title: Subscapularis tears and lesser tuberosity avulsion fractures in the pediatric patient.
abstract: BACKGROUND
  Pediatric subscapularis tears are known to be rare injuries. They are often associated with an avulsion fragment of the lesser tuberosity leading to dual description in the literature of either subscapularis tear or lesser tuberosity avulsion. Historically, they were managed nonoperatively; however, outcomes have improved with operative management. Nonoperative management often led to bony overgrowth at the lesser tuberosity that limited motion. The literature is limited to case reports and a few small case series, often not restricted to pediatric patients.
  
  
  METHODS
  Case series.
  
  
  METHODS
  Level 5.
  
  
  METHODS
  Radiographic and operative databases were retrospectively reviewed to identify pediatric patients with subscapularis tears or lesser tuberosity avulsions in the past 10 years.
  
  
  RESULTS
  Five cases of pediatric subscapularis tears were identified that underwent operative management. Of the 5 cases, 4 had delayed presentation. In 1 case, the lesser tuberosity fragment was initially missed on radiographic imaging. All patients underwent operative management.
  
  
  CONCLUSIONS
  These cases add to the body of knowledge of a rare pediatric injury that is commonly missed or diagnosis delayed. The importance of suspicion in the adolescent male patient without instability and unrelenting shoulder pain is stressed. Additionally, the importance of early magnetic resonance imaging with suspicion as well as an axillary view of the shoulder is demonstrated. As with all rare entities, it is important to disseminate information on natural history and interventions for this injury.
authors.affiliation: Hospital for Special Surgery, New York, New York.
authors.forename: Lauren E
authors.initials: LE
authors.lastname: LaMont
authors.affiliation: Hospital for Special Surgery, New York, New York.
authors.forename: Daniel W
authors.initials: DW
authors.lastname: Green
authors.affiliation: Hospital for Special Surgery, New York, New York.
authors.forename: David W
authors.initials: DW
authors.lastname: Altchek
authors.affiliation: Hospital for Special Surgery, New York, New York.
authors.forename: Russell F
authors.initials: RF
authors.lastname: Warren
authors.affiliation: Hospital for Special Surgery, New York, New York.
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Wickiewicz
keywords: imaging; pediatric sports medicine; radiology; rotator cuff; shoulder; sports trauma