Diagnostic difficulties in the radiological assessment of subscapularis tears.

Background: Radiological evaluation of rotator cuff tears are sensitive and specific. Accuracy may be low in diagnosing subscapularis tears.

Materials and methods: We retrospectively reviewed shoulder arthroscopies performed by two surgeons over 45 months. We reviewed patients who had subscapularis repairs and their preoperative imaging.

Result: 286 cases had imaging (193 MRIs, 93 USS) with 77 subscapularis repairs. MRI suggested 31 tears, arthroscopy confirmed 16 (30% sensitivity, 89% specificity). USS suggested 6 tears, arthroscopy confirmed 4 (13% Sensitivity, 97% specificity).

Discussion: Results demonstrated low accuracy for preoperative radiological subscapularis tear assessment. This has logistical, diagnostic and implications on treatment.