A man with capsulorrhaphy arthropathy had a ream and run procedure after which he was able to return to downhill and cross country skiing.
A body builder relative encouraged him to work on internal rotation curls using large weights after which the patient developed pain, increased passive external rotation to 90 degrees, weak internal rotation and anterior instability.
An MRI was interpreted as showing "edema within the subscapularis muscle belly reflects an acute to subacute partial intramuscular tear. Subscapularis tendon is obscured by susceptibility artifact".
Because of the history and physical findings, the patient was returned to the operating room for subscapularis reconstruction. A complete tear of the subscapularis was identified. The reamed glenoid was well healed.
A six suture tendon re-repair to bone was reinforced using a hamstring tendon graft passed first through the lesser tuberosity, then through the medial subscapularis tendon, and the sutured back on itself.
External rotation after the reconstruction was 10 degrees.
The plan is for 8 weeks of sling protection.
Addition information on the subscapularis can be found at this link:Subscapularis and shoulder arthroplasty: repair, failure and reconstruction
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