Chellamuthu Girinivasan, Sundar Shyam, Rajan David V
Ortho One Orthopaedic Speciality Centre, Coimbatore, India.
J Clin Orthop Trauma. 2022 Apr 12;28:101867. doi: 10.1016/j.jcot.2022.101867. eCollection 2022 May.
Subscapularis (SSc) is the prime internal rotator of shoulder. It is the most powerful rotator cuff muscle, maintaining the anterior force couple of shoulder. The tears in SSc as any other rotator cuff muscles might result from a traumatic event or more commonly from intrinsic degeneration. With the advent and widespread use of shoulder arthroscopy, SSc tears, which were once considered as "forgotten or hidden lesions" are now being increasingly recognized. Isolated SSc tears are relatively rare. They occur in combinations. Clinically internal rotation can be near normal because of the compensation provided by other internal rotators. It is not uncommon for patients with SSc tear to be normal on routine physical examination. The Bear Hug test (BHT) has high sensitivity and accuracy in the diagnosis of SSc tear. The combined use of BHT with Belly Press Test has been found optimal for diagnosis. US is an accurate and reliable method for diagnosing SSc tears and outperformed MRI in diagnosing partial-thickness SSc tears. The MRI is currently the most advanced imaging available for diagnosis. The specificity is up to 100%. However, the sensitivity is between 36 and 40%. The earliest classification system for SSc tears was by Fox et al. The commonly used classification is by Lafosse et al. The recent system by Yoo et al. is based on the insertion of SSc. The comma sign is gaining importance not only in arthroscopic diagnosis but also in MRI identification and repair of SSc. The mode of management is mainly arthroscopic. The techniques of repair of SSc are continuously progressing. However, there is no clear consensus on the double vs single-row repairs, biceps tendon management, and the role of coracoplasty. Future research must focus on these areas. Reserve shoulder arthroplasty is reserved for salvage in older age groups. Tendon transfers are performed in young active individuals with irreparable tears.
肩胛下肌（SSc）是肩部主要的内旋肌。它是最强大的肩袖肌群，维持肩部的前向力偶。肩胛下肌的撕裂与其他任何肩袖肌群一样，可能由创伤事件引起，更常见的是由内在退变导致。随着肩关节镜检查的出现和广泛应用，曾经被认为是“被遗忘或隐藏的病变”的肩胛下肌撕裂现在越来越受到认可。孤立的肩胛下肌撕裂相对少见，它们常合并出现。临床上，由于其他内旋肌的代偿作用，内旋功能可接近正常。肩胛下肌撕裂的患者在常规体格检查中表现正常并不罕见。熊抱试验（BHT）在肩胛下肌撕裂的诊断中具有较高敏感性和准确性。已发现BHT与腹部按压试验联合使用对诊断最为理想。超声是诊断肩胛下肌撕裂准确可靠的方法，在诊断部分厚度肩胛下肌撕裂方面优于磁共振成像（MRI）。MRI是目前用于诊断的最先进成像技术，特异性高达100%，但敏感性在36%至40%之间。最早的肩胛下肌撕裂分类系统由福克斯等人提出，常用的分类是拉福斯等人的分类方法。柳等人最近的系统基于肩胛下肌的附着点。逗号征不仅在关节镜诊断中，而且在MRI识别和肩胛下肌修复中都越来越重要。治疗方式主要是关节镜手术。肩胛下肌修复技术不断进步。然而，在双排与单排修复、肱二头肌腱处理以及喙突成形术的作用方面，尚无明确共识。未来的研究必须聚焦于这些领域。保留性肩关节置换术用于老年人群的挽救治疗。肌腱转移术用于年轻活跃、存在不可修复撕裂的个体。
