Subscapularis tendon tear (preoperative and postoperative ultrasound)
Presentation
Post-traumatic right shoulder pain for the last one month. Referred for an ultrasound to check the rotator cuff.
Patient Data
There is a full-thickness defect of the subscapularis tendon. It involves cranial 2/3rd fibers. The retraction is about 5 mm.
There is a suspicious hypoechoic area involving 1/3rd thickness of supraspinatus tendon. The rest of the supraspinatus tendon shows a normal echo pattern.
The infraspinatus tendon is intact. There is no subacromial-subbural effusion or glenohumeral joint effusion. Both supraspinatus and infraspinatus muscle bellies show normal volume and echopattern.
6 wk postoperative US
The repaired subscapularis tendon reaches up to the lesser tuberosity. There are sutures in the tendon substance. The repaired tendon appears thick and hypoechoic which is a normal finding in postoperative cuff.
There is a reverberation artifact at the lesser tuberosity cortex due to an anchor. The supraspinatus tendon is not repaired as there was a focal partial thickness tear. There is no bursal or joint effusion.
Case Discussion
The case shows preoperative and postoperative ultrasound in case of a full-thickness tear of the subscapularis tendon. Arthroscopic cuff repair was done in this case.
Postoperative ultrasound is done primarily to check the repaired tendon integrity.
The signs of the re-tear are an absence of the tendon continuity up to its footprint (greater or lesser tuberosity), fluid-filled defect replacing tendon and bare suture anchor. A thickened tendon with heterogeneous echo pattern is an expected finding in a postoperative cuff1. The sutures should be looked for in the tendon substance.
A full-thickness or partial-thickness defect in the cuff may represent a re-tear1. It may also be a normal postoperative finding if that part of the tear was not reparable1. In such cases, communication with the operating surgeon regarding detailed operative history is important.
Dislodged anchor, subacromial-subdeltoid bursitis are other abnormalities to be documented1.
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