History: 65-year-old lady with fall on outstretched hand… developed an avulsion fracture of the subscapularis tendon.
Treatment: A rare instance when such a large piece of bone was avulsed with the tendon. The subscapularis is attached to the lesser tuberosity and is an internal rotator of the shoulder and part of the four muscle group forming the rotator cuff. A tear in the subscap has to be repaired or else it will alter the force coupling of the shoulder… causing derangement of the shoulder.
In this case, as the fragment was large and rotated, an arthroscopic fixation would not have yielded a good result even in best of hands. Hence an open fixation with double row suture anchors was performed.