Two patients with an isolated traumatic rupture of the subscapular tendon

A man aged 65 and a woman aged 55 were referred to the orthopaedic clinic because of persistent pain in the right shoulder following a fall, 5 and I6 months earlier respectively. On physical examination they were found to have a painful shoulder and loss of strength on endorotation of the right arm. Ultrasound examination of the shoulder revealed subscapular tendon rupture in both patients, this was confirmed by MRI scan in the first patient. Treatment was operative repair of the tendon by a deltopectoral approach, followed by wearing a exorotation-limiting sling. After six months the first patient was free of complaints and the second patient was still experiencing pain when laying on the right shoulder. An isolated traumatic rupture of the subscapular tendon is uncommon and is often misdiagnosed or only discovered later. This diagnostic delay negatively influences the success of operative treatment. Focusing attention on the typical trauma mechanism, the character of the symptoms and the use of simple physical examination such as the lift-off test or the belly press test can lead to the correct diagnosis.