MSK RADIOLOGY

Subscapularis Tendon

Anatomy

Key Anatomical Features:
  • Arises from the undersurface of the scapula
  • Multi-pennate muscle
  • Tendon passes beneath the coracoid process and deep to the pectoralis
  • Contributes fibres to rotator sling and supraspinatus insertion
  • Upper border forms part of anterior interval

Injuries

Common Injury Patterns:
  • Tears are most common in association with advanced cuff disease
  • Subscapularis tendinopathy is more common at the superior border
  • Tears may be associated with subluxation of the biceps tendon
  • If a tear involves the interval only, the displaced biceps tendon will lie above the subscapular tendon
  • If there is a more significant injury, the biceps tendon lies against the humeral head
Uncommon Cause - Coracoid Impingement:
An uncommon cause of tendinopathy is impingement deep to a prominent coracoid process. In these patients, the coracoid process is usually elongated and the distance between its tip and the underlying humeral head is less than 9 mm.