Arthroscopic subscapularis repair is a shoulder surgery used to treat a tear in the subscapularis tendon, which is one of the important tendons of the rotator cuff. In my practice, I often see patients with shoulder pain who know about rotator cuff tears in general but have never heard of the subscapularis tendon. Because this tendon sits at the front of the shoulder, its injury is sometimes missed early or confused with more general shoulder pain, weakness, or stiffness. [1][2]

One important point I want Bangladeshi patients to understand is that not every subscapularis tear needs surgery. Some partial tears, degenerative tendon problems, or less severe cases may improve with proper rehabilitation, activity modification, and medical guidance. But when the tear is significant, function is limited, pain persists, or the shoulder remains weak and unstable despite treatment, surgical repair may be the better option. [1][3]

Arthroscopic repair means the surgery is performed through small incisions using a camera and specialized instruments. This allows the torn tendon to be assessed and repaired with less soft tissue disruption than a traditional large open approach in selected cases. [2][4]

What Is the Subscapularis Tendon?

The subscapularis is one of the four rotator cuff muscles. It sits on the front surface of the shoulder blade and attaches to the upper arm bone. Its main role is to help rotate the arm inward and contribute to shoulder stability. [2][4]

This tendon is important in many everyday actions, including:
– reaching behind the back
– tucking in a shirt
– fastening garments
– lifting objects close to the body
– pushing doors open
– controlling shoulder movement during overhead activity

When this tendon is torn, patients may experience not only pain but also weakness, loss of control, and difficulty with practical tasks.

How a Subscapularis Tear Happens

Subscapularis tears can happen after trauma, gradual wear-and-tear, or in association with other shoulder problems.

Traumatic Injury

A fall, sudden forceful movement, or shoulder injury may tear the tendon, especially in active adults or after a dislocation event. In some patients, the problem starts quite suddenly.

Degenerative Wear

Like other rotator cuff tendons, the subscapularis can also weaken over time. Age-related tendon changes, repetitive strain, poor shoulder mechanics, and untreated earlier shoulder problems may all contribute. [1][3]

Associated Shoulder Damage

Subscapularis tears may occur together with:
– biceps tendon instability or damage
– other rotator cuff tears
– shoulder impingement
– chronic shoulder instability
– previous shoulder trauma

That is one reason a full shoulder assessment is important rather than focusing on only one painful spot.

Symptoms of a Subscapularis Tear

The symptoms can vary depending on the size of the tear and whether other structures are involved.

Pain at the Front of the Shoulder

Many patients report pain more toward the front of the shoulder rather than the top or side. This may be worse with lifting, reaching, or rotating the arm inward.

Weakness

Weakness is often a major complaint. Patients may notice difficulty with:
– reaching across the body
– lifting bags or containers
– pushing heavy doors
– holding weight away from the body
– tucking the shirt behind the back
– personal grooming or dressing tasks

Restricted Function

Some people feel a catching sensation, reduced confidence in movement, or inability to use the shoulder normally during work or home tasks.

Night Pain

Shoulder pain may be worse at night, especially after a full day of use. This can affect sleep quality and delay recovery if not addressed. [1]

How I Diagnose This Problem

When I evaluate a patient with suspected subscapularis injury, I combine the clinical history, examination, and imaging findings. I do not rely on one sign alone.

History Taking

I ask:
– when the pain started
– whether there was trauma
– which movements feel weak
– whether the patient can reach behind the back
– whether sleep is affected
– whether there was a previous dislocation or shoulder surgery
– whether the patient has manual work or repetitive arm use

In Bangladesh, I also pay attention to whether household or work responsibilities have forced the patient to keep using the painful arm despite worsening symptoms.

Physical Examination

There are clinical tests that can suggest subscapularis injury, but shoulder diagnosis is often more reliable when the whole pattern is considered. I assess:
– range of motion
– pain location
– internal rotation strength
– biceps involvement
– other rotator cuff function
– signs of stiffness or instability

Imaging

MRI is often useful when a rotator cuff tear is suspected, but subscapularis tears can sometimes still be underestimated before surgery. Ultrasound may help in some settings. X-rays can also be useful to assess the overall shoulder condition, though they do not show tendon tears directly. [2][4]

When Arthroscopic Subscapularis Repair Is Considered

Not every patient with a sore shoulder needs this operation. Arthroscopic subscapularis repair is more likely to be considered when:
– there is a confirmed tendon tear
– pain and weakness continue despite conservative care
– shoulder function is significantly limited
– the tear is repairable
– the patient’s activity needs and symptoms justify surgery

I usually explain to my patients that the purpose of surgery is not just pain relief. It is also to restore tendon function, improve strength, and reduce the risk of long-term shoulder dysfunction when a meaningful tear is present.

What Happens During Arthroscopic Repair

In arthroscopic repair, a small camera is inserted into the shoulder joint through a small incision. Other small portals are used for instruments. The torn subscapularis tendon is identified, any associated issues may be assessed, and the tendon is repaired back to bone using anchors and sutures. [4][5]