title: INTEGRITY OF THE SUBSCAPULARIS TENDON AFTER OPEN SURGERY FOR THE TREATMENT OF ANTERIOR SHOULDER INSTABILITY: A CLINICAL AND RADIOLOGICAL EVALUATION.
abstract: OBJECTIVE
  To evaluate the integrity of the subscapularis tendon by strength, function and magnetic resonance imaging after deltopectoralis access for anterior shoulder instability.
  
  
  METHODS
  20 patients with anterior shoulder instability have been evaluated. Minimum follow-up was 12 months, with a mean of 40 months. Only male patients were included, with a mean of age of 29 years (20 - 42 years). The patients have been submitted to physical examinations of mobility, muscular strength, Belly Test and Gerber Test. The isokinetic strength in internal and external rotation, in angular speeds of 60(0)/s and 180(0)/s, for both shoulders was measured using a dynamometer. In 15 patients magnetic resonance imaging (MRI) was carried out on both shoulders for evaluating the thickness, cross-sectional area and atrophy of the subscapularis muscle.
  
  
  RESULTS
  A significant difference was found between torque peaks at the speed of 60(0)/s for internal (p=0.036) and external (p=0.008) rotation. However, at 180(0)/s the opposite happens (internal rotation: p=0.133; external rotation: p=0.393). Subscapularis muscle thickness and area are significantly smaller than the normal side, with a deficit of 19% and 23%, respectively. According to Rowe and UCLA scores, we find excellent and good results for the majority of patients, with a mean of 88 and 31.6 points, respectively.
  
  
  CONCLUSIONS
  Despite of the good functional results, open surgery can limit strength and reduce the thickness and the cross-sectional area of subscapularis muscle. However, the best results were found in the patients who had the dominant side operated.
authors.affiliation: Post-graduate Student, School of Medicine, Universidade de São Paulo (USP), Ribeirão Preto, SP, Brazil.
authors.forename: Osvandré
authors.initials: O
authors.lastname: Lech
authors.affiliation: Professor, Department of Biomechanics, Medicine and Rehabilitation of the Locomotor Apparatus, School of Medicine, Universidade de São Paulo (USP), Ribeirão Preto, SP, Brazil.
authors.forename: Paulo
authors.initials: P
authors.lastname: Piluski
authors.affiliation: Professor, Department of Internal Medicine, School of Medicine, Universidade de São Paulo (USP), Ribeirão Preto, SP, Brazil.
authors.forename: Renato
authors.initials: R
authors.lastname: Tambani
authors.affiliation: Professor, Department of Internal Medicine, School of Medicine, Universidade de São Paulo (USP), Ribeirão Preto, SP, Brazil.
authors.forename: Nero
authors.initials: N
authors.lastname: Castro
authors.affiliation: Post-graduate Student, School of Medicine, Universidade de São Paulo (USP), Ribeirão Preto, SP, Brazil.
authors.forename: Gilnei
authors.initials: G
authors.lastname: Pimentel
keywords: Anterior shoulder instability; Magnetic resonance imaging; Subscapularis