The subscapularis inserts on the lesser tubercle in a comma-shaped footprint extending from the superior-most lesser tubercle edge inferiorly. The upper 25-30% of the subscapularis is critical for anterior shoulder stability and is most commonly torn in subscapularis pathology. PASTA (partial articular surface tendon avulsion) lesions of the subscapularis occur at its superior footprint from forced external rotation.
Internal rotation and anterior glenohumeral stabilisation through the subscapularis footprint on the lesser tubercle
Subscapularis tears are classified by the Lafosse classification based on the percentage of tendon torn (Grade I: partial-thickness; Grade II: upper third; Grade III: upper two-thirds; Grade IV: complete; Grade V: complete with fatty infiltration). The bear hug test (pressing the palm on the opposite shoulder and resisting the examiner lifting the elbow) and belly press test assess subscapularis integrity. Arthroscopic repair with lateralised anchors through the rotator interval achieves best footprint restoration.
Upper subscapularis footprint tear from forced external rotation or anterior dislocation producing positive belly press and bear hug tests managed with arthroscopic repair.
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