Peter Attia· MD
if a guy just has a straight up supraspinatus tear you don't even need to enter the capsule necessarily depending on how close it is no you do because you want to first of all you want to see everything you want to make sure that you're not missing anything which is common in the athletes there's a couple of interesting variations I'm going to draw some pictures okay so um here I've drawn three sequential axillary views which are a bird's eye views looking straight down on the top of your shoulder if I were sitting on top looking straight down so we've got the glenoid the socket here toward the head and we've got the ball out here toward the outside where the deltoid lives and then you I've drawn the this is the supraspinatus I've drawn in here on the top in the back as we talked about before that's the infraspinatus and then in the front is the subscapularis so these are the things and those are the three the teres minor which is the fourth muscle the rotator cuff it's not really a relevant player in the pathology very true yeah it almost never tears okay um this is actually really a cool way to look at it it's not normal that we usually look at them from front and back but the bird's eye view is what allows you to see how the subscapularis and the infraspinatus are stabilizing the front and the back while the supraspinatus is coming in over the top yes yes is the supraspinatus that wide relatively speaking yeah it's pretty wide wow so maybe maybe more about here here it is uh let I drew it a little wide there okay but that's interesting again in an anatomic diagrams because you're looking at it from the front it looks like a tiny little muscle yes but it's broad it has three dimensionality and that's about three roughly three three and a half centimeters of width going to back wow okay great and so um there's three different views the most common one is the middle one and that's because that's anterior the biceps is here that's an anterior Superior tear that's the one that the overhead athletes get a lot non-throwing athletes but tennis players um volleyball players um and weight lifters and that is is one of the critical zones where it can get rung out and not have good blood supply and that's where they tear that's where I had my little tears