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Lengthening of the subscapularis tendon as a sign of partial tearing in continuity


Meyer, Dominik C; Zimmermann, Stefan M; Wieser, Karl; Bensler, Susanne; Gerber, Christian; Germann, Marco (2016). Lengthening of the subscapularis tendon as a sign of partial tearing in continuity. Journal of Shoulder and Elbow Surgery, 25(1):31-37.

Abstract

BACKGROUND: The quantification of a subscapularis tendon lesion may be difficult on magnetic resonance imaging, as well as during arthroscopic inspection. Consequently, the surgical decision of whether to only debride a degenerated tendon or to lateralize the more intact tendon portion may be arbitrary. This study aims to quantify the length of the subscapularis tendon as a sign of partial tendon tearing.
METHODS: We retrospectively identified 92 magnetic resonance arthrography studies of suspected rotator cuff lesions obtained 3 months before shoulder arthroscopy. The myotendinous junction was identified, and the subscapularis tendon and muscle lengths were measured. Findings on arthroscopy performed later were used as the diagnostic gold standard for tendon integrity and compared with the magnetic resonance data.
RESULTS: Arthroscopy showed an intact subscapularis tendon in 43 patients, tendinopathy in 21 patients, and a partial rupture in 28 patientsThe mean subscapularis tendon lengths were 40 mm in cases of intact subscapularis musculotendinous units, 45 mm in cases of tendinopathy, and 53 mm in cases of partial tears, whereas the mean subscapularis muscle lengths were 105 mm, 94 mm, and 95 mm, respectively, in these groups.
CONCLUSION: Partial tears of the subscapularis tendon lead to muscle shortening by approximately 10% and elongation of the tendon by approximately 32%, which may be interpreted as muscle retraction and a tendon rupture in continuity. If the subscapularis tendon has an apparent length of greater than 60 mm, the probability of a tear is 98%. Determination of the tendon length may therefore be a useful additional tool to quantify the integrity of the subscapularis tendon and degree of myotendinous retraction.

Abstract

BACKGROUND: The quantification of a subscapularis tendon lesion may be difficult on magnetic resonance imaging, as well as during arthroscopic inspection. Consequently, the surgical decision of whether to only debride a degenerated tendon or to lateralize the more intact tendon portion may be arbitrary. This study aims to quantify the length of the subscapularis tendon as a sign of partial tendon tearing.
METHODS: We retrospectively identified 92 magnetic resonance arthrography studies of suspected rotator cuff lesions obtained 3 months before shoulder arthroscopy. The myotendinous junction was identified, and the subscapularis tendon and muscle lengths were measured. Findings on arthroscopy performed later were used as the diagnostic gold standard for tendon integrity and compared with the magnetic resonance data.
RESULTS: Arthroscopy showed an intact subscapularis tendon in 43 patients, tendinopathy in 21 patients, and a partial rupture in 28 patientsThe mean subscapularis tendon lengths were 40 mm in cases of intact subscapularis musculotendinous units, 45 mm in cases of tendinopathy, and 53 mm in cases of partial tears, whereas the mean subscapularis muscle lengths were 105 mm, 94 mm, and 95 mm, respectively, in these groups.
CONCLUSION: Partial tears of the subscapularis tendon lead to muscle shortening by approximately 10% and elongation of the tendon by approximately 32%, which may be interpreted as muscle retraction and a tendon rupture in continuity. If the subscapularis tendon has an apparent length of greater than 60 mm, the probability of a tear is 98%. Determination of the tendon length may therefore be a useful additional tool to quantify the integrity of the subscapularis tendon and degree of myotendinous retraction.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > Balgrist University Hospital, Swiss Spinal Cord Injury Center
Dewey Decimal Classification:610 Medicine & health
Language:German
Date:2016
Deposited On:15 Oct 2015 16:08
Last Modified:05 Apr 2016 19:27
Publisher:Elsevier
ISSN:1058-2746
Publisher DOI:https://doi.org/10.1016/j.jse.2015.06.014
PubMed ID:26234662

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