This patient is a 14 year-old boy who injured his shoulder during a football tackle where his arm was forced into abduction. He was initially advised to rest and let the injury heal by itself, but after several weeks he still had pain and weakness when moving the shoulder. He particularly had pain putting his arm behind his back and great weakness when trying to return to football and making a tackle. An MRI scan revealed an uncommon injury; the subscapularis muscle (the rotator cuff muscle at the front of the shoulder) had torn from the humerus, taking a fragment of bone with it. The image above shows a horizontal slice through the shoulder, with the subscapularis muscle tendon (yellow arrow) retracted from its normal attachment to the shoulder bone (red arrow).

In young and active patients with injuries like this, surgery often provides the quickest and most definitive path to full functionality of the shoulder.

The operation began with an arthroscopic assessment of the shoulder, which involves keyhole incisions and a small camera to view the inside of the joint. The fragment of bone that had been torn from the humerus can be seen in this image.

Next, the injury was exposed through an incision at the front of the shoulder and strong sutures were passed through the bone fragment and the subscapularis tendon. The bony fragment and the subscapularis tendon were completely detached from the front of the shoulder, and could be moved back and forth freely (as seen in the images below).

The sutures were then secured to the humerus so that the bone fragment and subscapularis muscle were held tightly back in their normal position. This allows the bone to heal and the subscapularis muscle to perform its normal function.

After several weeks in a sling the patient began a gradual return to full activity. Once the bone has healed fully, he will be able to play sport again and use his shoulder without pain.