Coracohumeral Ligament Research Articles

The Association between the Magnetic Resonance Imaging Findings of Adhesive Capsulitis and Shoulder Muscle Fat Quantification Using a Multi-Echo Dixon Method.

ObjectiveTo investigate the association between the magnetic resonance imaging (MRI) findings of adhesive capsulitis and shoulder muscle fat percentages using a multi-echo Dixon method.Materials and MethodsTwenty-four patients with clinical diagnoses of adhesive capsulitis and either intact rotator cuffs or Ellman grade 1 partial tears as indicated by MRI scans were included. Two radiologists independently evaluated MRI scans of adhesive capsulitis as follows: presence or absence of axillary recess capsular and extracapsular hyperintensities; thickness of the coracohumeral ligament; thickness of abnormal rotator interval soft tissue; and thickness of glenoidal/humeral axillary recess capsules. Fat quantifications of the supraspinatus, infraspinatus, teres minor, subscapularis, teres major and posterior deltoid muscles were performed using multi-echo Dixon imaging at three locations. Inter-rater agreement was assessed. Differences in fat percentages were assessed and correlations between fat percentages and quantitative measurements were evaluated.ResultsThe fat percentage of the supraspinatus was significantly higher in patients with extracapsular hyperintensity (present, 3.00 ± 1.74%; absent, 1.81 ± 0.80%; p = 0.022). There were positive correlations between the fat percentage of the teres minor and the thicknesses of the abnormal rotator interval soft tissue (r = 0.494, p = 0.014) and the glenoidal axillary recess capsule (r = 0.475, p = 0.019). After controlling for the effects of age, sex and clinical stage, the relationship between the teres minor fat percentage and the thickness of the abnormal rotator interval soft tissue was statistically significant (r = 0.384, p = 0.048). Inter-rater agreement was almost perfect for fat quantification (intraclass correlation coefficients [ICC] > 0.9) and qualitative analyses (k = 0.824), but were variable for quantitative measurements (ICC, 0.170–0.606).ConclusionSeveral MRI findings of adhesive capsulitis were significantly related to higher fat percentages of shoulder muscles.

Arthroscopic Coracohumeral Ligament Release for Patients With Frozen Shoulder

Arthroscopic pancapsular release has been recommended for recalcitrant frozen shoulder, but regaining range of motion has not been sufficient compared with the unaffected side. There is no consensus about the reasons for these remaining restrictions in range of motion, but residual capsular or connective tissue must be considered a candidate. A thickened coracohumeral ligament at the rotator interval has been reported as one of the most specific manifestations of frozen shoulder. It covers wider portions of the subscapularis tendon, supraspinatus tendon, and infraspinatus tendon than previously reported. We describe an arthroscopic surgical technique for the release of the entire coracohumeral ligament including the subscapularis and supraspinatus portions and the release of the inferior and posterior parts of the glenohumeral ligament using the 7-o'clock portal. These procedures are essential and reliable methods to release the entire joint capsule to regain full range of motion for frozen shoulder.

Anatomical structure of the coracohumeral ligament and its effect on shoulder joint stability.

In this study, coracohumeral ligament (CHL) specimens were carefully dissected to observe its length, width, thickness and tension at different positions of the shoulder joint, thereby elucidating its effects on shoulder joint stability. Fresh frozen shoulder joints from 40 normal adult cadaveric specimens were dissected to reveal the CHL. With the shoulder joints placed at different positions, the length of the CHL and the width and thickness of the middle part of the ligament were measured. The changes in tension of the CHL were also observed. When the shoulder joint maintained the neutral position, the length of the CHL was 52.23 ± 1.02 mm and the width and thickness of the middle part of the ligament were 15.95 ± 0.59 mm and 1.46 ± 0.06 mm, respectively. When the shoulder joint moved from the neutral position to 90° external rotation, from the neutral position to 30° adduction or from the neutral position to 30° flexion/extension or when the shoulder joint is pulled down with a 5 kg weight, the CHL was elongated and thinned, maintaining a strained state. When the shoulder joint moved from the neutral position to 90° internal rotation, from the neutral position to 90° abduction or from the neutral position to 30° flexion/ extension, the CHL was shortened and thickened, maintaining a relaxed state. The CHL may limit the external rotation, adduction and downward movement of the shoulder joint and the process from the neutral position to the 30° flexion/extension, maintaining shoulder joint stability.

Development of the human shoulder joint during the embryonic and early fetal stages: anatomical considerations for clinical practice.

Although several studies have been published regarding the morphology and anatomical variations of the human shoulder joint, most have dealt with adult individuals. Those looking into the development of the joint have been focused on specific structures or have observed specimens in advanced gestational stages. The goal of this paper is to perform a complete analysis of the embryonic and early fetal development of the elements in the shoulder joint, and to clarify some contradictory data in the literature. In our study, serial sections of 32 human embryos (Carnegie stages 16-23) and 26 fetuses (9-13weeks) were analyzed. The chondrogenic anlagen of the humerus and the medial border of the scapula can be observed from as early as Carnegie stage 17, whereas that of the rest of the scapula appears at stage 18. The osteogenic process begins in week 10 for the humeral head and week 11 for the scapula. At stage 19 the interzone becomes apparent, which will form the glenohumeral joint. In the next stage the glenohumeral joint will begin delaminating and exhibiting a looser central band. Denser lateral bands will join the humeral head (caput humeri) and the margins of the articular surface of the scapula, thus forming the glenoid labrum, which can be fully appreciated by stage 22. In 24-mm embryos (stage 21) we can observe, for the first time, the long head of the biceps tendon (which is already inserted in the glenoid labrum by week 9), and the intertubercular sulcus, whose depth is apparent since week 12. Regarding ligamentous structures, the coracohumeral ligament is observed at the end of Carnegie stage 23, whereas the primitive glenohumeral ligament already appeared in week 10. The results of this study provide a detailed description of the morphogenesis, origin and chronological order of appearance of the main intrinsic structures of the human shoulder joint during late embryonic and early fetal development. We expect these results to help explain several functional aspects of the shoulder joint, and to clarify some contradictory data in the literature regarding this complex anatomical and biomechanical structure, helping future researchers in their efforts.

Early postoperative magnetic resonance imaging findings after arthroscopic rotator cuff repair: T2 hyperintensity of the capsule can predict reduced shoulder motion.

The purpose of this study was to investigate whether postoperative shoulder magnetic resonance imaging (MRI) findings correlate with postoperative shoulder range of motion (ROM) at about 4 months after arthroscopic rotator cuff repair (ARCR). Signal-intensity changes of the capsule, pericapsular soft tissue at the axillary recess, and subcoracoid fat triangle, as well as the thickness of the capsule at the axillary recess and coracohumeral ligament were assessed on preoperative and postoperative MR images of 232 patients. The ROM was evaluated preoperatively and at about 4 months after ARCR. T2 hyperintensity of the capsule, pericapsular soft tissue at the axillary recess, and signal change of the subcoracoid fat triangle were detected in 155, 107, and 89 cases, respectively, on postoperative MRI. Among these cases, 129, 98, and 69 cases, respectively, showed newly developed signal changes. The mean thicknesses of the capsule and coracohumeral ligament were 1.89 ± 0.69 and 1.64 ± 0.51mm, respectively, on preoperative MRI and 3.74 ± 1.12 and 2.42 ± 0.56mm, respectively, on postoperative MRI. At the 4-month follow-up, the mean external rotation (ER), internal rotation (IR), abduction, forward flexion, and extension were 77, 73, 76, 83, and 82%, respectively, of the contralateral side. Newly developed T2 hyperintensity of the capsule and pericapsular soft tissue at the axillary recess on postoperative MRI significantly correlated with the postoperative limitation of ER (p = 0.039) and IR (p = 0.020). Newly developed signal changes of the capsule, pericapsular soft tissue at the axillary recess, and subcoracoid fat triangle were often detected on postoperative MRI at 4 months after ARCR. Furthermore, newly developed T2 hyperintensity of the capsule and pericapsular soft tissue at the axillary recess correlated with limited ROM in ER and IR at 4 months after ARCR.

Shoulder Periarthritis and its Imaging Features in Patients with Type 1 Diabetes Mellitus

Aim: There is limited information on periarthritis/adhesive capsulitis of the shoulder (ACS) in patients with type-1-diabetes mellitus (T1D). We assessed the prevalence and characteristics of ACS in patients with type-1-diabetes mellitus. Methods: Consecutive 267 patients attending 'Diabetes of Young Clinic' were screened for ACS. Those with clinical features of ACS were further assessed by 'shoulder pain and disability index' (SPADI), radiograph and MRI of the shoulder. The average glycemic status (HbA1c) during preceding 2 years was assessed in patients with and without ACS. Controls were age and sex matched healthy subjects (1:1 ratio). Results: Sixteen of 267 patients (6.0%) with type-1-diabetes had clinical features of ACS, unlike none of the healthy controls (P < 0.001). Internal and external rotation of the shoulders was the most frequently restricted movements in ACS. Thickened coracohumeral ligament and axillary pouch obliteration was characteristic MRI feature, present in 80.0% in 73.3% cases, respectively. Though 14/16 type-1-diabetes patients with ACS were symptomatic, they never reported these complaints in diabetic clinic with the treating physicians. On regression analysis (odds ratio; 95% CI), duration of diabetes (1.1; 1.03-1.17, P < 0.01), retinopathy (3.6; 1.05-12.52, P = 0.04), and limited joint mobility (6.4; 1.88-21.95, P < 0.01) were independent predictors for presence of ACS in type-1-diabetes. The mean HbA1c and lipid levels were comparable in patients with or without ACS. Conclusions: Six percent of patients with type-1-diabetes had ACS, which can be detected on clinical screening and confirmed by imaging to help initiate early treatment.

Sonography in diagnosis of adhesive capsulitis of the shoulder: a case-control study.

Adhesive capsulitis (AC) of the shoulder has been a diagnosis of exclusion on sonography due to lack of specific diagnostic criteria. This study prospectively assesses the efficacy of sonography using multiple static and dynamic parameters for diagnosis of AC. Shoulder sonography was performed independently by two musculoskeletal radiologists on 90 subjects (60 symptomatic and 30 controls). All symptomatic subjects were subjected to an MRI. Based on clinical and MRI diagnosis, three groups were made: AC (n=30), painful shoulders (PS) (n=30), and control group (CL) (n=30). The sonographic parameters studied were: coracohumeral ligament (CHL) thickness, increased soft tissue in rotator interval (static parameters) and restriction of abduction and external rotation on dynamic scanning. These were compared within the three groups and the accuracy of each parameter in isolation and in combination for diagnosis of AC was calculated. Sonographic visualisation of CHL (96.7%) and its mean thickness (1.2mm) were highest in the AC group (p<0.01). A cut-off value of 0.7mm was found to be accurate (sensitivity 93.1%, specificity 94.4%) for diagnosing AC. Increased soft tissue in the rotator interval was seen in the AC group and had a high sensitivity of 86.2% and specificity of 92.8%. On dynamic scanning, restriction of external rotation was specific (sensitivity 86.2%, specificity 92.8%), whereas restriction in abduction was non-specific (specificity 6.7%). Inter-observer agreement was substantial for CHL visualisation (kappa 0.66). Overall, sonography, using multiple parameters, revealed a high sensitivity and specificity (100 and 87%, respectively) for diagnosis of AC of the shoulder. Sonography revealed a high accuracy for diagnosing AC of the shoulder and in differentiating it from other causes of painful shoulder. It, thus, has the potential to be adopted as a preferred imaging modality.

Do the Findings of Magnetic Resonance Imaging, Arthrography, and Ultrasonography Reflect Clinical Impairment in Patients With Idiopathic Adhesive Capsulitis of the Shoulder?

ObjectiveTo investigate the correlation between arthrography, magnetic resonance imaging (MRI), and ultrasonography (US) findings in patients with idiopathic adhesive capsulitis (IAC) of the shoulder and their clinical presentation as well as functional impairment. DesignCross-sectional observational study. SettingInstitutional practice. ParticipantsPatients (N=75) with a clinical diagnosis of unilateral IAC. InterventionsContrast-enhanced MRI, single-contrast arthrography, and US were performed in all patients. Main Outcome MeasuresThe thickness of the axillary recess, coracohumeral ligament (CHL), and enhanced portion in the rotator cuff interval was measured using MRI. Arthrography was used to calculate the total score of shoulder arthrographic criteria. US was used to measure the thickness of the inferior glenohumeral ligament (IGHL) and CHL, and the IGHL ratio and CHL ratio were calculated by comparing those of the unaffected side. ResultsNone of the MRI parameters was correlated with clinical assessment scores. The total score of shoulder arthrographic criteria was negatively correlated with passive range of motion of the total shoulder motion (P<.05), shoulder forward flexion (P<.05), and abduction (P<.05). The total Constant-Murley score was well correlated with the total score of shoulder arthrographic criteria (P<.05). The total shoulder joint space capacity was positively correlated with passive range of motion of the total shoulder motion (P<.05) and shoulder forward flexion (P<.05). The IGHL thickness, IGHL ratio, CHL thickness, and CHL ratio were negatively correlated with shoulder external rotation (P<.05). ConclusionsThe findings of arthrography and US in patients with IAC of the shoulder were correlated with clinical assessment scores, whereas all measuring parameters on MRI were not. US is recommended as the preferred option for diagnosing IAC of the shoulder because it is noninvasive, reflects the clinical features of IAC, and provides anatomical accuracy.

Does coracohumeral ligament (chl) release in concomitant with arthroscopic rotator cuff repair prevent postoperative stiffness? (a retrospective case control study)

Does coracohumeral ligament (chl) release in concomitant with arthroscopic rotator cuff repair prevent postoperative stiffness? (a retrospective case control study)

The Rotator Interval - A Link Between Anatomy and Ultrasound.

Shoulder pathologies of the rotator cuff of the shoulder are common in clinical practice. The focus of this pictorial essay is to discuss the anatomical details of the rotator interval of the shoulder, correlate the anatomy with normal ultrasound images and present selected pathologies. We focus on the imaging of the rotator interval that is actually the anterosuperior aspect of the glenohumeral joint capsule that is reinforced externally by the coracohumeral ligament, internally by the superior glenohumeral ligament and capsular fibers which blend together and insert medially and laterally to the bicipital groove. In this article we demonstrate the capability of high-resolution musculoskeletal ultrasound to visualize the detailed anatomy of the rotator interval. MSUS has a higher spatial resolution than other imaging techniques and the ability to examine these structures dynamically and to utilize the probe for precise anatomic localization of the patient's pain by sono-palpation.

Imaging of the coracoglenoid ligament: a third ligament in the rotator interval of the shoulder.

The coracoglenoid ligament (CGL) forms part of the anterosuperior capsuloligamentous complex of the shoulder. Although it has received attention in the anatomical literature, it has not been investigated on imaging. The purpose of this study is to determine the percentage value and the interobserver agreement of identification and classification of the CGL on MR and MR arthrography (MRA) imaging. Retrospectively, 280 MR and 150 MRA examinations were evaluated for detection of the CGL by two musculoskeletal radiologists. On the MRA examinations the CGL configuration in relation to the superior glenohumeral (SGHL) and coracohumeral ligament (CHL) was classified into five types. Additionally, the percentage of intra-articular appearance of the CGL and its mean thickness value were calculated. Finally, a possible correlation between pathological condition and anatomical type was evaluated on MRA. The CGL could be identified in 56%/54% of MRI and in 76%/77% of MRA examinations. On MRA, the CGL was detected as distinct structures in 37%/35% of cases and it appeared fused (partially or totally) with the SGHL and/or CHL in 39%/42%; it was absent in 12%/12% and it appears undistinguishable in the remaining cases. The interobserver agreement was excellent (κ=0.98 for detection on MRI; p=0.927 for classification of anterosuperior anatomy on MRA; κ=0.873 and 0.978 for identification on sagittal and axial external rotation MRA respectively; κ=0.943 for classification as intra- or extra-articular on MRA). The CGL can be reliably identified on MRI and MRA.

Non-contrast MRI diagnosis of adhesive capsulitis of the shoulder

PurposeTo investigate non-contrast MRI findings of clinical adhesive capsulitis. Methods31 non-contrast, non-arthrographic, shoulder MRIs were evaluated for coracohumeral ligament thickness, rotator interval infiltration, and axillary recess thickening/edema. ResultsIn detection of adhesive capsulitis, sensitivity is 76.7% and specificity is 53.3% for coracohumeral ligament thickening, sensitivity is 66.7% and specificity is 55.2% for coracohumeral ligament thickening and rotator interval infiltration, and sensitivity is 23.3% and specificity is 86.7% for coracohumeral ligament thickening, rotator interval infiltration, and axillary recess thickening/edema. ConclusionsAdhesive capsulitis can be accurately diagnosed on non-contrast MRI shoulder examinations with appropriate clinical criteria without direct MR arthrography.

A comparative study of the behaviors of normal and frozen shoulder: A finite element study

Frozen shoulder is a common condition characterized by a stiff shoulder. Thickening of an axillary pouch and a coracohumeral ligament, which are the passive stabilizers of the shoulder joint, is widely known as a manifestation of frozen shoulder. In this study, the effect of frozen shoulder on the shoulder behavior was investigated by using five finite element shoulder models. Finite element analysis was performed for the shoulder motions. The rotational angle, strain distribution, and the stress distribution were assessed relatively. The mean rotational angle was 54.9 ± 4.5° in external rotation, 35.9 ± 2.8° in internal rotation, 21.2 ± 6.0° in adduction, and 28.2 ± 2.1° in abduction. The resultant angle was decreased 4.1° in external rotation, 4.6° in internal rotation, 1.5° in adduction, and 2.3° in abduction from the normal shoulder to frozen shoulder respectively. The thickening of the AP had more effect on the rotational motions and abduction, on the other hand, the thickening of the CHL had more effect on adduction. The overall strain distribution was similar between the normal and frozen shoulder, however, the high-strain area and the strain value were reduced in frozen shoulder.

CT arthrography of adhesive capsulitis of the shoulder: Are MR signs applicable?

ObjectiveTo determine if diagnostic signs of adhesive capsulitis (AC) of the shoulder at Magnetic Resonance Imaging (MRI) and arthrography (MRA) are applicable to CT arthrography (CTA). Methods22 shoulder CTAs with AC were retrospectively reviewed for features described in MR literature. The control group was composed of 83 shoulder CTA divided into four subgroups 1) normal (N=20), 2) omarthrosis (N=19), 3) labral injury (N=23), and 4) rotator cuff tear (N=21). Two musculoskeletal radiologists assessed the rotator interval (RI) for obliteration, increased width and thickening of coracohumeral ligament (CHL). The width and capsule thickness of the axillary recess were measured. ResultsThe width of the axillary recess was significantly decreased in the AC group (4.6±2.6mm versus 9.9±4.6mm, p≤0.0001; sensitivity and specificity of 84% and 80%). Thickness of the medial and lateral walls of the axillary capsule was significantly increased in the AC group (5.9±1.3mm versus 3.7±1.1mm, p≤0.0001 and 5.7±1mm versus 3.5±1.3mm, p≤0.0001, respectively). CHL thickness was significantly increased in the AC group (4.1±1mm (p≤0.001)) in comparison to others groups. Obliteration of the RI was statistically significantly more frequent in patients with AC (72.7% (16/22) vs. 12% (10/83), p<0.0001). Width of the RI did not differ significantly between patients and controls (p≥0.428). ConclusionDecreased axillary width, and thickened axillary capsule are MR signs of AC applicable to CTA. Evaluation of rotator interval seems useful and reproducible only for obliteration.

Adhesive Capsulitis of the Shoulder

Adhesive capsulitis is the primary cause of loss of movement of the shoulder, other causes being trauma, rotator cuff dysfunction and arthritis. It consists of a restriction in the range of both passive and active movements of the shoulder; Has a prevalence of 2-5% of the population and is more common in diabetic patients (11-20%). Primary adhesive capsulitis is idiopathic, but there are theories involving endocrinological, immunological, inflammatory and biomechanical mechanisms; while the secondary is of known cause, either intrinsic or extrinsic (systemic). Clinically it is characterized by three phases: painful, adhesive and resolutive. Distinguishing adhesive capsulitis and impingement syndrome can clinically be difficult, as symptoms, in addition to the dysfunction of the muscles of the rotator cuff, in conjunction with rupture can lead to adhesive capsulitis, or coexist both entities overlap. Among the sonographic findings in adhesive capsulitis they are: hypervascularity and loss of echogenicity intervals rotator thickening coracohumeral ligament, sonographic evidence of movement restriction, fluid in the bicipital groove, fluid in the more lateral aspect of the subdeltoid bursa and integrity of the tendons of the rotator cuff muscles.

Adhesive Capsulitis of the Shoulder: Evaluation With US-Arthrography Using a Sonographic Contrast Agent

Adhesive capsulitis (AC) is a painful and disabling disorder, which caused restricted motion and chronic pain of shoulder. Intracavitary contrast-enhanced ultrasound has recently applied to assess obstructive bile duct diseases, tubal patency, vesicoureteric reflux and so on. The aim of this study was to detect the value of US-arthrography by injecting the contrast agent SonoVue into glenohumeral joint compared with US in diagnosing AC. Utrasound (US) and US-arthrography images of 45 patients with AC were compared with that of 45 control subjects without AC with MRI as a gold standard. Patients with AC had a significantly thickened coracohumeral ligament (CHL, 3.1mm) and inferior capsule (3.5 mm) on US, and a decreased volume of axillary recess (1.14 ml) on US-arthrography compared with the control subjects. Filling defect (91.1%) and synovitis-like abnormality (75.6%) in the joint on US-arthrography were more sensitive than that of rotator interval abnormality (71.1%), thickened CHL more than 3 mm (64.4%), thickened inferior capsule more than 3.5 mm (66.7%) on US respectively for diagnosis of AC. Consequently, US-arthrography was more effective method than US for assessment of AC. Filling defects of joint cavity and synovitis-like abnormality in the joint are characteristic US-arthrography findings for diagnosing AC.

Immediate Effects of Positional Stretching of Coracohumeral Ligament in Individuals with Adhesive Capsulitis

Immediate Effects of Positional Stretching of Coracohumeral Ligament in Individuals with Adhesive Capsulitis

Clinical evaluation of arthroscopic treatment of shoulder adhesive capsulitis

ObjectiveTo evaluate the results of arthroscopic releases performed in patients with adhesive capsulitis refractory to conservative treatment. MethodsThis was a retrospective study, conducted between 1996 and 2012, which included 56 shoulders (52 patients) that underwent surgery; 38 were female, and 28 had the dominant side affected. The mean age was 51 (29–73) years. The mean follow-up was 65 (12–168) months and the mean preoperative time was 8.9 (2–24) months. According to Zukermann's classification, 23 cases were considered primary and 33 secondary. With the patient in the lateral decubitus position, circumferential release of the joint capsule was performed: joint debridement; rotator interval opening; coracohumeral ligament release; anterior, posterior, inferior, and finally antero-inferior capsulotomy. A subscapularis tenotomy was performed when necessary. All patients underwent intense physical therapy in the immediate postoperative period. In 33 shoulders, an interscalene catheter was implanted for anesthetic infusion. Functional results were evaluated by the UCLA criteria. ResultsImproved range of motion was observed: mean increase of 45° of elevation, 41° of external rotation and eight vertebral levels of medial rotation. According to the UCLA score excellent results were obtained in 25 (45%) patients; good, in 24 (45%); fair, in two (3%); and poor, in two (7%). Patients who had undergone inferior capsulotomy achieved better results. Only 8.8% of patients who used the anesthetic infusion catheter underwent postoperative manipulation. Seven patients had complications. ConclusionThere was improvement in pain and range of motion. Inferior capsulotomy leads to better results. The use of the interscalene infusion catheter reduces the number of re-approaches.

Blood supply of the subacromial bursa and rotator cuff tendons on the bursal side.

Vascularity of the subacromial bursa and rotator cuff tendons is key factors in the pathogenesis of subacromial bursitis and impingement syndrome, rotator cuff tendinitis, and rotator cuff tears. The purpose of this study was to investigate and describe blood supply to the cranial and caudal parts of the subacromial bursa and the vascularity of the rotator cuff tendons on the bursal side. Fourteen fresh cadaveric shoulders from six females and eight males with a mean age of 71.7 (±10.8) years were studied. Before dissection, an arterial injection of 10% aqueous dispersion of latex was administered. Post-injection, the shoulders were fixed in an alcohol-formalin-glycerol solution. The cranial and caudal bursa of all specimens was mainly supplied by the thoracoacromial, suprascapular, and anterior and posterior circumflex humeral arteries. The cranial part of the bursa was supplied anteriorly by the thoracoacromial artery, and posteriorly and medially by the posterior circumflex humeral artery as far as the medial third. The caudal part received arterial blood anteriorly from the anterior circumflex humeral artery, and posteriorly and medially by the posterior circumflex humeral artery as far as the medial third of the caudal bursa. In addition, the suprascapular artery branched at the upper surface of the coracohumeral ligament, and the subcoracoid artery branched at the under surface of the same ligament. The subacromial bursa appears well vascularized. The results of the present investigation showed that blood supply to the subacromial bursa at the caudal part and rotator cuff tendons on the bursal side was linked to the same arteries. The subcoracoid artery supplied interval rotator structures close to the caudal bursa. It is the wish of the authors that this meticulous anatomical work will help surgeons in their day-to-day clinical work, e.g. to minimize the risk of complications such as perioperative bleeding.

Correlations of coracohumeral ligament and range of motion restriction in patients with recurrent anterior glenohumeral instability evaluated by magnetic resonance arthrography

Evaluation of range of motion (ROM) restriction before treatment of shoulder disorders is important for predicting the final functional outcomes. The purpose of this study was to investigate correlations of thickness of the coracohumeral ligament (CHL) and ROM restriction in patients with recurrent anterior glenohumeral instability. Between January 2005 and March 2015, 181 shoulders (137 male and 44 female patients; mean age, 29.3 years) with recurrent anterior glenohumeral instability treated with an arthroscopic Bankart repair were enrolled in this study. We evaluated preoperative ROM, thickness of the CHL, and obliteration of the subcoracoid fat triangle on magnetic resonance arthrography. ROM measurements, including forward flexion (FF), external rotation with the arm at the side (ER), and hand behind the back (HBB), were made in a standing position. There were significant negative correlations between FF and age (P < .001) and between HBB and age (P < .001) but not between ER and age (P = .11). The thickness of the CHL significantly increased with age (P < .001). FF, ER, and HBB were significantly restricted in patients with obliteration compared with those without obliteration (P < .001, P = .004, P < .001, respectively). Obliteration of the subcoracoid fat triangle and the thickness of the CHL positively correlated with ROM restrictions, and these changes were greater with age in patients with recurrent anterior glenohumeral instability.