Non-insertional tendinopathy of the subscapularis

Abstract

Purpose:(1) Describe a previously unreported finding involving the intra-articular portion of the subscapularis, the Conrad lesion. (2) Describe a novel classification system for the spectrum of non-insertional tendinopathy of the subscapularis. (3) Report the outcomes of surgical treatment of this spectrum of pathology.Materials and Methods:Outcomes of 34 patients (23 males and 11 females, mean age 60.5 ± 7.5) with non-insertional tendinopathy of the subscapularis treated arthroscopically were retrospectively reviewed. All patients had anterior shoulder pain with no weakness during belly-press testing and no subscapularis footprint involvement on magnetic resonance imaging. All patients were managed with subscapularis tendon debridement and side-to-side repair along with treatment of concomitant pathology.Results:Seven patients had a Type I lesion (so-called Conrad lesion) – a nodule on the leading edge of the subscapularis. Eighteen patients had a Type II lesion – a visible split tear with degeneration in the upper ½ of the intra-articular tendon. Nine patients had a Type III lesion – more extensive splitting in the tendon with advanced tendon degeneration. At a mean follow-up of 24 months, 97% of patients were completely satisfied. Significant improvements were seen in forward elevation (152 ± 12° to 172 ± 5°, P < 0.001) and visual analog scale pain scores (5.9 ± 1.7-0.6 ± 1.0, P < 0.001). Internal rotation strength and external rotation motion at the side were maintained. ASES scores averaged 95.4 ± 7.4, disabilities of arm, shoulder and hand scores averaged 6.19 ± 9.8, Western Ontario Rotator Cuff scores averaged 91.7 ± 9.3 and the average University of California at Los Angeles score was 33.1 ± 2.4.Conclusions:We present a previously unreported finding of the subscapularis, the Conrad lesion, along with a novel classification system for non-insertional tendinopathy of the subscapularis. Arthroscopic treatment of this spectrum of tendinopathy along with concomitant shoulder pathology eliminated pain and improved patient outcomes without detrimental effects.Level of Evidence:IV, Retrospective Case Series.

Recovery of subscapularis and shoulder function following arthroscopic treatment of isolated anterior and combined anterosuperior rotator cuff lesions

“…Arthroscopic treatment options for the subscapularis include debridement of partial lesions or irreparable tears or suture anchor repair and side-to-side stitches of horizontal split lesions [5][6][7][8][9]. Although studies have focused on each of these reconstruction techniques in detail, a differentiation between extension and type of lesion of the subscapularis and possible surgical technique has not taken place [1,5,6,8,10].…”

Subscapularis tendon tear classification and diagnosis: A systemic review and meta-analysis

“…Yoo et al described a classification based on a three-dimensional anatomic footprint ( 30 ). Dierckman’s classification was based on noninsertional tendinopathy of the subscapularis ( 40 ). None of the classifications included interstitial tears of the subscapularis tendon described by Saremi et al ( Figure 5F ) ( 35 ).…”