• Clinics in Shoulder and Elbow
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• v.22 no.1
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• pp.3-8
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• 2019

Background: This study aimed to compare the subscapularis muscle volume between the intact groups (group I) and supraspinatus tendon tear groups (group T) based on the sex and three different age groups. Methods: Subjects with a group I and subjects with group T without any other lesions were retrospectively evaluated from among patients who received a magnetic resonance imaging (MRI) scan between January 2011 and December 2013. The MRI scans were studied by a consultant radiologist. The subscapularis muscle volume was compared according to the age and sex; the age groups were categorized as patients in their 40s, 50s, and 60s. The volume of subscapularis muscle was measured by three-dimensional reconstructed images acquired through the axial section of 1.5T MRI. Results: No statistically significant differences were observed between subscapularis muscle volume of the group I and group T, except for male patients in their 50s (group I: $100,650mm^3$ vs. group T: $106,488mm^3$) and 60s (group I: $76,347mm^3$ vs. group T: $99,549mm^3$) (p<0.05). Males had a larger mean volume of subscapularis muscle than females, and the subscapularis muscle volume decreased in a linear manner with increasing age. Conclusions: Decrease in subscapularis muscle volume was observed with increasing age, and the impact of supraspinatus tear on subscapularis muscle volume is age and sex dependent.

• Clinics in Shoulder and Elbow
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• v.8 no.1
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• pp.43-48
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• 2005

We report the case of a heterotopic ossification in the subscapularis muscle. A 30-year-old woman was diagnosed as a heterotopic ossification in the right subscapularis muscle. X-rays, a CT scan and a MRI showed bone-like lesions in the muscle. The location of the ossification was both inferior and anterior to the joint. The mass nearly bridged between the proximal humerus and the inferior portion of the coracoid process. Symptoms did not respond to rest, NSAIDs for 3 months and to stretching exercises treatment for 6 months. Excision and biopsy was performed through deltopectoral approach. Disodium Etidronate was administered during the postoperative period. She regained normal range of motion postoperatively and improved in the shoulder pain after performing strengthening exercises with Therabands. We think that a cause of limitation of the shoulder was impingement between the mass and the coracoid process, and that another cause was adhesion between the mass and the joint capsule. We conclude that excision and postoperative rehabilitation exercises are good methods for a heterotopic ossification in the subscapularis muscle for those that are nonresponsive to nonoperative treatments.

• Clinics in Shoulder and Elbow
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• v.19 no.2
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• pp.90-95
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• 2016

Background: The aim of this study was to investigate the correlation between the type of subscapularis tendon tears diagnosed during arthroscopy and the outcomes of physical tests and of isokinetic muscle strength tests. Methods: We preoperatively evaluated physical outcomes and isokinetic muscle strength of 60 consecutive patients who underwent an arthroscopic rotator cuff repair and/or subacromial decompression. We divided the patients into five groups according to the type of subscapularis tear, which we classified using Lafosse classification system during diagnostic arthroscopic surgery. Results: When we performed a trend analysis between the outcomes of the physical tests and the severity of subscapularis tendon tear, we found that both the incidence of positive sign of the collective physical tests and that of individual physical tests increased significantly as the severity of the subscapularis tear increased (p<0.001). Similarly, the deficit in isokinetic muscle strength showed a tendency to increase as the severity of subscapularis tear increased, but this positive correlation was statistically significant in only the deficit between those with Lafosse type II tears and those with Lafosse type III tears. Conclusions: Although no single diagnostic test surpasses above others in predicting the severity of a subscapularis tear, our study implies that, as a collective unit of tests, the total incidence of the positive rate of the physical tests and the extent of isokinetic strength deficit may correlate with severity of subscapularis tears.

• Clinics in Shoulder and Elbow
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• v.17 no.4
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• pp.185-189
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• 2014

We report a case of intramuscular hemangioma in the subscapularis muscle and the resulting impairment of shoulder function in an adult patient. A nineteen-year-old female complained of shoulder pain and the development of a mass in the absence of previous trauma. Physical examinations, including lift-off and belly-press tests, showed abnormality. X-ray showed multiple calcifications in the front of the scapula. Magnetic resonance imaging showed a soft-tissue mass occupying almost the entire intramuscular portion of the subscapularis muscle. An arthroscopic examination excluded the possibility of a joint invasion, after which the entire mass was successfully removed by open excision. The displacement of the subscapularis by the mass was relieved after the surgery. Pathological diagnosis of the tissue confirmed a cavernous hemangioma. Both shoulder pain and function was improved after operation. There was no evidence of recurrence even at the 2-year follow-up. Rare forms of hemangioma adjacent to the shoulder joint could be successfully managed with surgical excision. Differential diagnosis, such as synovial chondromatosis, pigmented villo-nodular synovitis, and malignant sarcoma, should also be considered.

• Clinics in Shoulder and Elbow
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• v.22 no.2
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• pp.110-112
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• 2019

In reverse ball shoulder replacement, surgery is usually performed using a deltopectoral approach or an anterosuperior transdeltoid approach. The deltopectoral approach is to incise the pectoralis major to upper 1/3 to 1/2, and subscapularis tendon should be removed at the lesser tuberosity of the humerus. This approach has the problem of breaking the shoulder deltoid instead of incising the rotator cuff. Therefore, we report a detailed procedure of reverse ball shoulder replacement using approach without incision of the pectoralis major muscle and subscapularis muscle.

• Clinics in Shoulder and Elbow
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• v.25 no.4
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• pp.282-287
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• 2022

Background: Muscular forces drive proximal humeral fracture deformity, yet it is unknown if arm position can help mitigate such forces. Our hypothesis was that glenohumeral abduction and humeral internal rotation decrease the pull of the supraspinatus and subscapularis muscles, minimizing varus fracture deformity. Methods: A medial wedge osteotomy was performed in eight cadaveric shoulders to simulate a two-part fracture. The specimens were tested on a custom shoulder testing system. Humeral head varus was measured following physiologic muscle loading at neutral and 20° humeral internal rotation at both 0° and 20° glenohumeral abduction. Results: There was a significant decrease in varus deformity caused by the subscapularis (p<0.05) at 20° abduction. Significantly increasing humeral internal rotation decreased varus deformity caused by the subscapularis (p<0.05) at both abduction angles and that caused by the supraspinatus (p<0.05) and infraspinatus (p<0.05) at 0° abduction only. Conclusions: Postoperative shoulder abduction and internal rotation can be protective against varus failure following proximal humeral fracture fixation as these positions decrease tension on the supraspinatus and subscapularis muscles. Use of a resting sling that places the shoulder in this position should be considered.

• Korean Journal of Acupuncture
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• v.34 no.4
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• pp.185-190
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• 2017

Objectives : The research was conducted for the use of HT1 in the shoulder disease through correct acupuncture. Methods : (1) The contents were compared through reviewing literature. (2) The literature was studied in conjunction with the shoulder pathology and anatomical structures. Results : (1) The location of HT1 is described as 'in the axilla, over the axillary artery' in many literature, and the depth of HT1 is as shallow as 1 cm. The WHO standard also follows this. (2) There were many references to 'in the axilla, between the big muscles' in later generations, but there were mixed opinions about the exact muscle names. Based on the acupunctural review and the musculoskeletal study, the big muscles are considered to be 'Pectoralis major' and 'Latissimus dorsi'. (3) Among the muscles constituting the rotator cuff, applying acupuncture on HT1 is essential for 'Subscapularis m.'. Therefore, it is effective to stimulate 'Subscapularis m.' to a depth of 1.5 to 4 cm. Conclusions : The accurate acupoint of HT1 enables various uses of flank, armpit, shoulder and arm diseases as well as cardiopathy. Especially, it helps to treat the muscles through safe and effective acupuncture in shoulder rotator cuff disorder.

• The Academic Congress of Korean Shoulder and Elbow Society
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• 2009.03a
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• pp.74-74
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• 2009

The purpose of this study was to estimate force of muscles that constituted the rotator cuff during elevation motion in scapula plane, using a skeletal muscle model and quantitatively evaluate rotator cuff function in vivo. A healthy volunteer was measured with an open MR and CT system at elevation positions in scapula plane (MR: $30^{\circ}$, $60^{\circ}$, $90^{\circ}$, $120^{\circ}$, $150^{\circ}$, CT: $0^{\circ}$). After reconstruction three-dimensional MRI-based and CT-based bone surface models, matched each models with registration technique. Then supraspinatus, infraspinatus, subscapularis, teres minor, deltoid (anterior, middle, posterior portions) represented as plural lines. These lines were proportional to physiologic cross-sectional area (PCSA) and defined straight line to bind origin and insertion. Force of supraspinatus became greatest at $59^{\circ}$ of elevation. Subsequently force of deltoid middle portion became greatest at $89^{\circ}$ of elevation. Infraspinatus and subscapularis were active at the meantime. In addition, supraspinatus was active during elevation. These results resembled clinical finding and were proved force couples that contribute to mobility and stability of shoulder complex.

• Clinics in Shoulder and Elbow
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• v.19 no.4
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• pp.241-244
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• 2016

Calcific tendinitis of the shoulder joint is common disease causing acute pain, mainly involving the supraspinatus or infraspinatus muscle, and less frequently the teres minor or subscapularis muscle. This study reports on the satisfactory arthroscopic removal of calcium deposits as well as infraspinatus and supraspinatus muscle repair without relapse via minimal incision using suture anchors. This was a case of atypically extensive calcific tendinitis involving the infraspinatus muscle, with a bursal side partial rupture of the supraspinatus muscle in a 61-year-old female whose chief complaint was chronic pain of the right shoulder exacerbated by limited movement.

• Clinics in Shoulder and Elbow
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• v.13 no.1
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• pp.79-85
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• 2010

Purpose: To evaluate the results from arthroscopic repair versus debridement for full-thickness tears of the upper subscapularis tendon. Materials and Methods: Ninety-nine patient outcomes were evaluated and compared prospectively. Sixty-nine patients with full-thickness tears of the upper subscapularis tendon underwent arthroscopic repair (group I) and thirty patients underwent simple debridement (group II) between May 2003 and October 2007. In all patients, the tear was localized to the superior one third of the upper subscapularis tendon. The results of the treatment were assessed by evaluating the UCLA, ASES, and VAS for pain and internal rotation strength scores before and after the operation. Results: In groups I and II, UCLA, ASES, VAS, and internal rotation muscle power (perfect score = 5) scores were improved after surgery. In comparing group I and group II, the UCLA and VAS scores were not significantly different (p>0.05), while the ASES and internal rotation strength scores were significantly different (p<0.05). Conclusion: The arthroscopic repair of full-thickness tears of the upper subscapularis tendon was a better surgical method than simple debridement.