These are my disclosures. I just lost 10 seconds. Sorry Gus. No problem, buddy. You're doing fine So subscapularis tears to me are not as rare as some articles have suggested and I'll try to give you some insights on how To identify them and find them just to give you some Perspective while I was making this talk. I looked at my cases for the first four plus months of the year and of those 34% had a subscapularis repair Of course, this is surgeon dependent in my decision to do it if we eliminated the isolated subscaps there 25% Had subscap repair and this is similar to numbers from 2005 that I had in a poster in 2006 at the animating But all had biceps pathology. So if you want to look for the subscap also look for other associated pathologies So, where is the subscapularis tear? Honestly, if you want to know about it look for it before surgery anticipated These are all the physical exam findings that we know increased external rotation weak belly press Abnormal lift off modified lift off with a hand slaps and also pay attention to the biceps and poster superior cuff Imaging is helpful There's one finding that I Submitted to a meeting recently that I call the Oz subscapularis and you can find it in all cases It's associated with a subscapularis tear that can be easily repaired But MRI it helps you anticipate it the most I'm just gonna focus due to time on the coronal views That's our typical finding. We're comfortable with this if we go a few cuts foot, you know further anterior This is what I tend to look for fluid medial to the coracoid Because it should normally the muscle should normally a butt That's one thing second if you see a vertical biceps obvious and third you can often see the comet tissue on MRI So, let's take a case example, here's your tear and tear Lee here's the comet tissue Let's go inside the shoulder and here you have it There is the comet tissue right in your view and you should look for it This is all all the images in the beach chair. This is the only allow the cubit is bone. I'm gonna throw you guys So then as you advance forward Then you look down and you can see the rolled edge of the subscapularis and through the poster superior tear you retract it laterally Then you can find the rolled edge of the subscapularis Sometimes the comet tissue is a little bit hidden if you pull the biceps out of the way this is not a large subscapularis tear, but there it is right in front of you and If you retract it laterally There's a more anatomic position for the subscapularis On the flip side the very very small the hidden lesions you can identify Look down the biceps groove the biceps look normal, but now you look down you can see the lesion That allows the biceps to sublux and let me look there's another example pretty decent but then when you look down the groove, you can see the shelf of the exposed lesser tuberosity and And the pathology is the biceps subluxing over that shelf and causing tears even small little splits So you do want to look for it? here's the comet tissue the subscapularis and I'm also looking for the middle glenohumeral ligament normally in the neutral position It should be at or lateral to the glenoid rim, so I know when I retract it laterally That's where I want to find it, and that's where I want to end up with my repair here in external rotation So let's look at one quick case example You can see on the axial view which you're all familiar with but also look for fluid You can see the biceps is subluxed, and this is that same patient the biceps is perched right here on the edge And this right shoulder viewing from posterior And here's the exposed lesser tuberosity and these can typically be repaired through a single anterior portal with a good outcome so some principles Reviewed some diagnostic findings so that you can anticipate it. I Do think the comet tissue is very important to identify and look for the middle glenohumeral ligament as we retract the tendon laterally This is a case just happened right as of finishing up the talk to other failed repairs And you can see here's the comet tissue, so I knew this would be more easily repairable As you retract it laterally so those are the things I hope have helped you gain some insight on how to find the subscapularis. Thanks

subscapularis tears

shoulder surgeries

identification

repair

comet tissue