Arthroscopic subscapularis tendon repair utilising Smith and Nephew Healicoils
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The subscapularis is the largest of the rotator cuff tendons, lying anterior to the shoulder and playing a vital role in both humeral head depression and stabilising against anterior shoulder dislocation.
With improved imaging and arthroscopic techniques, as well as a growing cohort of “sport-active” older patients, Surgeons are increasingly recognising and treating ever more subscapularis tears in this demanding patient group. Rotator cuff tears involving the subscapularis are less common than those involving the more superior parts of the rotator cuff.
Subscapularis tears usually originate in the superior bands of the tendon and propagate distally. They can result from acute external rotation injuries or occur more chronically due to subcoracoid impingement. Burkhart described the “roller wringer” effect where the upper subscapularis tendon is pinched between the lesser tuberosity and the tip of the coracoid process causing tendon attrition. A coraco-humeral interval of less than 6mm can be considered to be stenotic and is probably associated with the development of such tears.
In many instances the tear may be associated with a biceps tendon which has slipped out of it’s groove and cut through the subscapularis tendon, and this should be looked for and treated also. Combined tears of subscapularis, supraspinatous and infraspinatous if large can result in defunctioning of overhead ability and proximal migration of the humeral head and can also be repaired arthroscopically.
Readers will also find of use Mark Crowthers comprehensive techniques Arthroscopic rotator cuff repair using modified Arthrex suture-bridge techniqueas well as Arthroscopic subacromial decompression
These both cover extensively with the detail required to perform shoulder arthroscopy.
Author:Mr Faisal Hussain FRCS (Tr & Orth)
Institution: The Royal Orthopaedic Hospital, Birmingham, UK