Isolated subscapularis rupture in an adolescent – Arthroscopic repair and outcome – Case study

Abstract

more commonly known as‘‘stingers’’ or‘‘burners’’.Inanacutesetting,theseverityofpaincanoften limit accurate examination and diagnosis. However, thepotential for injury progression to a possible irreparable statehighlights theimportanceofinitiallyexcludingrotatorcufftearsinall adolescents. We hereby present a case of an adolescent malewho sustainedatraumaticruptureofhissubscapularistendonanddiscuss our management.2. Case reportA 13-year-old boy sustained an injury to his right, dominantshoulder whilst playing rugby. He played football in the academyof a Premier League professional soccer club and county levelrugby union. He was tackled running forward, falling heavily ontohis fully abducted externally rotated right arm. He had immediatesevere pain and was unable to continue playing. He sustained ananterior shoulder dislocation, which was relocated by a physio-therapist at the time of injury. Following two weeks ofphysiotherapy, a more significant injury was suspected and hewas referred to the senior author.On examination there was tenderness anteriorly. He achievedactive flexionto1508andabductionto708,withfurthermovementlimited by pain. He demonstrated external rotation to 508 withdiscomfort. There was possible anterior translation of theglenohumeral joint in 308 of external rotation. He had markedanterior apprehension of his shoulder at 808 abduction and 208external rotation. Additionally the patient had a positive bellypress sign and bear hug test indicating involvement of thesubscapularis. There did not appear to be any supraspinatus,infraspinatus