The subscapularis muscle originates from the subscapular fossa and its tendinous fibres converge on the lesser tuberosity, but the muscle belly lies against the anterior thoracic cage. The costal surface of the subscapularis has periosteal-like attachments to the ribs through which scapulothoracic motion is transmitted.
The subscapularis tendon at the chest wall level is relevant in scapulothoracic dissection for total scapulectomy and in posterolateral thoracotomy where the subscapularis must be elevated from the chest wall. Subscapularis snapping against the chest wall (scapulothoracic bursitis) is addressed by examining the costal subscapularis-chest wall interface. Serratus anterior and subscapularis share this chest wall territory.
Subscapularis-chest wall interface irritation producing a grinding or snapping sensation with scapular movement, managed by scapulothoracic bursa injection and periscapular muscle strengthening.
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