Understanding the Subscapularis Muscle and Surgical Techniques for Repairing it

insertion of subscapularis

lesser tubercle of humerus

The subscapularis muscle is one of the four muscles of the rotator cuff in the shoulder joint.

It originates from the subscapular fossa of the scapula (shoulder blade) and inserts onto the lesser tubercle of the humerus (upper arm bone).

To insert the subscapularis muscle, the patient is usually placed in a lying-down (supine) position.

The affected arm is then rotated outward (externally rotated) and flexed to 90 degrees so that the elbow is pointing to the ceiling.

The surgeon may make an incision on the skin to access the shoulder joint.

To reach the subscapularis muscle, the surgeon may use various approaches, including the deltopectoral approach or the subscapularis-splitting approach.

In the deltopectoral approach, the surgeon makes an incision along the anterior (front) aspect of the shoulder to access the subscapularis muscle.

In the subscapularis-splitting approach, the surgeon makes a smaller incision on the skin and splits the subscapularis muscle fibers longitudinally to access the underlying structures.

Once the muscle is exposed, the surgeon may use a combination of sharp and blunt dissection to separate the muscle fibers and locate its insertion onto the lesser tubercle of the humerus.

The surgeon may then use surgical sutures to reattach the subscapularis muscle to its insertion point on the bone.

In some cases, the surgeon may also use anchors or screws to secure the sutures in place.

After the procedure is complete, the surgeon will close the incision and dress the wound. The patient may need to wear a sling for a period of time to immobilize the shoulder and allow the muscle to heal properly.

Physical therapy and rehabilitation exercises may also be prescribed to help restore strength, mobility, and function to the shoulder joint.

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