This case series describes 16 men with isolated traumatic rupture of the subscapularis tendon, a lesion previously reported only rarely. It characterizes the clinical syndrome, injury mechanism, and imaging findings. It introduces and validates a new bedside diagnostic maneuver, the lift-off test.
When a patient presents with anterior shoulder pain and weakness after a forced external rotation or hyperextension injury to an adducted arm, think subscapularis rupture, not a strained muscle. The key exam finding is the lift-off test: ask the patient to place the dorsum of the hand on the lower back and lift it away. Inability to lift indicates a torn subscapularis.
Remember the two prerequisites for validity. Passive internal rotation must be full and active internal rotation must not be limited by pain. Otherwise the test cannot be interpreted. Support the clinical diagnosis with ultrasound first and add MRI in questionable cases. On arthrography, medial dislocation of the biceps tendon is a diagnostic clue.
The absence of instability distinguishes this from anterior dislocation with subscapularis injury, because the inferior glenohumeral ligament stays intact. At surgery, use a deltopectoral approach and protect the axillary nerve.
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This case series describes 16 men with isolated traumatic rupture of the subscapularis tendon, a lesion previously reported only rarely. It characterizes the clinical syndrome, injury mechanism, and imaging findings. It introduces and validates a new bedside diagnostic maneuver, the lift-off test.
When a patient presents with anterior shoulder pain and weakness after a forced external rotation or hyperextension injury to an adducted arm, think subscapularis rupture, not a strained muscle. The key exam finding is the lift-off test: ask the patient to place the dorsum of the hand on the lower back and lift it away. Inability to lift indicates a torn subscapularis.
Remember the two prerequisites for validity. Passive internal rotation must be full and active internal rotation must not be limited by pain. Otherwise the test cannot be interpreted. Support the clinical diagnosis with ultrasound first and add MRI in questionable cases. On arthrography, medial dislocation of the biceps tendon is a diagnostic clue.
The absence of instability distinguishes this from anterior dislocation with subscapularis injury, because the inferior glenohumeral ligament stays intact. At surgery, use a deltopectoral approach and protect the axillary nerve.