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KMID : 1036220190220030135
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Clinics in Shoulder and Elbow
2019 Volume.22 No. 3 p.135 ~ p.138
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Rotating Arm Internally Can Change the Arthroscopic Diagnosis of a Partial-thickness Tear of the Subscapularis
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Kim Hyung-Suk
Song Hyun-Seok
Kang Seung-Gu
Han Sung-Bin
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Abstract
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Background: The aims of this study were (1) to examine the footprint of the subscapularis tendon using the traditional posterior portal and 30° arthroscope by simple internal rotation of the arm during surgery, and (2) to classify the pattern of a subscapularis partial-thick-ness tear.
Methods: This study analyzed a total of 231 patients with a partial-thickness subscapularis tear from 550 consecutive patients under-going an arthroscopic operation who had a visualization of the subscapularis tendon footprint by internal rotation of the arm. First, the patients were classified into four categories according to the tear pattern: (1) stable lamination, (2) unstable lamination, (3) avulsion, and (4) laminated avulsion. Randomized arthroscopic videos were reviewed blindly by two independent orthopedic surgeons. The pattern of the tear of the subscapularis at the neutral position and after internal rotating the arm were assessed and compared with the treatment decision (level IV case series).
Results: Stable lamination, unstable lamination, avulsion, and laminated avulsion were observed in 9.1% (n=21), 20.8% (n=48), 41.1% (n=95), and 29.0% (n=67) of cases, respectively. In 145 out of 231 cases (62.8%), the decision was changed after inspecting the foot-print after internal rotation of the arm, and the treatment method was changed in 116 (50.2%) cases.
Conclusions: In a subscapularis tendon partial-thickness tear, inspecting the footprint of the subscapularis tendon is essential to diagnos-ing and deciding on the appropriate treatment. In addition, simply internal rotating the arm during surgery when using the traditional posterior portal and 30° arthroscope can be a valuable method.
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KEYWORD
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Rotator cuff, Subscapularis, Diagnosis, Arthroscopy
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