**6. Types of subscapularis tears**

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 lesion-related findings.

The classification system by Lafosse:

II Complete lesion superior one third

III Complete lesion superior two-thirds

IV Complete lesion with head centered and fatty degeneration<stage3

V Complete lesion with eccentric head and fatty degeneration>stage3

A type I tear is a simple erosion of the upper third of the tendon without any disconnection to the bone (**Figure 12**).

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

A type III lesion is characterized by involvement of all the insertion of the tendon without detachment of the lower third of the muscular portion (**Figure 14**).

In type IV tears, the subscapularis tendon is completely detached from the lesser tuberosity and the humeral head is centered within the joint (**Figure 15**).

**Figure 12.** Type I tear.

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

**Figure 9.** MRI axial view.

48 Advances in Shoulder Surgery

**Figure 10.** MRI coronal view.

**Figure 13.** Type II tear.

**Figure 14.** Type III tear.

In a type V lesion, the lesion is complete, the humeral head is translated anteriorly and superiorly, with coracoid impingement and fatty degeneration of the muscle fibers of the subscapu-

Subscapularis Repair

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http://dx.doi.org/10.5772/intechopen.74734

There are multiple treatment options in the management of subscapularis tears, with non-operative care indicated in some. In older, inactive patients with smaller a traumatic tears a conservative treatment comprised of physical therapy, anti-inflammatories, and activity modification must be tried. Patients unresponsive to conservative treatment can be considered for surgical repair.

laris (**Figures 16** and **17**).

**Figure 17.** Type V tear Intra-articular view.

**7. Treatment**

**Figure 16.** Type V tear.

**Figure 15.** Type IV tear.

**Figure 16.** Type V tear.

**Figure 17.** Type V tear Intra-articular view.

In a type V lesion, the lesion is complete, the humeral head is translated anteriorly and superiorly, with coracoid impingement and fatty degeneration of the muscle fibers of the subscapularis (**Figures 16** and **17**).
