Dr. Ticker recently gave the inaugural lecture to an international group of musculoskeletal radiologists, OCAD, on “Subscapularis Tears: Principles & Arthroscopic Management.”
Dr. Ticker first co-authored articles on the subscapularis muscle and tendon in the 1990s. He has continued to write and lecture on the subscapularis, it’s unique pathologies, and repair techniques he utilizes in his patient care.
(This lecture was created for a group of over 1000 musculoskeletal radiologist around the globe.)
Subscapularis Tears: Why Accurate Diagnosis and Specialized Expertise Matter
Subscapularis tendon tears are increasingly recognized as a critical yet often underdiagnosed cause of shoulder pain and dysfunction. In this educational presentation, Dr. Jonathan Ticker discussed how greater clinical awareness and better imaging interpretation have changed how these injuries are recognized and treated. He also emphasized that subscapularis injuries play a key role in shoulder dysfunction and their treatment strongly influence surgical outcomes.
Understanding the Subscapularis Tendon and Its Clinical Importance
The subscapularis is the largest and most powerful muscle/tendon group of the rotator cuff. It is responsible for internal rotation and anterior shoulder stability. Dr. Ticker explained that tears of the subscapularis are far more common than previously believed. This is particularly common in patients with rotator cuff or biceps tendon problems. Even so, these injuries are often overlooked during early evaluations, which can delay the correct treatment and affect long-term recovery.
Challenges in Diagnosing Subscapularis Tears
Accurate diagnosis of subscapularis tears requires a combination of detailed clinical examination and careful imaging review. Dr. Ticker noted that MRI findings can be subtle, especially in partial tears, and may be misinterpreted without focused expertise. He emphasized the importance of recognizing key imaging and arthroscopic landmarks to avoid incomplete or inaccurate diagnoses.
The Relationship Between the Subscapularis, Biceps, and Rotator Cuff
A major focus of the presentation was the close anatomical and functional relationship between the subscapularis tendon, the biceps tendon, and the posterior superior rotator cuff. Dr. Ticker explained that untreated subscapularis tears can compromise rotator cuff repairs and lead to persistent pain or surgical failure. He compared incomplete repairs to “only zipping up a zipper halfway,” underscoring the need for a comprehensive approach to shoulder pathology.
Surgical Management and Outcomes
Dr. Ticker reviewed his arthroscopic approach to subscapularis repair, highlighting principles of tendon mobilization, anchor placement, and secure fixation. He also discussed the importance of addressing associated conditions, such as biceps instability, or biceps tears during surgery. Based on his decades of surgical experience, Dr. Ticker showed that identifying and repairing subscapularis injuries leads to better shoulder stability, fewer re-tears, and improved outcomes for patients overall.
Why Specialized Expertise Improves Shoulder Care
The presentation reinforced the value of specialized orthopedic expertise in diagnosing and treating complex shoulder injuries. Subscapularis tears often require specialized clinical judgment, advanced imaging interpretation, and precise surgical techniques. These skills are developed through focused training and experience. Early identification and timely intervention can prevent tendon retraction, irreparable damage, and prolonged recovery.
Key Takeaways for Clinicians and Care Teams
Dr. Ticker’s previous experience teaches the importance of thorough evaluation, subspecialty knowledge, and a systematic approach to shoulder injuries. When surgeons actively look for subscapularis issues and understand how they affect overall shoulder movement, they’re better equipped to make accurate diagnoses. This helps them perform stronger repairs and helps patients achieve better long-term results.