**5. Imaging**

X-Rays will demonstrate any coracoid pathology, associated acromial spur degenerative changes (**Figures 6** and **7**).

Ultrasonography (USG) is less reliable than MRI in diagnosing the Subscapularis tears.

USG is more preferred to assess the tendon repaired after shoulder arthroscopy (**Figure 8**).

MRI is the noninvasive procedure of choice to diagnose subscapularis rears. It provides higher diagnostic reliability. Arthro-MRI is even more perfect and accurate as compared to conventional MRI in patients with subscapularis tendon tears.

An indirect sign, often associated with partial subscapularis tears, is a medial dislocation of the long head of the biceps.

There are high chances of partial tears being missed on conventional MRI as compared to Contrast MRI. Fatty degeneration (fatty infiltration) is negative prognostic factor for full

functional recovery of the shoulder. The percentage of fatty infiltration predictive of success

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MR arthrography is accurate in the detection and grading of lesions in the subscapularis tendon. The specificity of findings on transverse images for this diagnosis can be improved by

including ancillary signs and findings from parasagittal images (**Figures 9**–**11**).

after cuff repair is lower than 75%.

**Figure 8.** Ultrasonography of subscapularis tear.

**Figure 7.** Coracoid impingement x-ray.

**Figure 6.** X-ray rockwood view.

**Figure 7.** Coracoid impingement x-ray.

functional recovery of the shoulder. The percentage of fatty infiltration predictive of success after cuff repair is lower than 75%.

MR arthrography is accurate in the detection and grading of lesions in the subscapularis tendon. The specificity of findings on transverse images for this diagnosis can be improved by including ancillary signs and findings from parasagittal images (**Figures 9**–**11**).

**Figure 8.** Ultrasonography of subscapularis tear.

**Figure 6.** X-ray rockwood view.

positive.

**5. Imaging**

46 Advances in Shoulder Surgery

changes (**Figures 6** and **7**).

the long head of the biceps.

All these tests allow diagnosing a partial tear in 30% of cases. More than 50% of tendon thickness is torn when the Napoleon test is positive; more than 75% when the lift-off test is

X-Rays will demonstrate any coracoid pathology, associated acromial spur degenerative

Ultrasonography (USG) is less reliable than MRI in diagnosing the Subscapularis tears.

conventional MRI in patients with subscapularis tendon tears.

USG is more preferred to assess the tendon repaired after shoulder arthroscopy (**Figure 8**).

MRI is the noninvasive procedure of choice to diagnose subscapularis rears. It provides higher diagnostic reliability. Arthro-MRI is even more perfect and accurate as compared to

An indirect sign, often associated with partial subscapularis tears, is a medial dislocation of

There are high chances of partial tears being missed on conventional MRI as compared to Contrast MRI. Fatty degeneration (fatty infiltration) is negative prognostic factor for full

**6. Types of subscapularis tears**

The classification system by Lafosse: II Complete lesion superior one third III Complete lesion superior two-thirds

lesion-related findings.

to the bone (**Figure 12**).

**Figure 12.** Type I tear.

In comparison with other rotator cuff tears, subscapularis tear is less common, it seems to have been underestimated. Because of recent attentions to subscapularis tendon, new types of such tendon's lesions have been identified and described. The subscapularis tendon tears may be classified as partial and complete, retracted and not retracted, superior involving the upper third and inferior (extended to the lower third. Lafosse described a five-type classification of subscapularis tendon lesions according to anatomic data and arthroscopic

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A type I tear is a simple erosion of the upper third of the tendon without any disconnection

A type III lesion is characterized by involvement of all the insertion of the tendon without

In type IV tears, the subscapularis tendon is completely detached from the lesser tuberosity

In a type II is a frank detachment of the upper portion of the tendon (**Figure 13**).

IV Complete lesion with head centered and fatty degeneration<stage3 V Complete lesion with eccentric head and fatty degeneration>stage3

detachment of the lower third of the muscular portion (**Figure 14**).

and the humeral head is centered within the joint (**Figure 15**).

**Figure 9.** MRI axial view.

**Figure 10.** MRI coronal view.

**Figure 11.** MRI showing rotator cuff muscles.
