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Rotating Arm Internally Can Change the Arthroscopic Diagnosis of a Partial-thickness Tear of the Subscapularis
Clin Should Elbow 2019;22:135-138
Published online September 1, 2019;  https://doi.org/10.5397/cise.2019.22.3.135
© 2019 Korean Shoulder and Elbow Society.

Hyungsuk Kim, Hyun Seok Song , Seung Gu Kang, Sung Bin Han

Department of Orthopedic Surgery, Eunpyeong St. Mary셲 Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
Correspondence to: Hyun Seok Song
Department of Orthopedic Surgery, Eunpyeong St. Mary셲 Hospital, College of Medicine, The Catholic University of Korea, 1021 Tongil-ro, Eunpyeong-gu, Seoul 03312, Korea
Tel: +82-2-2030-4628, Fax: +82-2-2030-4629, E-mail: hssongmd@yahoo.com, ORCID: https://orcid.org/0000-0002-7844-2293
IRB approval: The Catholic University of Korea, St. Paul셲 Hospital (No. PC14RISI0055).
Received August 4, 2019; Revised August 11, 2019; Accepted August 11, 2019.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
 Abstract
Background: The aims of this study were (1) to examine the footprint of the subscapularis tendon using the traditional posterior portal and 30째 arthroscope by simple internal rotation of the arm during surgery, and (2) to classify the pattern of a subscapularis partial-thickness tear.
Methods: This study analyzed a total of 231 patients with a partial-thickness subscapularis tear from 550 consecutive patients undergoing 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 footprint 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 diagnosing and deciding on the appropriate treatment. In addition, simply internal rotating the arm during surgery when using the traditional posterior portal and 30째 arthroscope can be a valuable method.
Keywords : Rotator cuff; Subscapularis; Diagnosis; Arthroscopy