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Isolated Subscapularis Tear during Sparring in a Professional Boxer: A Case Report
Korean J Sports Med 2023;41:169-172
Published online September 1, 2023;  https://doi.org/10.5763/kjsm.2023.41.3.169
© 2023 The Korean Society of Sports Medicine.

Jun Bum Kim1, Sang Hun Lee2, Chang Hyun Kim1, Woo Jong Kim1

1Department of Orthopedic Surgery, Soonchunhyang University Cheonan Hospital, Cheonan, 2Department of Orthopedic Surgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
Correspondence to: Woo Jong Kim
Department of Orthopedic Surgery, Soonchunhyang University Cheonan Hospital, 31 Suncheonhyang 6-gil, Dongam-gu, Cheonan 31151, Korea
Tel: +82-41-570-2170, Fax: +82-41-570-7234
E-mail: 89489@schmc.ac.kr
Received July 10, 2023; Revised August 2, 2023; Accepted August 15, 2023.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
 Abstract
The subscapularis tendon is the largest and most powerful muscle in the rotator cuff, playing a more important role in raising the arm than the supraspinatus or infraspinatus tendon. Subscapularis tendon tears are uncommon, but when it does occur, symptoms are often minimal and diagnosis can be delayed until severe atrophy occurs, leading to weakness of the shoulder muscles. Therefore, early diagnosis and surgical repair of suspected subscapularis tendon injury in athletes is very important for achieving the best functional outcome. Shoulder injuries in professional boxers have been reported to account for only about 3% of all boxing injuries, but there is no specific research on the specific location of these injuries. In this study, the authors report on a case of isolated subscapularis tendon injury that occurred during sparring in a professional boxer and discuss the mechanism of injury and treatment outcomes along with a review of the literature.
Keywords : Subscapularis, Boxing
꽌 濡

뿭궗쟻쑝濡 寃ш컩븯洹쇱쓽 넀긽 썑긽諛 쉶쟾洹쇨컻 뙆뿴蹂대떎 뜙 二쇰ぉ諛쏆븘 솕쑝硫 씪遺 븰옄뱾 寃ш컩븯洹쇱쓣 寃ш젅쓽 쐄orgotten tendon 삉뒗 쐆idden lesion앹씠씪怨 移븯湲곕룄 뻽떎. 寃ш컩븯洹 뙆뿴쓽 쑀蹂묐쪧 떎瑜 쉶쟾洹쇨컻 뙆뿴쓣 룞諛섑븳 寃쎌슦 30%뿉꽌 50%濡 蹂닿퀬릺吏留1 떒룆 뙆뿴 5% 씠궡濡 쓷븯吏 븡 寃껋쑝濡 븣젮졇 엳떎2. 寃ш컩븯洹쇱 떎瑜 썑긽諛 쉶쟾洹쇨컻 빐遺븰쟻 李⑥씠媛 엳뒗뜲, 뙆뿴 떆 쟾삎쟻씤 쉶쟾洹쇨컻 뙆뿴쓽 利앹긽씠 굹굹吏 븡怨 씠몢洹 怨좊옉 쐞濡 遺李⑸릺뼱 쟾痢 뙆뿴씠 릺뜑씪룄 寃ъ씤씠 嫄곗쓽 뾾뒗 寃쎌슦媛 엳뼱 떖媛곹븳 닔異뺤씠 諛쒖깮븷 븣源뚯 吏꾨떒씠 吏뿰맆 닔 엳떎.

寃ш컩븯洹쇱 쉶쟾洹쇨컻뿉꽌 媛옣 겕怨 媛뺣젰븳 洹쇱쑁쑝濡, 洹뱀긽洹쇱씠굹 洹뱁븯洹쇰낫떎 뙏쓣 삱由щ뒗 뜲 뜑 以묒슂븳 뿭븷쓣 븳떎. 뵲씪꽌 넀긽맂 寃ш컩븯洹쇱쓽 닔蹂듭 뼱源 洹쇱쑁쓽 빐遺븰쟻 援ъ“瑜 蹂듭썝븯怨 媛뒫븳 理쒖긽쓽 湲곕뒫쟻 寃곌낵瑜 뼸湲 쐞빐 슫룞 꽑닔뿉寃 留ㅼ슦 以묒슂븯떎.

봽濡쒗럹뀛꼸 沅뚰닾 꽑닔뿉꽌 諛쒖깮븳 뼱源 넀긽 쟾泥 boxing injury쓽 3% 젙룄留 李⑥븯뒗 寃껋쑝濡 蹂닿퀬릺굹 援ъ껜쟻씤 遺쐞뿉 븳 議곗궗뒗 븘吏 뾾뒗 떎젙씠떎3. 옄뱾 븳 봽濡쒗럹뀛꼸 沅뚰닾 꽑닔뿉꽌 뒪뙆留 룄以 諛쒖깮븳 寃ш컩븯洹쇱쓽 떒룆 넀긽뿉 븯뿬 諛쒖깮쓽 硫붿빱땲利섏쓣 븣븘蹂닿퀬 移섎즺 寃곌낵瑜 臾명뿄 怨좎같怨 븿猿 蹂닿퀬븯怨좎옄 븳떎.

利 濡

蹂 利앸 蹂닿퀬뒗 닚泥쒗뼢븰援 泥쒖븞蹂묒썝 쓽븰뿰援ъ쑄由ъ떖쓽쐞썝쉶쓽 떖쓽瑜 넻怨쇳븯쑝硫(No. 2023-02-011), 엫긽궗吏꾩쓣 룷븿븳 蹂 蹂닿퀬쓽 異쒗뙋뿉 빐 솚옄쓽 꽌硫 룞쓽瑜 諛쏆븯떎.

16뀈쓽 봽濡쒗럹뀛꼸 沅뚰닾 寃쎈젰쓣 媛吏 42꽭 궓옄 솚옄媛 5媛쒖썡 쟾 沅뚰닾 뒪뙆留 以 닔긽븯뿬 諛쒖깮븳 醫뚯륫 뼱源 넻利앹쓣 二쇱냼濡 궡썝븯떎. 삤瑜몄넀옟씠 꽑닔(orthodox)씤 洹몃뒗 醫뚯륫 由щ뱶 濡 썒(lead long hook) 룞옉쓣 븯뜕 以 媛묒옉뒪읇寃 뼱源 븵履쎌뿉 李뼱吏뒗 벏븳 넻利앹쓣 뒓瑗덈떎怨 湲곗뼲뻽떎. 怨쇨굅젰긽 듅씠 궗빆씠굹 닔긽 쟾 뼱源 넻利앹쓣 씪쑝궗 留뚰븳 蹂묐젰 궗빆 뾾뿀떎. 닔긽 吏곹썑 뼱源⑥쓽 슫룞 젣븳씠 엳뿀怨 듅엳 뼱源⑥쓽 궡쉶쟾 떆 넻利앹씠 떖븯떎怨 븯떎. 궡썝 떆 吏꾩같 寃궗뿉꽌 뿰遺議곗쭅 遺醫낆씠굹 硫띿 뾾뿀怨 醫뚯륫 뼱源 쟾諛⑹쑝濡 쟾諛섏쟻씤 븬넻쓣 蹂댁떎. 뒫룞 諛 닔룞쟻 愿젅 媛룞踰붿쐞(range of motion)쓽 젣븳 諛 닔룞쟻 쇅쉶쟾 踰붿쐞쓽 利앷뒗 뾾뿀쑝굹, 愿젅슫룞 떆 寃ш컩븯洹 遺李 遺쐞쓽 넻利앹쓣 샇냼븯떎. Lift-off test, bear hug test뿉꽌 뼇꽦 냼寃, belly-press test뿉꽌뒗 쓬꽦 냼寃ъ쓣 蹂댁떎. 젙긽씤 슦痢↔낵 鍮꾧탳빐꽌 궡쉶쟾 떆 洹쇰젰 빟솕릺뼱 엳뿀쑝굹 쇅쉶쟾 떆 洹쇰젰 젙긽씠뿀떎. 닔닠 쟾 떆媛곸쟻 긽궗 泥숇룄(visual analogue scale, VAS)뒗 7젏씠뿀怨, Constant-Murley shoulder score뒗 65젏, American Shoulder and Elbow Surgeons (ASES) score뒗 43젏씠뿀떎. 떒닚 쁺긽寃궗뿉꽌 씠긽 냼寃ъ 뾾뿀떎. 蹂몄썝뿉꽌 떆뻾븳 옄湲곌났紐낆쁺긽(magnetic resonance imaging, MRI)뿉꽌 Lafosse classification 3쓽 닚닔븳 쇅긽꽦 寃ш컩븯洹쇱쓽 쟾痢 뙆뿴 냼寃ъ쓣 蹂댁怨 떎瑜 쉶쟾洹쇨컻 諛 씠몢옣洹, 씠몢옣洹 솢李(pulley)쓽 씠긽 냼寃ъ 蹂댁씠吏 븡븯떎(Fig. 1).

Fig. 1. Axial (A) and sagittal (B) cuts of T2-weighted magnetic resonance imaging of the left shoulder demonstrating full-thickness tear of the subscapularis tendon (arrows).

寃ш컩븯洹 쟾痢 뙆뿴 냼寃ъ뿉 븯뿬 痢≪쐞 옄꽭濡 愿젅긽셿愿젅(glenohumeral joint) 궡뿉꽌 in box technique쑝濡 遊됲빀 굹궗紐살쓣 씠슜븯뿬 愿젅寃쎌쟻 遊됲빀닠쓣 떆뻾븯떎. 쟾諛, 썑諛, 쟾쇅痢 3媛쒖쓽 궫엯援щ 씠슜븯뿬 닔닠쓣 떆뻾뻽怨, 썑諛 궫엯援щ 넻븯뿬 愿젅긽셿愿젅쓣 솗씤븯쓣 븣 씠몢옣洹쇱 씠긽씠 뾾뿀쑝굹 寃ш컩븯洹쇱씠 쟾痢 뙆뿴릺뼱 븯遺 洹쇱쑁痢듭뿉 쐞異뺤씠 삩 냼寃ъ씠 솗씤릺뿀떎. 떎瑜 愿젅 궡 援ъ“臾쇱쓽 씠긽 諛쒓껄릺吏 븡븯떎. 냼寃곗젅쓽 寃ш컩븯洹 遺李⑸쐞瑜 뵾吏 諛뺣━(decortication) 씠썑 씉닔꽦 遊됲빀 굹궗紐 2.9-mm JuggerKnot soft anchor (Biomet Sports Medicine) 1媛쒖 4.5-mm Healix suture anchor (DePuy Synthes) 1媛쒕 냼寃곗젅뿉 궫엯븯뿬 씪뿴 遊됲빀닠(single row technique)쓣 떆뻾븯떎(Fig. 2). 닔닠 以 寃ш컩븯洹쇱뿉 tension씠 븘二 떖븯吏뒗 븡븯怨 鍮꾧탳쟻 옒 떦寃⑥꽌 遊됲빀븷 닔 엳뿀떎. 닔닠 썑 4二쇨컙 30° 쇅쟾 蹂댁“湲곕 쑀吏븯硫 뙏轅덉튂 슫룞怨 吏꾩옄 슫룞쓣 젣쇅븳 슫룞 젣븳쓣 떆뻾븯떎. 닔닠 4二 썑遺꽣 닔룞 愿젅슫룞쓣 꽌꽌엳 떆옉븯뿬 6二쇱㎏遺꽣뒗 뒫룞 愿젅슫룞 諛 洹쇰젰슫룞쓣 떆뻾븯怨, 沅뚰닾뒗 썒 룞옉쓣 젣쇅븳 굹癒몄 슫룞쓣 떆옉븯떎. 닔닠 3떖 썑 諛섎痢↔낵 鍮꾧탳븯뿬 grade 5 룞씪븳 닔以쓽 젙긽 洹쇰젰쓣 쉶蹂듯븯怨 愿젅 媛룞踰붿쐞 젣븳 뾾씠 援닿끝 180°, 쇅쟾 180°, 쇅쉶쟾 60°, 궡쉶쟾 T7쓽 쟾 媛룞 踰붿쐞쓽 愿젅슫룞씠 媛뒫븯뿬 썒 룞옉룄 씠쟾 닔以쑝濡 媛뒫븯떎. 닔닠 6떖吏 珥덉쓬뙆 異붿떆 쁺긽 寃궗뿉꽌 寃ш컩븯洹 遊됲빀 遺쐞뒗 쑀빀맂 냼寃ъ쓣 蹂댁떎(Fig. 3). 솚옄뒗 씪긽 깮솢 諛 슫룞뿉 엳뼱꽌 넻利 삉뒗 遺덊렪媛먯쓣 샇냼븯吏 븡븯쑝硫 VAS뒗 0젏, Constant-Murley shoulder score뒗 99젏, ASES score뒗 95젏쑝濡 솗씤릺뿀떎.

Fig. 2. (A) Full-thickness tear of the subscapularis tendon (arrow) from the posterior portal with the patient in the lateral decubitus position. (B) Repaired subscapularis tendon using two suture anchors.

Fig. 3. Postoperative ultrasonographic imaging at 6 months showing an intact subscapularis tendon repair (arrow).
怨 李

1835뀈 Smith媛 cadaver뿉꽌 泥섏쓬 諛쒓껄븯뿬 蹂닿퀬븳 씠옒 뿬윭 臾명뿄뿉꽌 寃ш컩븯洹 넀긽쓣 諛쒗몴븯쑝굹 씠뒗 二쇰줈 꽦옣뙋씠 洹쇨굔 議곗쭅蹂대떎 빟븳 怨④꺽쟻쑝濡 誘몄꽦닕븳 泥냼뀈뿉꽌 냼寃곗젅쓽 寃ъ뿴 怨⑥젅怨 룞諛섎릺嫄곕굹 寃ш젅쓽 쟾諛 깉援ъ 뿰愿릺뼱 諛쒖깮뻽떎뒗 蹂닿퀬怨, 寃ъ뿴 怨⑥젅 諛 깉援ъ 뿰愿 뾾뒗 떒룆 넀긽 뱶臾쇱뿀떎4,5. 젇 솚옄뱾뿉꽌 寃ш컩븯洹쇱쓽 넀긽 二쇰줈 媛뺤젣쟻씤 쇅쉶쟾(forced external rotation) 諛 怨쇱떊쟾(hyperextension)쓣 룞諛섑븳 쇅긽怨 愿젴븯뿬 諛쒖깮븯怨, 40꽭 씠긽쓽 슫룞 꽑닔뿉꽌뒗 湲곗〈쓽 눜뻾꽦 蹂솕 삉뒗 遺遺 뙆뿴씠 엳뒗 긽깭뿉꽌 鍮꾧탳쟻 쟻 뿉꼫吏쓽 쇅긽뿉룄 뙆뿴맆 닔 엳떎6. 沅뚰닾 꽑닔뱾뿉꽌 뼱源 넀긽 봽濡쒗럹뀛꼸(4%)蹂대떎 븘留덉텛뼱(9%)뿉꽌 몢 諛 씠긽 넂寃 諛쒖깮븯硫7, 쁽옱源뚯 沅뚰닾 꽑닔뱾뿉꽌 寃ш컩븯洹 뙆뿴 꽦씤씠 븘땶 泥냼뀈湲 沅뚰닾 꽑닔뱾뿉 援븳릺뼱 蹂닿퀬릺뿀떎. Polousky Harms8뒗 14꽭 沅뚰닾 꽑닔뿉꽌 諛쒖깮븳 寃ш컩븯洹 떒룆 뙆뿴쓣 open deltopectoral approach瑜 넻븯뿬 닔닠븯怨, Park 벑9 13꽭 沅뚰닾 꽑닔뿉꽌 諛쒖깮븳 寃ш컩븯洹 寃ъ뿴 怨⑥젅쓣 愿젅寃쎌쟻 닔닠濡 移섎즺븯뿬 슦닔븳 엫긽쟻 寃곌낵瑜 뼸뿀떎怨 蹂닿퀬븯떎.

沅뚰닾뿉꽌 썒 룞옉 源껋뿉 뙏쓣 쐶몢瑜 븣 紐몄쓽 以묒떖怨 벑쓣 쉶쟾떆궓 썑 諛섎룞怨 븿猿 뙏轅덉튂瑜 90° 씠긽 援쏀 닔룊쟻쑝濡 긽諛⑹쓣 媛寃⑺븯뒗 湲곗닠濡, 二쇰줈 긽諛⑹쓽 꽦쓣 끂由ъ留 紐몄쓣 留욎텛湲 쐞빐꽌룄 궗슜븳떎. 썒쓽 湲곗닠 以 뿬윭 媛吏 蹂삎씠 엳吏留 洹몄쨷 由щ뱶 濡 썒 嫄곕━쓽 李⑥씠媛 엳뒗 긽뿉寃 由щ뱶 移섎 媛寃⑺븯湲 쐞빐 겙 룄빟怨 븿猿 뼱源⑤ 떊쟾븯硫댁꽌 쇅쉶쟾 긽깭뿉꽌 궡쉶쟾쑝濡 룞옉 蹂솚쓣 븯寃 릺뒗뜲, 씠踰 利앸쓽 寃쎌슦 씠 룞옉 떆 寃ш컩븯洹쇱씠 媛뺥븯寃 닔異뺥븯硫댁꽌 뙆뿴맂 寃껋쑝濡 깮媛곷맂떎(Fig. 4).

Fig. 4. (A, B) The anteroposterior and lateral movements prior performing the lead long hook. (C) The movements after performing the lead long hook. (D) A tear of the subscapularis tendon (arrowhead) may occur between these movements.

寃ш컩븯洹쇱 쉶쟾洹쇨컻 옒쓽 53%瑜 李⑥븯뒗 媛옣 겕怨 媛뺣젰븳 洹쇱쑁씠硫 궡쉶쟾洹쇱쑝濡 옉슜븯怨 愿젅긽愿젅쓽 쟾諛 븞젙솕뿉 以묒슂븳 뿭븷쓣 븳떎. 삉븳 씠몢옣洹쇱쓽 븞젙꽦뿉룄 以묒슂븳 뿭븷쓣 븯誘濡10, 寃ш컩븯洹 넀긽 떆 씠몢옣洹쇱쓽 궡痢 븘깉援ш 諛쒖깮븷 닔 엳怨 씠뒗 寃ш컩븯洹 뙆뿴쓽 듅吏뺤쟻 吏뺥썑 以 븯굹씠떎.

吏꾩같 寃궗뿉꽌 솚옄뱾 쟾삎쟻쑝濡 寃ш젅 쟾諛⑹쓽 넻利앹쓣 샇냼븯硫 냼寃곗젅 遺쐞瑜 珥됱쭊뻽쓣 븣 븬넻쓣 샇냼븷 닔 엳떎. 삉븳, 닔룞쟻 쇅쉶쟾쓽 愿젅 媛룞踰붿쐞媛 利앷븯怨 lift-off, belly-press, bear hug test뿉꽌 뼇꽦 냼寃ъ쓣 蹂댁씤떎. Bear hug test뒗 寃ш컩븯洹쇱쓽 긽遺 1/3쓣 룊媛븷 닔 엳怨 옉 뙆뿴뿉꽌룄 뼇꽦쓣 蹂댁씪 닔 엳뼱 媛옣 誘쇨컧븳 寃궗濡 븣젮졇 엳떎.

寃ш컩븯洹쇱쓽 遺遺 뙆뿴씠 諛쒖깮뻽쓣 寃쎌슦 닔닠쟻쑝濡 移섎즺븷吏 蹂댁〈쟻쑝濡 移섎즺븷吏뿉 빐꽌뒗 븘吏 끉씠 엳吏留, 遺遺 뙆뿴쓣 諛⑹튂븯硫 쟾痢 뙆뿴濡 吏꾪뻾븯怨 洹 吏꾨떒 떆湲곌 鍮좊쇱닔濡 닔닠쟻 移섎즺뿉 諛섏쓳씠 醫뗫떎怨 蹂닿퀬릺怨 엳쑝誘濡 議곌린 吏꾨떒씠 以묒슂븯硫 듅엳 슫룞 꽑닔뿉寃뚮뒗 닔닠쟻 移섎즺媛 꽑샇맂떎. 삉븳 썝씤뿉 뵲씪꽌 쇅긽꽦 삉뒗 鍮꾩쇅긽꽦쑝濡 遺꾨쪟븷 닔 엳뒗뜲 쇅긽꽦 뙆뿴 닔닠쟻 移섎즺뿉, 鍮꾩쇅긽꽦 뙆뿴 蹂댁〈쟻씤 移섎즺뿉 뜑 옒 諛섏쓳븳떎怨 븣젮졇 엳怨, 理쒓렐 臾명뿄 蹂닿퀬뿉 뵲瑜대㈃ 愿젅寃쎌쟻 닔닠 諛 open surgery 紐⑤몢 醫뗭 寃곌낵瑜 蹂닿퀬븯怨 엳떎5.

옄뱾 臾명뿄쑝濡 蹂닿퀬맂 諛 뾾뒗, 젇 沅뚰닾 꽑닔뿉꽌 諛쒖깮븳 寃ш컩븯洹쇱쓽 떒룆 뙆뿴쓣 寃쏀뿕븯떎. 寃ш컩븯洹쇱쓽 떒룆 뙆뿴 뱶臾쇨린 븣臾몄뿉 쓽떖븯吏 븡쑝硫 吏꾨떒씠 뼱졄怨, 닔닠씠 뒭뼱吏 寃쎌슦 뙆뿴씠 吏꾪뻾릺뼱 닔닠 寃곌낵뿉 쁺뼢쓣 겮移 닔 엳떎. 뵲씪꽌 沅뚰닾 꽑닔뿉寃 뼱源 넻利앹씠 諛쒖깮븳 寃쎌슦 理쒓렐쓽 슫룞 諛 솢룞젰, 닔긽 硫붿빱땲利섍낵 떊泥 寃吏꾩쓣 떆뻾븯怨, 쉶쟾洹쇨컻 넀긽씠 쓽떖맂떎硫 MRI 寃궗瑜 넻빐 蹂묐쓣 솗씤븯뒗 寃껋씠 젙솗븳 吏꾨떒怨 移섎즺뿉 룄씠 맆 寃껋쑝濡 깮媛곹븳떎.

Conflict of Interest

No potential conflict of interest relevant to this article was reported.

Author Contributions

Conceptualization, Methodology, Project administration, Visualization: WJK, SHL. Data curation, Formal analysis: WJK, CHK. Writing뱋riginal draft: SHL. Writing뱑eview & editing: WJK, JBK.

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