Non-Insertional Tendinopathy of the Subscapularis

PURPOSE:

(1) Describe a previously unreported finding involving the intra-articular portion of the subscapularis, the Conrad lesion. (2) Describe a novel classification system for the spectrum of non-insertional tendinopathy of the subscapularis. (3) Report the outcomes of surgical treatment of this spectrum of pathology.

MATERIALS AND METHODS:

Outcomes of 34 patients (23 males and 11 females, mean age 60.5 ± 7.5) with non-insertional tendinopathy of the subscapularis treated arthroscopically were retrospectively reviewed. All patients had anterior shoulder pain with no weakness during belly-press testing and no subscapularis footprint involvement on magnetic resonance imaging. All patients were managed with subscapularis tendon debridement and side-to-side repair along with treatment of concomitant pathology.

RESULTS:

Seven patients had a Type I lesion (so-called Conrad lesion) – a nodule on the leading edge of the subscapularis. Eighteen patients had a Type II lesion – a visible split tear with degeneration in the upper ½ of the intra-articular tendon. Nine patients had a Type III lesion – more extensive splitting in the tendon with advanced tendon degeneration. At a mean follow-up of 24 months, 97% of patients were completely satisfied. Significant improvements were seen in forward elevation (152 ± 12° to 172 ± 5°, P < 0.001) and visual analog scale pain scores (5.9 ± 1.7-0.6 ± 1.0, P < 0.001). Internal rotation strength and external rotation motion at the side were maintained. ASES scores averaged 95.4 ± 7.4, disabilities of arm, shoulder and hand scores averaged 6.19 ± 9.8, Western Ontario Rotator Cuff scores averaged 91.7 ± 9.3 and the average University of California at Los Angeles score was 33.1 ± 2.4.

CONCLUSIONS:

We present a previously unreported finding of the subscapularis, the Conrad lesion, along with a novel classification system for non-insertional tendinopathy of the subscapularis. Arthroscopic treatment of this spectrum of tendinopathy along with concomitant shoulder pathology eliminated pain and improved patient outcomes without detrimental effects.

Full Article: Non-Insertional Tendinopathy of the Subscapularis

Mark Getelman, MD

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John P

Aug 14, 2024

by John P on Mark Getelman, MD

I am so eternally thankful for Dr. Getelman’s skillful repair of my right shoulder. Pain is mostly absent. Limitations are great, as far as weight bearing and quick muscle movements, but the absence of pain has greatly made sleep, reaching for items, using a kitchen knife once again, washing my hair and brushing my teeth "normal" once more.

His time and expertise on my surgery is much appreciated.

To think about the quality of some regularity he will return to the next patient from a truly grateful past candidate.

Thank you Doctor, for your steady hand and complex, complicated, compassionate repair.

Sincerely,

John P.

Steven

Apr 30, 2018

by Steven on Mark Getelman, MD

Shoulder Rotator cuff pantient

Dr. Getelman and his assistant Katie did an excellent job on my rotator cuff surgery April 12, 2017. The shoulder needed an extensive amount of work. I took PT (physical therapy) very seriously the following four months. Due to a successful surgery and a lot of PT I was able to get all my range of motion back and great strength. I also approved on how efficient the office staff are. I am very thankful to all that helped me.

Anonymous

Apr 12, 2018

by Anonymous on Mark Getelman, MD

They are very knowledgeable and professional.

I had an excellent experience with Dr. Getelman and his staff. They are very knowledgeable and professional.