HealthCareMagic is now Ask A Doctor - 24x7 | https://www.askadoctor24x7.com

Can Subscapularis Tear That Is Not Repired Lead To Complications?

Posted on Tue, 27 May 2014

Question: On October 8, 2013, I had a work injury. I did an MRI that revealed a Subscapularis tear ( small) full thickness tear from my Orthopedic's findings. My Orthopedic told me that I needed to have it surgically repaired. During that time I developed Adhesive Capsulitis and was under extreme pain ( waiting 3 mths for Ins to approve surgery.) My Orthopedic finally got me scheduled for surgery 8 days ago. He found lots of scar tissue that he had to clean out and explained to me that my shoulder is angry. He didn't repair my Subscap since he discovered all of this. I had follow up today and he gave me a Cortisone shot and continue with therapy. Should I be worried about not repairing this tear or is it something I should worry about? I work a physical job using my arms to the consistently.

Answered by Dr. Karl Logan (31 minutes later)

Brief Answer:
Likely to need further surgery

Detailed Answer:
hi,

thanks for your question.

your surgeon may have been concerned that in the prescence of a frozen shoulder or adhesive capsulitis that repairing your subscapularis tear would have made your adhesive capsulitis worse.

it is likely therefore that you will continue to have symptoms related to this tear in terms of weakness and a painful XXXXXXX of motion although these will be superceded by the symptoms from your adhesive capsulitis until they improve.

I predict that in the medium to long term you will require further surgery for repair of the rotator cuff tear.

I hope this answers your question.

best wishes

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Karl Logan (28 minutes later)

My Orthopedic told me he doesn't think my pain is related to my tear. He told me that I shouldn't worry about having any complications related to using my right arm. Should I be concerned even if its a small tear?

Answered by Dr. Karl Logan (12 minutes later)

Brief Answer:
Time will tell

Detailed Answer:
Hi

Thanks for your follow up question

Small full thickness tears can be symptomatic but they are also more easily repaired than bigger tears.

The only way you will know for sure is when the symptoms from your adhesive capsulitis resolve and you can make an assessment of your ongoing pain and weakness which will be due to the tear in your subscapularis tendon. you can at this stage push for further operative intervention if necessary although if you at this stage have relatively few symptoms a repair of the tear is not indicated.

Best wishes

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Karl Logan (24 minutes later)

Thanks for your answers to these!,

I am worried however since it's been 7 mths or so that my Dr is giving up on this injury. He did see some tiny tears along the tendon during my surgery. Do you think that is against me as well?

I think his plan is to release me for work in about 8 wks or so. I am very concerned I'll be aggravating this tear. He told me mths ago that anything I did would aggravate this tear now i'm so confused :(

Thanks for your help!

Answered by Dr. Karl Logan (13 minutes later)

Brief Answer:
See advice below

Detailed Answer:
hi,

thanks for your follow up question.

if the symptoms related to your adhesive capsulitis have improved but you still have symptoms related to your subscapularis tendon tear then a steroid and local anesthetic shot into your subscapular space should give you some indication if how much improvement might be expected with repair of the the tear. if the tear is small and or only partial thickness then the shot may also provide some permanent relief from your symptoms. Physiotherapy can also be of benefit.

i hope this answers your question. your surgeon sounds very reasonable and so I would continue to give him feedback as to your current symptoms so he can make an informed decision regarding your ongoing therapy. if your are unhappy with your surgeons advice you can always ask your family dr a second opinion.

best wishes

Above answer was peer-reviewed by : Dr. Yogesh D

Follow up: Dr. Karl Logan (26 minutes later)

Do you still feel with regard to your expertise,that I will need further treatment for repair of subscapularis? I did before my recent surgery have weakness and XXXXXXX of pain just below my shoulder in the front when I lifted or lowered my right arm?While I was doing physiotherapy before my surgery it seemed my frozen shoulder was better to me that I could feel the weakness I had in the shoulder,weird sensations. But now after the surgeon cleaned it out, I am masked once again with irritation of my shoulder masking the weakness.

Thanks for your help!

Answered by Dr. Karl Logan (9 hours later)

Brief Answer:
Your symptoms will dictate your need for surgery

Detailed Answer:
hi,

I see many patients with a painful XXXXXXX secondary to tendonitis of the rotator cuff.

The majority improve with a local and steroid injection followed by Physiotherapy.

In those who do not improve further investigation with MRI or ultrasound indicated to assess the tear.

If the tear is large, full thickness and symptoms continue the a repair is indicated. If the tear is small and the patient had minimal symptoms a policy of observation can be adopted. If symptoms worsen then the injection can be repeated, tests can be repeated and a further decision made about operative intervention.

I hope this answers your further question

Note: For further queries, consult a joint and bone specialist, an Orthopaedic surgeon. Book a Call now.

Above answer was peer-reviewed by : Dr. Vaishalee Punj