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Division of Subscapularis & Capsule


- Discussion:
    - w/ arm in external rotation, upper & lower borders of subscapularis can be visualized and palpated;
    - rotator cuff interval (soft spot) between supraspinatus & subscapularis is identified;
    - subscapularis tendon is tagged just shy of insertion;
    - subscapularis tendon and subajacent capsule are separated w/ cautery;
    - inferior dissection will encounter AHCA and axillary nerve;
    - greater exposure is obtained by dividing coracohumeral ligament which is located just medial to intra-articular Biceps tendon;
    - nerves to the rotator cuff muscles lie on their deep surface, & medial dissection on the deep muscles may jeopardize their nerve supply;
    - small (< 1 cm) defect is normally found in the capsule just below coracoid process, the articular opening of the subcoracoid recess;
         - labram may remain attached to capsular ligaments, or may remain on glenoid side of rupture;
         - this should not be confused with a Bankart Lesion