Subscapularis: Symptoms, Causes, and How to Prevent It

Subscapularis: Symptoms, Causes, and How to Prevent It
Subscapularis - Photo by
SHARE - The subscapularis is a muscle in your shoulder that helps you rotate your arms inward (internal rotation). It is the largest muscle in the rotator cuff, which is a group of muscles that attach the upper arm to the shoulder.

These muscles help you lift and rotate your arms. The subscapularis is connected from the shoulder blade to the upper arm bone (humerus). All rotator cuff muscles, including the subscapularis muscle, can be torn due to overuse, trauma, or age-related conditions.

The size of the tear determines what treatment is needed. Tear in the subscapularis muscle most often occurs near the end of the tendon which is connected to the humerus. Tearing of the subscapular muscles can also cause problems with the biceps.

What causes subscapular muscle tearing?

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In young people, injuries are the main cause causing the subscapularis muscle to tear. Subscapular muscles can be torn when you lift weights that are too heavy using your hands. In the elderly, subscapular tears are usually caused by tendon and muscular structures that are weakened by age.

Inflammation of the tendons can also cause tears in the subscapularis. Inflammation of the tendon can occur when other rotator cuff muscles compress the subscapularis muscle and cause it to tear.

Subscapularis Tear Symptoms

The most common symptom of subscapularis tears is shoulder pain, especially on the front shoulder. You might also hear or feel a "click" on your shoulder when you rotate your arm.

Some symptoms of subscapular muscle tears are very similar to symptoms of tears in other rotator cuff muscles. Symptoms include:

  • pain that worsens at night
  • shoulder or arm weakness
  • pain that gets worse when you lift your arms

Other symptoms of tearing of the subscapular muscle typically include:

  • Bicep muscle weakness
  • having difficulty reaching for something in your back pocket or reaching for your back
  • pain in the lower part of your collarbone
  • the arm will rotate outward (palm facing forward) by itself

How to prevent shoulder bursitis?

The key to preventing tearing of the subscapularis muscle is to reduce tension in the shoulder joint. Here are some things you can do to prevent subscapular muscle tearing:

  • strengthen shoulder muscles.
  • improve posture when standing or sitting to reduce pressure on the joints.
  • warm-up and stretch shoulders before exercising or doing activities that require the use of repeated shoulder joints.
  • resting shoulders after doing activities that involve repeated shoulder use.

How is the handling of subscapular muscle tearing?

Orthopedists can diagnose a tear in the subscapularis muscle by conducting special tests such as:

  • Lift-off test. Your doctor will ask you to put your hands on your lower back and then try to lift them. If you can't raise your hand, this is a sign that you have a torn subscapular muscle.
  • Bear hug test. You will place the hand of the problematic arm on the opposite shoulder. Your doctor will try to pull your hands off your shoulders by rotating your arms outwards. If you cannot maintain your hand position on your shoulder, you may experience a tear in your upper subscapular muscle.
  • Belly press test. You will put your hands on your stomach and squeeze your stomach, using only your hands (not your wrists or elbows). If this test causes pain, you may experience a tear in the subscapularis muscle.
  • After the examination, your doctor may do an MRI. The tests above can help your doctor narrow down the conditions that might occur, but MRI examination can help determine if there is a tear in the subscapularis muscle, and see how serious the tear is.

Subscapularis muscle

1. Medication use

  • Mild to moderate pain - Treated with non-steroidal anti-inflammatory drugs.
  • Severe to Very Severe pain - Treated with opioids.
  • Muscle cramps - Treated with muscle relaxants.

2. Physiotherapy

Physiotherapy can be tried before surgery. Physiotherapy is continued for 6 to 8 weeks. Physiotherapy with anti-inflammatory drugs can help relieve pain and rebuild the muscle strength of the subscapularis. Tears with partial thickness can heal completely after undergoing physiotherapy.

3. Cortisone injections

Cortisone with local anesthesia is injected in and around the injured tendons and muscles. Patients are scheduled for injections 3 to 4. Each injection is carried out at intervals of 2 weeks.

4. Surgery

a. Arthroscopic Procedure

A partial or full tear of the thickness of the subscapularis muscle is repaired by arthroscopic surgery. Arthroscopic surgery is a minimally invasive surgical procedure performed with a relatively small incision.

b. Open surgery

A skin incision is made over the injured tendon and tear. The injured tendon or muscle is opened and sutured. The size of the surgical wound in an open surgery procedure is certainly greater when compared to the arthroscopic procedure.

c. Shoulder Joint Replacement

If severe pain continues after several attempts of surgery to repair a tendon or a muscle tear, then the surgical treatment has failed. If this happens, shoulder joint replacement surgery will be considered.


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