**3. Symptoms**

**2. Overview**

42 Advances in Shoulder Surgery

**Figure 1.** Subscapularis anatomy.

**Figure 2.** Coracoid impingement.

Subscapularis tendon tears have been firstly described by Smith [1] and Codman [2] Hauser

Subscapularis tendon tears may be partial or full thickness. Chronic overload or acute trauma may cause tears. Traumatic tears are usually secondary to a forced external rotation or extension of the shoulder with the arm abducted. These tears are more prevalent in young patients as a consequence of a shoulder dislocation [4, 5]. In chronic tears due to repeated micro trauma degeneration, there is always an associated supraspinatus tear and biceps tendinosis or subluxation along with subscapularis tear. In tears of long duration, there can be severe retraction of the tendon underneath coracoids process. Sometimes it get tucked to superior capsule or

reported in 1954 the first case of surgical repair of the subscapularis tendon [3].

glenohumeral ligaments forming a "Coma sign/tissue" as described by Burkhart [6].

The shoulder pain related to a subscapularis tendon tear is more anterior compared to the typical pain observed in patients with rotator cuff tears. There is weakness in internal rotation and abduction like buttoning the shirt, adjusting the tie, tucking the shirt in the back etc. as these functions requires active internal rotation. Since in most of the cases anterior supraspinatus and biceps tendon is also involved, forward flexion, supination and abduction- external rotation can also be painful.
