The subscapularis tendon inserts on the lesser tuberosity via its upper half (tendinous) and lower half (muscular). It forms the roof of the subcoracoid space and the floor of the coracohumeral interval. The upper subscapularis fibres at the superior tendon-bicipital groove junction form the pulley of the biceps long head — disruption of the subscapularis upper fibres produces biceps pulley lesions and medial biceps tendon subluxation.
Internal rotation force transmission; anterior glenohumeral stabilisation; the biceps long head pulley at the top of the bicipital groove
Subscapularis tears are classified by the Lafosse system (I-V). Isolated upper subscapularis tears produce the positive belly press and lift-off tests. Biceps medial subluxation from upper subscapularis and pulley disruption is confirmed by dynamic ultrasound. Arthroscopic subscapularis repair uses suture anchors placed in the lesser tuberosity with the arm in external rotation.
Upper subscapularis tendon disruption from a fall or forced external rotation producing internal rotation weakness and positive belly press test managed with arthroscopic repair.
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