Archives of Orthopaedic and Trauma Surgery

, Volume 139, Issue 5, pp 659–667 | Cite as

Accuracy of magnetic resonance imaging (MRI) for subscapularis tear: a systematic review and meta-analysis of diagnostic studies

  • Eduardo Angeli Malavolta
  • Jorge Henrique AssunçãoEmail author
  • Mauro Emilio Conforto Gracitelli
  • Talitha Koo Yen
  • Marcelo Bordalo-Rodrigues
  • Arnaldo Amado Ferreira Neto
Arthroscopy and Sports Medicine



The accuracy of MRI for subscapularis tear is lower than that of overall rotator cuff tears. Until now, no systematic reviews and meta-analysis have been conducted to compile these data. The purpose of this study was to determine, through a systematic review and meta-analysis, the diagnostic accuracy of MRI in the detection of subscapularis tendon tears.

Materials and methods

A systematic review of PubMed, EMBASE, and MEDLINE databases up to April 2017 was performed. All studies assessing the sensitivity and specificity of the MRI (index test) compared to arthroscopic surgical findings (reference test) for subscapularis tendon tear were included. A meta-analysis was performed to calculate pooled sensitivity, specificity, sROC curve, and diagnostic odds ratio values.


A total of 497 citations were identified. After applying the eligibility criteria, 14 articles were included, including 1858 shoulders with 613 subscapularis tears. For overall subscapularis tears, sensitivity was 0.68 (95% CI 0.64–0.72) and specificity was 0.90 (95% CI 0.89–0.92). Sensitivity was 0.93 (95% CI 0.83–0.98) for full-thickness tears and 0.74 (95% CI 0.66–0.82) for partial tears. Specificity was 0.97 (95% CI 0.94–0.98) for full-thickness tears and 0.88 (95% CI 0.85–0.91) for partial tears. Analyzing only studies with field of strength ≥ 1.5 T, sensitivity was 0.80 (95% CI 0.76–0.84) and specificity 0.84 (95% CI 0.81–0.87).


MRI is an accurate method for diagnosing subscapularis tendon tears; however, its accuracy is lower than that of overall rotator cuff tears, due to its lower sensitivity.

Level of evidence

III, systematic review of Level II and III studies.


Rotator cuff tear MR imaging Subscapularis tendon Accuracy Sensitivity Specificity 




Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.


  1. 1.
    Yamamoto A, Takagishi K, Osawa T, Yanagawa T, Nakajima D, Shitara H, Kobayashi T (2010) Prevalence and risk factors of a rotator cuff tear in the general population. J Shoulder Elb Surg 19:116–120. CrossRefGoogle Scholar
  2. 2.
    Colvin AC, Egorova N, Harrison AK, Moskowitz A, Flatow EL (2012) National trends in rotator cuff repair. J Bone Jt Surg Am 94:227–233. CrossRefGoogle Scholar
  3. 3.
    Pfirrmann CW, Zanetti M, Weishaupt D, Gerber C, Hodler J (1999) Subscapularis tendon tears: detection and grading at MR arthrography. Radiology 213:709–714CrossRefGoogle Scholar
  4. 4.
    Lo IKY, Burkhart SS (2002) Subscapularis tears: arthroscopic repair of the forgotten rotator cuff tendon. Tech Shoulder Elb Surg 3:282–291CrossRefGoogle Scholar
  5. 5.
    Waldt S, Bruegel M, Mueller D, Holzapfel K, Imhoff AB, Rummeny EJ, Woertler K (2007) Rotator cuff tears: assessment with MR arthrography in 275 patients with arthroscopic correlation. Eur Radiol 17:491–498. CrossRefGoogle Scholar
  6. 6.
    Lee JH, Yoon YC, Jee S, Kwon JW, Cha JG, Yoo JC (2014) Comparison of three-dimensional isotropic and two-dimensional conventional indirect MR arthrography for the diagnosis of rotator cuff tears. Korean J Radiol 15:771–780. CrossRefGoogle Scholar
  7. 7.
    Narasimhan R, Shamse K, Nash C, Dhingra D, Kennedy S (2016) Prevalence of subscapularis tears and accuracy of shoulder ultrasound in pre-operative diagnosis. Int Orthop 40:975–979. CrossRefGoogle Scholar
  8. 8.
    Leschinger T, Hackl M, Zeifang F, Scaal M, Muller LP, Wegmann K (2017) Nerve supplyof the subscapularis during anterior shoulder surgery: definition of a potential risk area. Arch Orthop Trauma Surg 137:135–140. CrossRefGoogle Scholar
  9. 9.
    de Jesus JO, Parker L, Frangos AJ, Nazarian LN (2009) Accuracy of MRI, MR arthrography, and ultrasound in the diagnosis of rotator cuff tears: a meta-analysis. AJR Am J Roentgenol 192:1701–1707. CrossRefGoogle Scholar
  10. 10.
    Morag Y, Jamadar DA, Miller B, Dong Q, Jacobson JA (2011) The subscapularis: anatomy, injury, and imaging. Skelet Radiol 40:255–269. CrossRefGoogle Scholar
  11. 11.
    Garavaglia G, Ufenast H, Taverna E (2011) The frequency of subscapularis tears in arthroscopic rotator cuff repairs: a retrospective study comparing magnetic resonance imaging and arthroscopic findings. Int J Shoulder Surg 5:90–94. CrossRefGoogle Scholar
  12. 12.
    Adams CR, Schoolfield JD, Burkhart SS (2010) Accuracy of preoperative magnetic resonance imaging in predicting a subscapularis tendon tear based on arthroscopy. Arthroscopy 26:1427–1433. CrossRefGoogle Scholar
  13. 13.
    Furukawa R, Morihara T, Arai Y, Ito H, Kida Y, Sukenari T, Horii M, Ikoma K, Fujiwara H, Kubo T (2014) Diagnostic accuracy of magnetic resonance imaging for subscapularis tendon tears using radial-slice magnetic resonance images. J Shoulder Elb Surg 23:e283–e290. CrossRefGoogle Scholar
  14. 14.
    Choo HJ, Lee SJ, Kim OH, Seo SS, Kim JH (2012) Comparison of three-dimensional isotropic T1-weighted fast spin-echo MR arthrography with two-dimensional MR arthrography of the shoulder. Radiology 262:921–931. CrossRefGoogle Scholar
  15. 15.
    Smith TO, Daniell H, Geere JA, Toms AP, Hing CB (2012) The diagnostic accuracy of MRI for the detection of partial- and full-thickness rotator cuff tears in adults. Magn Reson Imaging 30:336–346. CrossRefGoogle Scholar
  16. 16.
    Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med 151:264–269CrossRefGoogle Scholar
  17. 17.
    Whiting PF, Rutjes AWS, Westwood ME, Mallett S, Deeks JJ, Reitsma JB, Leeflang MM, Sterne JA, Bossuyt PM, QUADAS-2 Group (2011) QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med 155:529–536. CrossRefGoogle Scholar
  18. 18.
    Oh DK, Yoon YC, Kwon JW, Choi SH, Jung JY, Bae S, Yoo J (2009) Comparison of indirect isotropic MR arthrography and conventional MR arthrography of labral lesions and rotator cuff tears: a prospective study. AJR Am J Roentgenol 192:473–479. CrossRefGoogle Scholar
  19. 19.
    Adams CR, Brady PC, Koo SS, Narbona P, Arrigoni P, Karnes GJ, Burkhart SS (2012) A systematic approach for diagnosing subscapularis tendon tears with preoperative magnetic resonance imaging scans. Arthroscopy 28:1592–1600. CrossRefGoogle Scholar
  20. 20.
    Omoumi P, Bafort AC, Dubuc JE, Malghem J, Vande Berg BC, Lecouvet FE (2012) Evaluation of rotator cuff tendon tears: comparison of multidetector CT arthrography and 1.5-T MR arthrography. Radiology 264:812–822. CrossRefGoogle Scholar
  21. 21.
    Gyftopoulos S, O’Donnell J, Shah NP, Goss J, Babb J, Recht MP (2013) Correlation of MRI with arthroscopy for the evaluation of the subscapularis tendon: a musculoskeletal division’s experience. Skelet Radiol 42:1269–1275. CrossRefGoogle Scholar
  22. 22.
    Momenzadeh OR, Gerami MH, Sefidbakht S, Dehghani S (2015) Assessment of correlation between MRI and arthroscopic pathologic findings in the shoulder joint. Arch Bone Jt Surg 3:286–290Google Scholar
  23. 23.
    Malavolta EA, Assunção JH, Guglielmetti CL, de Souza FF, Gracitelli ME, Bordalo-Rodrigues M, Ferreira Neto AA (2016) Accuracy of preoperative MRI in the diagnosis of subscapularis tears. Arch Orthop Trauma Surg 136:1425–1430. CrossRefGoogle Scholar
  24. 24.
    Meyer DC, Zimmermann SM, Wieser K, Bensler S, Gerber C, Germann M (2016) Lengthening of the subscapularis tendon as a sign of partial tearing in continuity. J Shoulder Elb Surg 25:31–37. CrossRefGoogle Scholar
  25. 25.
    Jung JY, Jee WH, Chun CW, Kim YS (2017) Diagnostic performance of MR arthrography with anterior trans-subscapularis versus posterior injection approach for subscapularis tendon tears at 3.0 T. Eur Radiol 27:1303–1311. CrossRefGoogle Scholar
  26. 26.
    Fotiadou AN, Vlychou M, Papadopoulos P, Karataglis DS, Palladas P, Fezoulidis IV (2008) Ultrasonography of symptomatic rotator cuff tears compared with MR imaging and surgery. Eur J Radiol 68:174–179. CrossRefGoogle Scholar
  27. 27.
    Brockmeyer M, Schmitt C, Haupert A, Kohn D, Lorbach O (2017) Limited diagnostic accuracy of magnetic resonance imaging and clinical tests for detecting partial-thickness tears of rotator cuff. Arch Orthop Trauma Surg 137:1719–1724. CrossRefGoogle Scholar
  28. 28.
    Wright JM, Heavrin B, Hawkins RJ, Noonan T (2001) Arthroscopic visualization of the subscapularis tendon. Arthroscopy 17:677–684. CrossRefGoogle Scholar
  29. 29.
    Burkhart SS, Brady PC (2006) Arthroscopic subscapularis repair: surgical tips and pearls A to Z. Arthroscopy 22:1014–1027. CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Eduardo Angeli Malavolta
    • 1
  • Jorge Henrique Assunção
    • 1
    Email author
  • Mauro Emilio Conforto Gracitelli
    • 1
  • Talitha Koo Yen
    • 1
  • Marcelo Bordalo-Rodrigues
    • 1
  • Arnaldo Amado Ferreira Neto
    • 1
  1. 1.Department of Orthopedics and Traumatology, School of MedicineUniversity of São PauloSão PauloBrazil

Personalised recommendations