- See:
Rotator cuff:
- Anatomy:
- origin: entire anterior surface of the subscapularis fossa;
- insertion: lesser tuberosity of humerus and capsule of shoulder joint;
- action:
- main action: glenohumeral head depressor;
- in certain positions allows extension, adduction and medial rotation of humerus at shoulder;
- stabilization of the glenohumeral joint;
- reversed origin insertion action:
- when humerus is stabilized, abducts inferior border of the scapula;
- synergists:
teres major,
pectoralis major, latissimus dorsi;
- nerve supply:
- upper & lower
subscapular,
C5,
C6;
- subscapular nerve arises from posterior division of upper trunk, rather than from
posterior cord and herefore contains fibers only from C4-
C6;
- in some pts (30%) subscapular nerve does arise from
posterior cord;
- Considerations for Subscapularis Repair:
- biceps tendon management
- references:
- Repair of tears of the subscapularis.
-
Stabilization of the long head of the biceps tendon in the context of early repair of traumatic subscapularis tendon tears.
-
Pectoralis Major Tendon Transfers Above or Underneath the Conjoint Tendon in Subscapularis-Deficient Shoulders
-
Repair of Tears of the Subscapularis.
-
Traumatic anterosuperior rotator cuff tears: the outcome of open surgical repair.
-
Subscapularis tendon tear: an anatomic and clinical investigation.
- Pectoralis Major Transfer:
- subcoracoid pectoralis major tendon transfer:
- may improve function and diminish pain;
- subcoracoid position of the transfer allows redirection of the pectoralis major in a direction recreating the vector of the subscapularis tendon;
- references:
-
Transfer of pectoralis major for the treatment of irreparable tears of subscapularis: does it work?
-
Outcome of pectoralis major transfer for the treatment of irreparable subscapularis tears.
-
Pectoralis major transfer in the treatment of chronic subscapularis insufficiency
-
Pectoralis major tendon transfers above or underneath the conjoint tendon in subscapularis-deficient shoulders. An in vitro biomechanical analysis.
- Discussion: Surgical Dissection for Anterior Shoulder Reconstruction;
- w/ anterior dislocations the subscapularis is displaced forward, which creates traction injury to the
axillary nerve;
- nerve is tethered above by brachial plexus & below where it wraps around behind neck of humerus;
- during anterior shoulder reconstruction, the axillary nerve may be identified by passing a digit along anterior surface of subscapularis until the nerve is
encountered at lower margin of subscapularis as the nerve passes inferior to articular capsule on its way to
quadrangular space;
- before an incision is made in subscapularis, the arm should be externally rotated to avoid damage to
axillary nerve & circumflex vessels;
Repair of recurrent anterior dislocation of the shoulder using transfer of the subscapularis tendon.
Release of the subscapularis for internal rotation contracture and pain after anterior repair for recurrent anterior dislocation of the shoulder.
Operative treatment of irreparable rupture of the subscapularis. JBJS. 79-A (5):722-31, 1997 May.
The Subscapularis Footprint: An Anatomic Description of Its Insertion Site.
