Surgery for Subscapularis Tear Should Include Biceps Tendon Repair

Trauma with dislocation of the shoulder is a major cause of tendon tears in the shoulder. Damage to the subscapularis muscle is the subject of this study. Previous studies have shown that more than half the patients with a subscapularis tear also have biceps tendon instability. Instability is defined as a subluxation, dislocation, or rupture of the tendon.

Surgery is needed to repair these two problems. If only the subscapularis tendon is repaired, the patient may end up with soreness and spasms from an unstable biceps tendon. Cutting the biceps tendon or sewing it back to the bone often has poor results.

The authors of this study suggest saving and stabilizing the biceps tendon. They do this at the same time they repair the subscapularis tendon. They advise early treatment for the best results. A description of the procedure is given. The operation included refixation of the subscapularis and reconstruction of the biceps reflection pulley. Photos and drawings are included to show the technique.

This is the first study to report combined subscapularis and biceps tendon repairs. Compared to results of just the subscapularis repairs, function was improved about the same. The main difference was in patient comfort and appearance. With the additional biceps tendon repair, patients no longer had a Popeye bulge in the biceps. And they had less discomfort from spasms.

Follow-up clinical exam, X-rays, and ultrasound imaging are advised. The authors warn of the need to watch out for re-rupture. Some patients needed further surgery. This is especially true for those who delayed stabilization of the initial injury.

Reference: 

Dirk Maier, MD, et al. Stabilization of the Long Head of the Biceps Tendon in the Context of Early Repair of Traumatic Subscapularis Tendon Tears. In The Journal of Bone and Joint Surgery. August 2007. Vol. 89-A. No. 8. Pp. 1763-1769.

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