Subscapularis Avulsion in a 12-Year-Old Wrestler

Background: Traumatic rotator cuff injuries are infrequently encountered among pediatric patients. Literature describing isolated subscapularis injuries, specifically with an associated avulsion fracture of the lesser tuberosity, is limited to case reports, with most patients undergoing operative management. Indications: In this video submission, we present the case of a 12-year-old male patient who presented to the clinic with right shoulder pain following a traumatic injury during competitive wrestling. The patient's examination was notable for pain and weakness with testing of subscapularis function. Magnetic resonance imaging revealed an isolated right subscapularis injury with avulsion of the lesser tuberosity. There was maintained attachment of the superior aspect of the subscapularis insertion and integrity of the biceps sling, but the remainder of the lesser tuberosity apophysis was displaced. For these reasons, shoulder diagnostic arthroscopy and arthroscopic versus open subscapularis repair were pursued. Technique Description: The patient was placed in the standard beach-chair position. Diagnostic arthroscopy was performed, but there was limited visualization of the apophyseal avulsion, given that the superior border of the subscapularis tendon remained attached. Conversion to open repair via a standard deltopectoral approach was performed. A complete avulsion of the subscapularis tendon apophyseal complex distal to the biceps tendon was discovered. Two all-suture-based anchors were used to fixate the subscapularis avulsion to its native footprint. Postoperatively, the patient was made nonweightbearing in a sling and followed a standard rotator cuff repair protocol with gradual reestablishment of shoulder motion beginning at 6 weeks and initiation of rotator cuff strengthening at 3 months postoperatively. Results: There were no complications encountered throughout the procedure. The patient progressed with physical therapy, achieving full shoulder range of motion by 12 weeks. Strengthening was initiated at 3 months, and by the 6-month follow-up, the patient had returned to all sports, experiencing no pain or deficits in shoulder range of motion and strength. Discussion/Conclusion: This pediatric patient's subscapularis tear and lesser tuberosity avulsion fracture were successfully repaired via an open approach, resulting in an excellent outcome and a return to the previous level of sports activity. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.