Postoperative Rehabilitation Following Subscapularis Repair and Biceps Tenodesis in an Adolescent Overhead Athlete: A Resident's Case Report.

Background: The incidence of rotator cuff pathology in adolescent athletes is incredibly rare, consisting of only 1% of upper extremity injuries in those under the age of 20. Most rotator cuff injuries in this population are of the supraspinatus with few being of the subscapularis. The subscapularis aids with internal rotation and stabilization of the glenohumeral joint. Surgical management of these injuries in an adolescent athlete presents unique challenges due to periods of rapid growth in adolescence. Additional challenges exist in guiding post-operative physical therapy due to limited information on this injury. The purpose of this case report is to describe the surgical management and postoperative physical therapy of an adolescent, overhead athlete with a full thickness subscapularis tendon tear with concomitant long head of biceps tendon tear.

Case description: A 13-year-old, male overhead athlete with a complete subscapularis tendon tear and partial-thickness tendon tear of the long head of the biceps was treated surgically with open subscapularis tendon repair and bicep tenodesis. The subject completed 22 physical therapy sessions over 30 weeks including completion of a return-to-throwing program.

Outcomes: By the end of the course of treatment, the subject was able to return to sport and displayed clinically meaningful improvements in in range of motion and strength as well as patient reported outcome measures including the Pennsylvania Shoulder Score (PSS) and the QuickDASH.

Discussion: This case report emphasizes the uniqueness of an injury to the subscapularis tendon and long head of the biceps tendon tear in an adolescent overhead athlete along with the rarity of surgical intervention in this population. This case further outlines the success of surgical management following the use of a multi-phased rehabilitation program, allowing the athlete to safely return to sport.

Level of evidence: Level 5.