Anterosuperior Rotator Cuff Ruptures

  • Alessandro CastagnaEmail author
  • Raffaele Garofalo
  • Marco Conti


Anterosuperior rotator cuff tears are less common and behave differently from the posterior superior tear. The specific feature of this lesion is related to anatomy, clinical presentation, prognosis, and treatment. Clinical presentation for injury of the anterosuperior rotator cuff tear is extremely variable, particularly because the injury could be acute and traumatic versus degenerative; furthermore, it is also related to the tear extension. For function shoulder to be preserved in patients with anterosuperior rotator cuff tears, the mainstay of treatment consists of avoiding fatty infiltration into the lower subscapularis tendon. Subscapularis tendon in particular is prone to retraction and early irreversible changes of the muscle. In consequence, once diagnosis is done, this tendon should be repaired as soon as possible.

Open and arthroscopic surgical technique has been described to treat these lesions with satisfactory outcomes. However, early recognition and treatment of tear improve prognosis after repair. Younger age of patients, less degree of tissue retraction, and less fatty infiltration lead to a better clinical result.


Rotator Cuff Humeral Head Fatty Infiltration Great Tuberosity Supraspinatus Tendon 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. Barth JR, Burkhart SS, DeBeer JF (2006) The bear-hug test: a new and sensitive test for diagnosing a subscapularis tear. Arthroscopy 22(10):1076–1084CrossRefPubMedGoogle Scholar
  2. Bartl C, Salzmann GM, Seppel G et al (2011) Subscapularis function and structural integrity after arthroscopic repair of isolated subscapularis tears. Am J Sports Med 39(6):1255–1262CrossRefPubMedGoogle Scholar
  3. Bennett WF (2003) Arthroscopic repair of anterosuperior (supraspinatus/subscapularis) rotator cuff tears: a prospective cohort with 2- to 4-year follow-up. Classification of biceps subluxation/instability. Arthroscopy 19(1):21–33CrossRefPubMedGoogle Scholar
  4. Chao S, Thomas S, Yucha D, Kelly JD 4th, Driban J, Swanik K (2008) An electromiyographic assessment of the “bear hug”: an examination for the evaluation of the subscapularis muscle. Arthroscopy 24(11):1265–1270CrossRefPubMedGoogle Scholar
  5. Cofield RH (1991) Tears of the rotator cuff. In: Instructional course lectures. American Academy of Orthopaedic Surgeons, Rosemont, IL, pp 258–271Google Scholar
  6. Collin P, Matsumura N, Ladermann A, Denard PJ, Walch G (2014) Relationship between massive chronic rotator cuff tear pattern and loss of active shoulder range of motion. J Shoulder Elb Surg 23:1195–1202CrossRefGoogle Scholar
  7. Denard PJ, Ladermann A, Burkhart SS (2011) Arthroscopic management of subscapularis tears. Sports Med Arthrosc 19(4):333–341CrossRefPubMedGoogle Scholar
  8. Deutsch A, Altchek DW, Veltri DM, Potter HG, Warren RF (1997) Traumatic tears of the subscapularis tendon: clinical diagnosis, magnetic resonance imaging findings, and operative treatment. Am J Sports Med 25:13–22CrossRefPubMedGoogle Scholar
  9. Di Schino M, Augerau B, Nich C (2012) Does open repair of anterosuperior rotator cuff tear prevent muscular atrophy and fatty infiltration? Clin Orthop Relat Res 470:2776–2784CrossRefPubMedPubMedCentralGoogle Scholar
  10. Edwards TB, Walch G, Novè-Josserand L, Gerber C (2005) Anterior superior rotator cuff tears. Repairable and irreparable tears. In: JJP W, Iannotti JP, Flatow EL (eds) Complex revision problems in shoulder suregry, 2nd edn. Lippincott Williams and Wilkins, Philadelphia, pp 107–128Google Scholar
  11. Flury MP, John M, Goldhan J, Schwyzer HK, Simmen BR (2006) Rupture of the subscapularis tendon (isolated or in combination with supraspinatus tear): when is repair indicated? J Shoulder Elb Surg 15(6):659–664CrossRefGoogle Scholar
  12. Foad A, Wijdicks CA (2012) The accuracy of magnetic resonance imaging and magnetic resonance arthrogram versus arthroscopy in the diagnosis of subscapularis tendon injury. Arthroscopy 28(5):636–641CrossRefPubMedGoogle Scholar
  13. Fuchs B, Weishaupt D, Zanetti M, Hodler J, Gerber C (1999) Fatty degeneration of the muscles of the rotator cuff: assessment by computed tomography versus magnetic resonance imaging. J Shoulder Elb Surg 8:599–605CrossRefGoogle Scholar
  14. Garofalo R, Castagna A, Borroni M, Krishnan SG (2012) Arthroscopic transosseous (anchorless) rotator cuff repair. Knee Surg Sports Traumatol Arthrosc 20(6):1031–1035CrossRefPubMedGoogle Scholar
  15. Gerber C, Krushell RJ (1991) Isolated rupture of the tendon of the subscapularis muscle. Clinical features in 16 cases. J Bone Joint Surg Br 73:389–394PubMedGoogle Scholar
  16. Goutallier D, Postel JM, Bernageau J, Lavau L, Voisin MC (1994) Fatty muscle degeneration in cuff ruptures. Pre- and postoperative evaluation by CT scan. Clin Orthop Relat Res 304:78–83Google Scholar
  17. Habermeyer P, Magosch P, Pritsch M, Scheibel MT, Lichtenberg S (2004) Anterosuperior impingement of the shoulder as a result of pulley lesions: a prospective arthroscopic study. J Shoulder Elb Surg 13:5–12CrossRefGoogle Scholar
  18. Hawkins RJ, Kennedy JC (1980) Impingement syndrome in athletes. Am J Sports Med 8:151–158CrossRefPubMedGoogle Scholar
  19. Ide J, Tokiyoshi A, Hirose J, Mizuta H (2007) Arthroscopic repair of traumatic combined rotator cuff tears involving the subscapularis tendon. J Bone Joint Surg Am 89(11):2378–2388PubMedGoogle Scholar
  20. Itoi E (2013) Rotator cuff tear: physical examination and conservative treatment. J Orthop Sci 18:197–204CrossRefPubMedPubMedCentralGoogle Scholar
  21. Kim SJ, Jung M, Lee JH, Kim C, Chun YM (2014) Arthroscopic repair of anterosuperior rotator cuff tears: in-continuity technique vs. disruption of subscapularis-supraspinatus tear margin: comparison of clinical outcomes and structural integrity between the two techniques. J Bone Joint Surg Am 96(24):2056–2061CrossRefPubMedGoogle Scholar
  22. Koo SS, Burkhart SS (2012) Subscapularis tendon tears: identifying mid to distal footprint disruptions. Arthroscopy 26(8):1130–1134CrossRefGoogle Scholar
  23. Lo IK, Burkhart SS (2003) (2003). The comma sign: an arthroscopic guide to the torn subscapularis tendon. Arthroscopy 19:334–337CrossRefPubMedGoogle Scholar
  24. Loew M, Magosch P, Lichtenberg S, Haebermeyer P, Porschke F (2015) How to discriminate between acute traumatic and chronic degenerative rotator cuff lesions: an analysis of specific criteria on radiography and magnetic resonance imaging. J Shoulder Elb Surg 24(11):1685–1693CrossRefGoogle Scholar
  25. Mansat P, Frankle MA, Cofield RH (2003) Tears in the subscapularis tendon: descriptive analysis and results of surgical repair. Joint Bone Spine 70:342–347CrossRefPubMedGoogle Scholar
  26. Namdari S, Henn F, Green A (2008) Traumatic anterosuperior rotator cuff tears: the outcome of open surgical repair. J Bone Joint Surg Am 90:1906–1913CrossRefPubMedGoogle Scholar
  27. Neer CS II (1972) Anterior acromioplasty for the chronic impingement syndrome in the shoulder: a preliminary report. J Bone Joint Surg Am 54:41–50CrossRefPubMedGoogle Scholar
  28. Nove’-Josserand L, Gerber C, Walch G (1997) Lesions of the anterosuperior rotator cuff. In: Warner JJP, Iannotti JP, Gerberc C (eds) Complex and revision problems in shoulder surgey. Lippincott-Raven, Philadelphia, pp 165–176Google Scholar
  29. Schnaser E, Toussaint B, Gillespie R, Lefebvre Y, Gobezie R (2013) Arthroscopic treatment of anterosuperior rotator cuff tears. Orthopedics 36(11):e1394–e1340CrossRefPubMedGoogle Scholar
  30. Tung G, Yoo D, Levine S, Brody J, Green A (2001) Subscapularis tendon tear: primary and associated signs on MRI. J Comput Assist Tomogr 25:417–424CrossRefPubMedGoogle Scholar
  31. Visonà E, Cerciello S, Godenèche A, Neyton L, Fessy MH, Novè-Josserand L (2015a) The “comma sign”: ana antomical investigation (dissection of the rotator interval in 14 cadaveric shoulders). Surg Radiol Anat 37(7):793–798CrossRefPubMedGoogle Scholar
  32. Visonà E, Paladini P, Merolla G, Cerciello S, Porcellini G (2015b) Strength recovery after arthroscopic anterosuperior cuff repair: analysis of a consecutive series. Musculoskelet Surg 99:S37–S42CrossRefPubMedGoogle Scholar
  33. Warner JJP, Gerber C (1997) Massive tears of the postero-superior rotator cuff. In: Warner JJP, Iannotti JP, Gerberc C (eds) Complex and revision problems in shoulder surgey. Lippincott-Raven, Philadelphia, pp 177–203Google Scholar

Copyright information

© ISAKOS 2017

Authors and Affiliations

  • Alessandro Castagna
    • 1
    • 2
    Email author
  • Raffaele Garofalo
    • 1
    • 2
  • Marco Conti
    • 1
    • 2
  1. 1.Shoulder and Elbow Unit, Humanitas Institute IRCCSMilanItaly
  2. 2.Upper limb Unit, F. Miulli Hospital Acquaviva delle fontiBariItaly

Personalised recommendations