Dominic Stone
The subscapularis is a muscle in the shoulder that is responsible for internal rotation of the arm. It is the largest and strongest of the four muscles that make up the rotator cuff, which attaches the upper arm to the shoulder. The subscapularis is prone to tears, which can be caused by overuse, trauma, or age-related degeneration. Symptoms of a subscapularis tear include pain in the front of the shoulder, clicking or popping sensations when moving the arm, and limited range of motion. Treatment options depend on the severity of the tear and can range from conservative treatments such as rest, ice, and pain medication to surgery in more severe cases.
| Characteristics | Values |
|---|---|
| Description | The subscapularis is a muscle in the shoulder that helps with internal rotation of the arm. It is the largest and strongest of the four muscles that make up the rotator cuff. |
| Function | The subscapularis muscle turns the arm inward and allows one to lift and rotate the arm. It also plays a role in shoulder adduction and extension and helps stabilize the shoulder. |
| Blood Supply | The primary blood supply to the subscapularis muscle is the subscapular artery, a branch of the axillary artery. |
| Innervation | The subscapularis muscle is innervated by both the upper and lower subscapular nerves (C5-C6) from the posterior cord of the brachial plexus. |
| Anatomy | The subscapularis muscle is a large, triangular-shaped muscle that originates from the subscapular fossa and inserts onto the lesser tubercle of the humerus. It consists of 60% tendon and 40% muscle. |
| Tendons | The subscapularis muscle has tendons that are prone to injuries, especially in athletes who participate in swimming, tennis, or throwing actions. |
| Symptoms of Tear | Shoulder pain, especially in the front of the shoulder. Clicking or popping noises when rotating or moving the arm. Weakness, limited range of motion, and pain in the bicep. |
| Causes of Tear | Overuse, trauma, or age-related degeneration. Sporting events, falls, and motor vehicle accidents are common causes of trauma. |
| Treatment | Depends on the size and severity of the tear. Conservative treatment for small tears includes icing, heat, pain medication, and physical therapy. Surgery may be recommended for larger tears or if conservative treatment is ineffective. |
| Exercises | Various exercises can be performed to improve the range of motion and strengthen the subscapularis, such as swinging the arm back and forth, holding a stick behind the back, and elbow rotation exercises. |
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What You'll Learn
Causes of subscapularis sprain
The subscapularis muscle is the largest and strongest muscle of the rotator cuff, which is a group of muscles that attach the upper arm to the shoulder. It is responsible for internally rotating the arm and enabling arm lifting and rotation.
A subscapularis sprain or tear can occur due to various reasons, and the causes can differ between younger and older individuals. Here are the common causes of a subscapularis sprain:
Causes in Younger Individuals
- Injury or Trauma: In younger people, a subscapularis tear usually occurs due to an injury, especially when the arm is overextended. Sporting events, such as throwing a baseball, are a common cause of tears in the subscapularis muscle.
- Traumatic Events: Traumatic incidents like falls or motor vehicle accidents can also lead to tears in the subscapularis muscle.
Causes in Older Individuals
- Degeneration: In older individuals, the subscapularis tendon can tear during strenuous daily activities, such as gardening, or due to a sudden fall. Tears in this muscle group often occur alongside tears in the supraspinatus tendon and the biceps tendon.
- Age-related Conditions: Age-related degeneration or arthritis can cause tears in the subscapularis muscle.
- Overuse: An overworked subscapularis muscle can lead to a frozen shoulder, making it challenging to lift the arm.
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Symptoms of subscapularis sprain
The subscapularis muscle is the largest and strongest of the four rotator cuff muscles. It is responsible for the internal rotation of the arm and helps in lifting and rotating the arm. A subscapularis sprain or tear can be caused by overuse, trauma, or age-related degeneration. Tears can be small or can go through most of the muscle. The size of the tear determines the treatment required.
- Pain in the front or deep within the shoulder joint is the most commonly reported symptom.
- Clicking or popping noises or feelings in the shoulder when rotating or moving the arm.
- Weakness in the affected shoulder, making it challenging to perform everyday tasks like lifting or reaching.
- Difficulty in rotating the arm.
- Pain when moving the shoulder, especially when the arm is raised above the shoulders.
- Tenderness and pain when pressing on the tendon insertion on the inside of the upper arm.
To diagnose a subscapularis tear, doctors may perform a variety of physical tests, including the lift-off test, bear hug test, and belly press test. Imaging studies, such as MRI or ultrasound, may also be used to assess the extent of the tear. Treatment for a subscapularis tear depends on the size of the tear and the patient's lifestyle. Small tears may only require conservative treatments such as icing, heat, pain medication, and physical therapy. Larger tears or those that do not heal with conservative treatment may require surgery.
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Diagnosis of subscapularis sprain
The subscapularis is a muscle in the shoulder that helps in the internal rotation of the arm. It is the largest and strongest of the four rotator cuff muscles. A subscapularis sprain or tear can occur due to overuse, trauma, or age-related degeneration. Tears can be small or large, and the size of the tear determines the treatment required.
Diagnosis of a subscapularis sprain involves a physical examination by a physician, who will take a full history and conduct a series of tests to help diagnose a subscapularis tear. The doctor will ask about any recent injuries to the arm or shoulder, specific symptoms, and any resulting functional limitations.
There are several tests that can be performed to diagnose a subscapularis tear:
- Lift-off test: The patient is asked to place their hand behind their back with the dorsum of the hand resting in the region of the mid-lumbar spine. The patient then tries to lift the hand off their back by maintaining or increasing internal rotation of the humerus and extension at the shoulder. An inability to lift the hand or maintain the arm position indicates a subscapularis tear.
- Bear hug test: The patient places the palm of the affected arm on their opposite shoulder, with their elbow anterior to the body. The physician then tries to pull the patient's hand off their shoulder by rotating their forearm outwards. If the patient cannot resist and their hand is pulled off the shoulder, it indicates a subscapularis tear.
- Belly press test: The affected arm is placed at the side, with the shoulder flexed 90 degrees and the palm of the hand resting on the patient's belly. The patient presses the palm of their hand against their belly in an internal rotation movement. If the patient experiences pain or shows internal rotation weakness compared to the opposite side, it suggests a subscapularis tear.
After conducting these tests, a physician may order an MRI to confirm the diagnosis and determine the severity of the tear. Treatment options depend on the size of the tear and the impact on the patient's daily life. Small tears may only require conservative treatment, such as icing, heat, pain medication, and physical therapy. Larger tears or those causing significant disability may require surgery, typically performed arthroscopically using a camera inserted through a small incision.
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Treatment of subscapularis sprain
Treatment for a subscapularis sprain or tear depends on the severity of the injury and the impact on the patient's life. If the tear is small and does not impede daily activities, a doctor may recommend a conservative treatment approach, including icing, heat, and pain medication such as ibuprofen or other non-steroidal anti-inflammatory drugs. Physical therapy may also be recommended to improve the range of motion and strengthen the subscapularis. This can include exercises such as:
- Holding a stick or pole behind the back and pulling it horizontally to stretch the arm across the back
- Using a resistance band attached to a doorknob or table leg, pulling the band with the elbow bent at a 90-degree angle, bringing the forearm to the stomach
- Leaning forward with one arm on a table for support and swinging the free arm back and forth, then side-to-side and in small circles
- Lying on the back, bending the elbow so that the fingers point up, and rotating the forearm forward and backward
If the tear is more severe or does not respond to conservative treatment, surgery may be recommended. This is especially true for younger, highly active patients or those with a full-thickness tear of the muscle. Surgery is typically performed arthroscopically, using a small camera inserted into the shoulder to guide the procedure. During surgery, the torn tendon is anchored back onto the bone using special stitches and surgical tapes.
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Exercises for subscapularis sprain
The subscapularis is a muscle in the shoulder that is responsible for internal rotation of the arm. It is the largest and strongest of the four muscles that make up the rotator cuff. A subscapularis tear can be caused by overuse, trauma, or age-related degeneration, resulting in pain, weakness, and limited range of motion in the shoulder. Treatment options depend on the severity of the tear and may include conservative approaches such as icing, medication, and physical therapy, or surgery in more severe cases.
Exercises for a subscapularis sprain aim to improve range of motion and strengthen the muscle. Here are some specific exercises that can help:
- Pendulum exercise: Place your non-injured arm on a table for support and let your injured arm hang freely. Gently swing your body forward and back, then side to side, allowing your injured arm to move like a pendulum. Repeat 12-20 times in each direction, twice a day.
- Stick stretch: Hold a stick or long object behind your back, with the affected arm lightly holding one end. Pull the stick to the side, stretching your affected arm across your back. Hold for 30 seconds, then release.
- Elbow rotation: Lie on your back and bend your elbow so your fingers point up and your elbow is on the ground. Keep your elbow bent and rotate your forearm forward until it touches the ground, then rotate it backward. Stop before touching the ground if it causes pain.
- Resistance band exercise: Secure a resistance band to a doorknob or table leg. Hold the band with your elbow bent at a 90-degree angle at your side. Pull the band, bringing your forearm to your stomach, and slowly return to the starting position. Repeat 12-20 times for 3 sets of 8 repetitions on each side.
- Shoulder stretch: Lie on your side with your unaffected arm under you, cradling your head. Keep your injured arm against your side with your elbow bent at a 90-degree angle. Slowly rotate your arm at the shoulder, raising it to a vertical position, and then slowly lower it back down.
It is important to note that you should always consult with a doctor or physical therapist before starting any exercises, especially if you are experiencing pain. They can guide you through the appropriate exercises and ensure they are performed correctly.
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Frequently asked questions
The subscapularis is a large, triangular-shaped muscle located beneath the shoulder blade. It is the largest, strongest part of the four rotator cuff muscles. Its primary function is the internal rotation of the humerus.
Subscapularis tears or tendon injuries can occur due to overuse, trauma, or age-related degeneration. Sporting events, falls, and motor vehicle accidents are common causes of trauma-induced tears.
The most common symptom is shoulder pain, especially in the front of the shoulder. Other symptoms include limited range of motion, clicking or popping noises when rotating the arm, and weakness.
Treatment depends on the severity of the sprain. Minor sprains may only require rest, ice, pain medication, and physical therapy. More severe sprains may require surgery, especially if there is significant disability or no improvement after conservative treatment.
