Our Summary

This research paper looks at an issue sometimes overlooked in shoulder surgery - a tear in the subscapularis tendon, which is part of the rotator cuff in our shoulder. When people have surgery to repair the rotator cuff, doctors often don’t notice or treat a tear in this particular tendon. This is a problem, because it can affect the success of the surgery and the patient’s recovery.

In the study, the authors looked back at 58 patients who had a second rotator cuff surgery because the first one didn’t work well. They found that nearly half of these patients had an unnoticed tear in the subscapularis tendon during their first surgery. They also noticed that the condition of these unnoticed tears got worse over time.

After the second surgery, the patients did generally better, but many of them still had issues, especially those with the subscapularis tears.

The takeaway from this study is that doctors need to pay more attention to possible subscapularis tears when doing shoulder surgeries. Careful examination before surgery and during the operation can help spot and treat these tears, which might improve the surgery results and the patients’ recovery.

FAQs

  1. Why is a tear in the subscapularis tendon often overlooked during rotator cuff surgery?
  2. How can unnoticed subscapularis tears affect the success of rotator cuff surgery and patient recovery?
  3. What steps can be taken to improve the detection and treatment of subscapularis tears during shoulder surgery?

Doctor’s Tip

One helpful tip a doctor might give a patient about rotator cuff repair is to make sure they communicate any symptoms or concerns they may have, especially if they are experiencing pain or limited range of motion in their shoulder after surgery. This can help the doctor identify any potential issues, such as a tear in the subscapularis tendon, and address them promptly to prevent further complications. It’s important for patients to be proactive in their recovery process and follow all post-operative instructions provided by their healthcare provider to optimize their healing and rehabilitation.

Suitable For

Patients who are typically recommended for rotator cuff repair surgery include those who have:

  1. Persistent shoulder pain that does not improve with conservative treatments such as rest, physical therapy, and anti-inflammatory medications.
  2. Significant weakness or loss of function in the shoulder that affects daily activities and quality of life.
  3. A large or full-thickness tear in the rotator cuff that is causing symptoms such as pain, weakness, and limited range of motion.
  4. Failed previous conservative treatments and are still experiencing symptoms that impact their daily life.
  5. Active individuals who want to return to sports or activities that require a strong and functional shoulder.
  6. Younger patients with acute traumatic tears or degenerative tears that are causing significant pain and limitation.

It is important for patients to undergo a thorough evaluation by an orthopedic surgeon to determine if they are a good candidate for rotator cuff repair surgery. The decision to proceed with surgery should be based on the severity of the tear, the patient’s symptoms and functional limitations, and their overall health and ability to tolerate surgery and rehabilitation.

Timeline

  • Before Rotator Cuff Repair:
  1. Patient experiences shoulder pain, weakness, and limited range of motion.
  2. Patient undergoes physical examination, imaging tests such as MRI, and possibly non-surgical treatments like physical therapy or injections.
  3. If conservative treatments fail, patient is recommended for rotator cuff repair surgery.
  • After Rotator Cuff Repair:
  1. Patient undergoes surgery to repair the torn rotator cuff, which may involve arthroscopic or open surgery.
  2. Recovery period typically includes physical therapy, pain management, and gradual return to normal activities.
  3. In some cases, patients may experience complications or persistent symptoms, leading to a need for a second surgery.
  4. If a tear in the subscapularis tendon is unnoticed during the first surgery, it can impact the success of the procedure and the patient’s recovery.
  5. Patients with unnoticed subscapularis tears may require a second surgery to address the issue, which can improve their outcomes and recovery.
  6. Regular follow-up appointments and rehabilitation are crucial for monitoring progress and ensuring optimal recovery after rotator cuff repair surgery.

What to Ask Your Doctor

  1. What is the likelihood of having a tear in the subscapularis tendon during rotator cuff surgery?
  2. How can a tear in the subscapularis tendon affect the success of the surgery and my recovery?
  3. What symptoms should I look out for that may indicate a tear in the subscapularis tendon?
  4. How can a tear in the subscapularis tendon be diagnosed before surgery?
  5. What steps will be taken during the surgery to ensure any tears in the subscapularis tendon are identified and repaired?
  6. What is the recovery process like for patients with a tear in the subscapularis tendon?
  7. What are the potential long-term effects of an untreated tear in the subscapularis tendon?
  8. Are there any specific exercises or physical therapy techniques that can help strengthen the subscapularis tendon after surgery?
  9. What is the success rate of rotator cuff surgery when a tear in the subscapularis tendon is identified and repaired during the procedure?
  10. Are there any additional precautions or considerations I should be aware of if I have a tear in the subscapularis tendon during rotator cuff surgery?

Reference

Authors: Yoon TH, Kim SJ, Choi YR, Cho JT, Chun YM. Journal: Am J Sports Med. 2021 Dec;49(14):3952-3958. doi: 10.1177/03635465211047485. Epub 2021 Oct 15. PMID: 34652226