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Subscapularis tendon tear

Case contributed by Maulik S Patel
Diagnosis almost certain

Presentation

Few days before the presentation, the patient had left shoulder trauma due to a fall on the ground. Complaining of left shoulder pain. Radiograph ruled out fracture/ dislocation.

Patient Data

Age: 60 years
Gender: Male
ultrasound

There is a full-thickness defect involving cranial 2/3rd width of the subscapularis tendon. The retracted tendon is about 35 mm away from the lesser tuberosity of the humeral head. The caudal most fibers of the tendon are intact. There is medial dislocation of the long head of biceps tendon which shows normal echopattern. The supraspinatus tendon shows few areas of altered echopattern without any fibers discontinuity. The infraspinatus tendon shows normal echopattern. There is no effusion in the subacromial-subdeltoid bursa or the glenohumeral joint. The acromioclavicular joint is normal.

The asymptomatic side was examined for comparison. It shows intact subscapularis with normally located long head of biceps tendon.

Case Discussion

A patient fell on the ground while climbing down the stairs. He tried to protect himself using the left upper limb resulting in excessive weight-bearing involving the left upper limb. He presented with left shoulder pain. The ultrasound shows a full-thickness tear of the subscapularis tendon with medial dislocation of the long head of the biceps tendon. The supraspinatus tendon shows mild changes of tendinosis without a tear.

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