion; (2) a 70-degree arthroscope allows one to “look around the corner” at the tear and its footprint; (3) a “posterior lever push” subluxes the humeral head to increase the anterior working space; and (4) because swelling further limits the ability to work anteriorly, the subscapularis tendon is addressed as the first step in the overall procedure.

Step-by-Step Guide to Surgical Technique

Step 1





Mar 28, 2020 | Posted by in ORTHOPEDIC | Comments Off on Subscapularis Tendon Tears: Arthroscopic Management

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