Abstract:We report the case of an 11-year-old, male, competitive hockey player with a complete rupture of the subscapularis insertion but no avulsion fracture of the lesser tuberosity. Ultrasound and MRI were performed before surgical repair with suture anchors. The boy regained a normal range of movement after 4 weeks of immobilization and 2 months of rehabilitation. This unique case (with the absence of lesser tuberosity avulsion) is compared with the 16 other cases of paediatric subscapularis avulsion fracture repor… Show more
“…1 , 22 In many reports, the subscapularis is repaired with sutures and anchors or drill holes through the lesser tuberosity footprint. 6 , 7 , 12 , 14 , 15 , 19 …”
Background:Pediatric subscapularis tears are known to be rare injuries. They are often associated with an avulsion fragment of the lesser tuberosity leading to dual description in the literature of either subscapularis tear or lesser tuberosity avulsion. Historically, they were managed nonoperatively; however, outcomes have improved with operative management. Nonoperative management often led to bony overgrowth at the lesser tuberosity that limited motion. The literature is limited to case reports and a few small case series, often not restricted to pediatric patients.Study Design:Case series.Level of Evidence:Level 5.Methods:Radiographic and operative databases were retrospectively reviewed to identify pediatric patients with subscapularis tears or lesser tuberosity avulsions in the past 10 years.Results:Five cases of pediatric subscapularis tears were identified that underwent operative management. Of the 5 cases, 4 had delayed presentation. In 1 case, the lesser tuberosity fragment was initially missed on radiographic imaging. All patients underwent operative management.Conclusion:These cases add to the body of knowledge of a rare pediatric injury that is commonly missed or diagnosis delayed. The importance of suspicion in the adolescent male patient without instability and unrelenting shoulder pain is stressed. Additionally, the importance of early magnetic resonance imaging with suspicion as well as an axillary view of the shoulder is demonstrated. As with all rare entities, it is important to disseminate information on natural history and interventions for this injury.
“…1 , 22 In many reports, the subscapularis is repaired with sutures and anchors or drill holes through the lesser tuberosity footprint. 6 , 7 , 12 , 14 , 15 , 19 …”
Background:Pediatric subscapularis tears are known to be rare injuries. They are often associated with an avulsion fragment of the lesser tuberosity leading to dual description in the literature of either subscapularis tear or lesser tuberosity avulsion. Historically, they were managed nonoperatively; however, outcomes have improved with operative management. Nonoperative management often led to bony overgrowth at the lesser tuberosity that limited motion. The literature is limited to case reports and a few small case series, often not restricted to pediatric patients.Study Design:Case series.Level of Evidence:Level 5.Methods:Radiographic and operative databases were retrospectively reviewed to identify pediatric patients with subscapularis tears or lesser tuberosity avulsions in the past 10 years.Results:Five cases of pediatric subscapularis tears were identified that underwent operative management. Of the 5 cases, 4 had delayed presentation. In 1 case, the lesser tuberosity fragment was initially missed on radiographic imaging. All patients underwent operative management.Conclusion:These cases add to the body of knowledge of a rare pediatric injury that is commonly missed or diagnosis delayed. The importance of suspicion in the adolescent male patient without instability and unrelenting shoulder pain is stressed. Additionally, the importance of early magnetic resonance imaging with suspicion as well as an axillary view of the shoulder is demonstrated. As with all rare entities, it is important to disseminate information on natural history and interventions for this injury.
“…This left 21 studies published in English between 1993 and 2020 that were included for analysis. 5,[21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40]…”
Section: Prisma Search Resultsmentioning
confidence: 99%
“…This left 21 studies published in English between 1993 and 2020 that were included for analysis. 5 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 Fig 1 Flowchart of study screening and selection in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement. …”
Section: Resultsmentioning
confidence: 99%
“…Only one included study was assessed to have good quality and, therefore, low risk of bias as per the Methodological Quality and Synthesis of Case Series and Case Reports framework proposed by Murad et al 23 Nine articles were assessed to have moderate quality and risk of bias, 24,[27][28][29]31,32,35,37,39 and 11 were assessed to have low quality and, therefore, high risk of bias. 5,21,22,25,26,30,33,34,36,38,40…”
“…Of these, all were reported as positive for signs of rotator cuff damage. 30,35,40 The time from injury to diagnosis was reported for 51 patients and ranged from 1 day to 24 months. Forty-five patients were diagnosed within 6 months of injury; of these, 11 were diagnosed within 1 month of injury.…”
Section: Patient Characteristics and Epidemiologymentioning
To systematically review the literature to determine the injury mechanisms, presentation, and timing of diagnosis for pediatric patients with intratendinous rotator cuff tears and to determine the efficacy of surgical intervention for affected patients. Methods: PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Scopus were searched. Studies were included if they involved only pediatric patients, soft-tissue rotator cuff injuries managed surgically, and reported outcomes. Patient characteristics, injury mechanisms, physical examination and imaging findings, time to diagnosis, surgical technique, and treatment outcomes were extracted. Findings were descriptively analyzed with weighted means and proportions. Results: Twenty-one studies comprising 78 patients were included. The age range was 8 to 17 years and 57 were male. The supraspinatus (n ¼ 56) was the most injured tendon. American football was the most reported sport played at the time of injury. Most patients were diagnosed within 6 months of injury via magnetic resonance imaging. Arthroscopic management was undertaken in 68 patients. Forty-six of 51 patients for whom data were available returned to sports at a range of 2.5 to 12 months postoperatively. Repair failure occurred in three patients. Conclusion: The extant literature regarding rotator cuff tears in pediatric patients is limited to reports of low methodological quality. Qualitative synthesis of this low-level literature reveals that rotator cuff tears are mostly reported in male collision sport athletes but may also occur in female athletes and/or throwing athletes. These injuries are often successfully managed via arthroscopic repair, and patients and their families can be reassured that the majority of patients return to sports following surgery.
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