Houston Methodist. Leading Medicine

Shoulder FAQ

Question:

I'm wondering if you could explain something to me. I've been diagnosed with an unusual rotator cuff tear. Well, I guess it's not so unusual because of my age (77 years old). But the surgeon says it's torn all the way down to the bone. Surgery will be done to restore the footprint. What does the footprint refer to?

Answer:

The subscapularis muscle is one of the four muscles and tendons that surround the shoulder called the rotator cuff. Rotator cuff tears (RCTs) usually involve the infraspinatus or supraspinatus tendons. But surgeons are starting to see more subscapularis tears in active seniors. With today's new technology, scientists have also discovered a concept called the tendon footprint. This refers to the shape of the tendon as it inserts or connects with the bone. Shape, width, and size of the subscapularis tendon have been mapped now. The subscapularis footprint is shaped like the outline of the state of Nevada. It is trapezoidal with a wider area at the top. Knowing where the tear is located within the footprint helps direct treatment. Degenerative processes are more common in older adults. For example, stress on the footprint (place where the subscapularis inserts) from failure of other rotator cuff tendons is more likely as we age. Most people with a torn subscapularis tendon need surgery for a good result. The procedure can be done with an open incision or arthroscopically through several portals (small puncture holes). The surgeon may find the tear is impossible to repair. But usually, the tendon is sutured back in place. The natural footprint is restored as much as possible. Stephen S. Burkhart, and Eloy Ochoa, Jr. Subscapularis Tendon Tears: Diagnosis and Treatment Strategies. In Current Orthopaedic Practice. September/October 2008. Vol. 19. No. 5. Pp. 542-547.

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