Shoulder problems are common in adults. Problems can come from injury, overuse, or aging. The rotator cuff is the most likely place for them to develop. This cuff consists of four muscles and their tendons, which attach around the shoulder to give it strength and motion.
Tears of the rotator cuff occur most often in two of the four muscle-tendon units. Occasionally, the third muscle is injured. Rarely, the fourth muscle, or subscapularis, is involved. The first case of a subscapularis tear without major trauma, overuse, or signs of aging has been reported.
A 49-year-old man with a history of a minor car accident and mild right shoulder pain started a weight-training program at home. He began a program of biceps curls using eight-pound dumbbells. Within two days, he started having severe right shoulder pain.
The doctor carefully examined him, making special note of the location of all painful symptoms. Touching and observing areas that were not painful also provided useful information. Some of the movements and tests could not be performed because of extreme shoulder pain. The doctor ordered MRI studies (magnetic resonance imaging) to confirm the diagnosis of a subscapularis tear.
The MRI showed this was a partial tear that did not require surgery. Fluid above the muscle seen on the MRI also proved this was not a long-term problem but one that occurred suddenly. MRI is not always needed, but it can be used to identify unusual rotator cuff tears. The test also shows the extent of damage. This is extremely helpful information for doctors when deciding whether surgery is needed.
In this case, a six-week program of physical therapy resulted in a good outcome. The patient progressed through a program of exercises for motion, strength, and proprioception (training to fine-tune the joint’s sense of position). The patient returned to work and recreational sports without any further problems.
Early diagnosis of a partial tear of the rotator cuff is important. By starting treatment early, the patient can avoid tearing the muscle completely, which would require surgery. Doctors use MRI studies to identify muscle or tendon tears and to design the best plan of treatment.