Gerber's 1996 landmark outcomes paper on operative repair of isolated subscapularis tendon rupture. 16 consecutive men were followed for a mean of 43 months after transosseous reinsertion to the lesser tuberosity. The central question: does surgical repair restore function, and does timing of repair matter?
Isolated subscapularis rupture was rarely diagnosed before Gerber's work — it was misattributed to impingement, and two patients in this series had already undergone acromioplasty for the wrong diagnosis.
This paper established the lift-off test and belly-press test as the clinical standard for subscapularis assessment, and it is why we check passive external rotation symmetry in every shoulder with unexplained weakness or a history of forceful external rotation injury.
When you see increased passive external rotation, a positive lift-off test, and weakness on internal rotation tasks, get imaging and refer early. The 36-month threshold is the line in the sand: repair before it and you can expect 88% of normal function; cross it and you are operating on a muscle that may be too degenerated to fully recover.
The belly-press test is your backup when the patient cannot reach behind the back. An elbow that drifts posterior while pressing the abdomen is a positive test and should raise immediate concern for subscapularis insufficiency.
Gerber's 1996 landmark outcomes paper on operative repair of isolated subscapularis tendon rupture. 16 consecutive men were followed for a mean of 43 months after transosseous reinsertion to the lesser tuberosity. The central question: does surgical repair restore function, and does timing of repair matter?
Isolated subscapularis rupture was rarely diagnosed before Gerber's work — it was misattributed to impingement, and two patients in this series had already undergone acromioplasty for the wrong diagnosis.
This paper established the lift-off test and belly-press test as the clinical standard for subscapularis assessment, and it is why we check passive external rotation symmetry in every shoulder with unexplained weakness or a history of forceful external rotation injury.
When you see increased passive external rotation, a positive lift-off test, and weakness on internal rotation tasks, get imaging and refer early. The 36-month threshold is the line in the sand: repair before it and you can expect 88% of normal function; cross it and you are operating on a muscle that may be too degenerated to fully recover.
The belly-press test is your backup when the patient cannot reach behind the back. An elbow that drifts posterior while pressing the abdomen is a positive test and should raise immediate concern for subscapularis insufficiency.