Hi OCAD community,
Thanks for your valuable insight as always. I received 8 responses over the week. Feel free to continue to comment and add to the discussion.
The majority said to be descriptive as this is confusing otherwise.
There are many classification systems for subscap tears. Some are listed in Table 2 of this article:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10050355/
This response from Dr David Rubin made the most sense to me:
Excellent question. From the radiologic/anatomic standpoint it is not a true full-thickness tear since the superficial fibers (transverse ligament) are intact. But to the surgeon seeing the tendon pulled off from the lesser tuberosity from the inside of the joint during arthroscopy, the tendon is completely avulsed (and easily repairable since it is not retracted). I adopt terminology to reflect that reality:
“The subscapularis tendon is completely avulsed from the lesser tuberosity but not retracted due to intact fibers of the transverse humeral ligament.”
So I just avoid the partial/full-thickness issue. I’ve never had a surgeon complain or indicate that he/she did not understand what I meant.
Here are all the other responses:
out of curiosity, why does it matter?
This sounds like splitting hairs to me.
Just describe what you see; if the transverse ligament (or some tiny part of the subscap) is still intact and the biceps is not dislocated with an otherwise torn and retracted subscap, just say so.
That’s how I play it anyway.
My usual verbiage is "Complete tear of the subscapularis tendon from its lesser tuberosity attachment. Some intact transverse humeral ligament fibers are preventing full tendon retraction. The humeral neck insertional fibers are intact." I usually comment on the humeral neck insertional fibers being torn or not. Not sure if it makes a difference for the surgeon…I should probably ask one of my surgeons but have never received any complaints with that type of description. Rare to see the lesser tube and humeral neck fibers gone, but I’ve seen it in a few MMA fighters from arm bars and American football players.
I don’t report the transverse humeral ligament.
I would call this “ stretching” of the subscap tendon without frank rupture.
I report this as a delaminating tear of the subscap and transverse humeral ligament stripped off the lesser tuberosity.
My understanding is that the ligament is comprised of bursal surface fibers of the subscap.
I don’t think attenuated residual tissue inserting onto the lateral margin of the groove has functional strength….this tendon is not working for him
I believe it is functionally a full thickness tear with a superimposed biceps pulley lesion
It seems as if the MT junction may be retracted, but it is difficult to know
Why is the contrast in the bursa? Is it extravasation or is there FT tear of the superior cuff?
(To answer this question – there was a full thickness tear of the supraspinatus tendon in this case as well)
FT tear. It’s how surgeons I’ve talked to about it approach it as well. I’ll be descriptive that it’s nonretracted with fibers attaching across the groove at the greater tub.
Great question. I am in the camp of continuation of subscap tendon but curious about what others say.
I’m curious if you ever got a response, as I’ve grappled with this for a while. I usually read it as "full thickness tear of the subscapularis tendon from the lesser tuberosity, though it remains in continuity with an intact transverse humeral ligament." I feel like that makes it clear what’s going on to the referrer, even if technically, the ligament is a part of the tendon.
Thanks!
Emad
On Sat, Jun 8, 2024 at 11:37 AM Emad Allam <eallam> wrote:
Hi OCADers!
Question about semantics.
If the subscapularis tendon is completely torn from the lesser tuberosity but the transverse humeral ligament is still intact, would you call this a partial-thickness or full-thickness tear?
I’ve attached an image of an MR arthrogram showing something like that.I have heard some radiologists and surgeons say this would be a full-thickness tear of the subscap. But I’ve found some literature that implies otherwise.
Figure 2 in this article calls it a deep partial tear:
https://www.sciencedirect.com/science/article/pii/S1877056820303480#fig0010
This article implies there is no true transverse humeral "ligament", just continuation of the subscap tendon:
https://journals.sagepub.com/doi/10.1177/0363546505278698
Hoping for some clarification.
Thanks!
Emad Allam
Loyola University Medical Center
