Subscapularis: Diagnosis & Therapy of Subscapularis Tendon Rupture

The subscapularis tendon plays a central role in the stability and mobility of the shoulder joint.

As the largest muscle of the rotator cuff, the subscapularis muscle is primarily responsible for the internal rotation and ventral movement of the arm.

Ruptures of the subscapularis tendon are less common than those of the supraspinatus tendon, but can cause severe functional limitations.

In this article you will learn:

• The anatomical role of the subscapularis

• Typical causes and symptoms of a rupture

• Diagnostics and imaging procedures

• Conservative and surgical treatment options

• Rehabilitation and follow-up treatment

• Prognosis and long-term course

Anatomy and function of the subscapularis

The subscapularis muscle originates on the anterior surface of the scapula (subscapular fossa) and extends to the anterior surface of the humeral head (lesser tubercle). Its powerful tendon stabilizes the joint anteriorly and enables internal rotation of the arm.

As part of the rotator cuff The muscle works closely with the supraspinatus, infraspinatus and teres minor and contributes significantly to dynamic shoulder stability.

Causes of a subscapularis tendon rupture

• Acute injuries (e.g. fall, dislocation)

• Degeneration due to aging and wear

• Overload during professional or sporting activities

• Combination with ruptures of other rotator cuff tendons

A subscapularis rupture often occurs in combination with a tear of the supraspinatus tendon .

Typical symptoms

• Pain in the front shoulder area

• Internal rotation weakness

• Uncertainty or instability in certain movements

• Restrictions in everyday activities (e.g. putting on a jacket, driving a car)

• Night pain or problems lying on the affected side

  
  

Diagnostics

The diagnosis includes:

• Clinical tests (lift-off, belly press, bear-hug test)

• MRI examination to visualize the tendon tear, possible retractions or muscle fatty degeneration

• Ultrasound as a complementary procedure

Accompanying injuries such as a labral tear or a lesion of the biceps tendon are often also present .

Treatment options

Conservative

In certain cases (partial tear, minor discomfort), non-surgical treatment may be useful:

• Immobilization in the acute phase

• Physiotherapy to maintain mobility

• Strengthening the shoulder muscles

• Anti-inflammatory medications or injections (e.g. PRP, hyaluronic acid)

Surgical – Arthroscopic Reconstruction

In cases of complete tear or severely limited function, arthroscopic suturing is the standard method.

Advantages:

• Minimally invasive

• Less pain

• Fast healing process

• Simultaneous treatment of concomitant injuries

The tendon is reattached to the bone with suture anchors. In cases of severe retraction, a tendon transfer may be necessary.

Follow-up treatment & rehabilitation

Healing requires structured aftercare:

0–6 weeks:

• Immobilization in a sling

• Passive movement exercises

6–12 weeks:

• Start of active mobilization

• Coordination training

From week 12:

• Targeted muscle building

• Return to everyday stress

After 6 months, full strain (including sports) is usually possible again.

forecast

With early treatment, the chances of recovery are very good. However, delayed treatment can lead to muscle fatty degeneration, retraction, and chronic symptoms—even rotator cuff arthropathy .

Conclusion:

• The subscapularis tendon is crucial for internal rotation and stability of the shoulder

• A tear causes pain, loss of strength and restricted movement

• Precise diagnostics using MRI are essential

• Surgical treatment is usually performed arthroscopically with very good results

• Structured follow-up treatment is a prerequisite for complete recovery

FAQs about subscapularis tendon rupture

What is a subscapularis tendon rupture?

A subscapularis tendon rupture is a tear of the subscapularis tendon, which is part of the rotator cuff. It often leads to pain, loss of strength, and limited movement, especially during internal rotation of the shoulder.

What symptoms occur with a subscapularis tendon tear?

Typical symptoms include shoulder pain, weakness during internal rotation, a feeling of instability, and limited mobility, especially when dressing or carrying.

How is a subscapularis tendon rupture diagnosed?

Diagnosis is made through clinical tests (e.g. lift-off or bear-hug test) and imaging techniques such as MRI, which visualizes the tendon tear and possible accompanying injuries.

Can a subscapularis tendon rupture be treated without surgery?

Partial or minor tears can be treated conservatively—e.g., with physical therapy, pain medication, and injections. Complete tears usually require surgery.

How does surgery for a subscapularis tendon rupture proceed?

The tendon is reattached to the bone arthroscopically using suture anchors. This minimally invasive procedure allows for a gentle restoration of shoulder function, followed by targeted rehabilitation.

Do you suspect a subscapularis tendon rupture?

👉 Then make an appointment with our specialist – we offer specialized diagnostics and individual treatment plans.

Prof. Dr. med. Ben Ockert

Specialist in orthopedics

and trauma surgery,

Sports medicine

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