Subscapularis repair is an operation to reattach the subscapularis tendon — the largest and strongest rotator cuff tendon — to the front of the humerus. It is performed for tears caused by injury or degeneration.
The procedure may be performed arthroscopically or through an open incision at the front of the shoulder. The torn subscapularis tendon is identified, mobilised, and reattached to its footprint on the lesser tuberosity using suture anchors. The biceps tendon, which is commonly damaged with subscapularis tears, is addressed at the same time (tenodesis or tenotomy). The operation takes one to two hours.
Surgery is recommended for symptomatic subscapularis tears causing anterior shoulder pain, weakness of internal rotation, and difficulty lifting the hand behind the back. It may also be repaired as part of a larger rotator cuff reconstruction.
Physiotherapy focusing on remaining rotator cuff muscles, activity modification, pain medication, and injections.
MRI to assess tear size and retraction. Standard pre-assessment.
Restoration of internal rotation strength and reduction of anterior shoulder pain. Success rates for repair are approximately 80-85%.
Loss of external rotation is common after subscapularis repair.
Post-operative discomfort for several weeks.
The repaired tendon may fail to heal, particularly with large or chronic tears.
Musculocutaneous or axillary nerve injury.
Shoulder infection.
Stiffness may develop.
General anaesthesia with a nerve block.
Sling for six weeks. Internal rotation is restricted during healing. Gentle exercises begin under physiotherapy guidance. Active movement from six weeks. Strengthening from three months. Full recovery six to twelve months.
Reviews at two weeks, six weeks, and three months.
The subscapularis is the largest rotator cuff muscle and is critical for internal rotation and anterior stability of the shoulder. Tears cause significant weakness.