Superior Glenohumeral Ligament Research Articles

Sonographically-navigated frozen shoulder release (S-FSR): A modified technique for sonographically-navigated, in-office hydrodilatation of adhesive capsulitis

We describe a new technique for hydrodilatation of the frozen shoulder, which we coined ‘Sonographically-Navigated Frozen Shoulder Release (S-FSR)’ or ‘Dr Gonzalez's technique.’ Traditional treatments include a combination of conservative and surgical modalities, such as non-steroidal anti-inflammatories, physical therapy, and open capsular release. We describe a modification to hydrodilatation of the frozen shoulder. Our technique describes the gradual dilation of the glenohumeral (GH) capsule with the goal of seeing a gentle release of the frozen shoulder. Furthermore, we outline our protocol for patient preparation with preprocedural diazepam 5 mg and Hydrocodone 5 mg-Acetaminophen 325 mg, one tablet each. During the procedure, we inject a solution of 10 mL lidocaine mixed with 2 mL of 40 mg/mL triamcinolone acetonide injection (80 mg total) through an anterior approach at the level of the rotator interval for pain control. Following this injection, we proceed to fenestrate the superior glenohumeral ligament (SGHL) in the process. We conclude the procedure with hydrodilatation of the GH joint (GHJ) through the posterior approach with approximately 50 mL of 0.9% normal saline, or until an expansion and release of the GH joint is visualized under ultrasound visualization. A full instruction video can be found at: https://www.youtube.com/watch?v = ZNB0R0hkeok&ab_channel = DrJorgeA.Gonzalez

Biceps Pulley Lesions: Diagnostic Accuracy of Nonarthrographic Shoulder MRI and the Value of Various Diagnostic Signs.

There is limited data in the literature regarding the role of nonarthrographic MRI for detecting biceps pulley (BP) lesions. To assess the accuracy of nonarthrographic MRI for detecting BP lesions, and to evaluate the diagnostic value of various MRI signs (superior glenohumeral ligament discontinuity/nonvisibility, long head of biceps (LHB) displacement sign or subluxation/dislocation, LHB tendinopathy, and supraspinatus and subscapularis tendon lesions) in detecting such lesions. Retrospective. 84 patients (32 in BP-lesion group and 52 in BP-intact group-as confirmed by arthroscopy). 1.5-T, T1-weighted turbo spin echo (TSE), T2-weighted TSE, and proton density-weighted TSE spectral attenuated inversion recovery (SPAIR) sequences. Three radiologists independently reviewed all MRI data for the presence of BP lesions and various MRI signs. The MRI signs and final MRI diagnoses were tested for accuracy regarding detecting BP lesions using arthroscopy results as the reference standard. Furthermore, the inter-reader agreement (IRA) between radiologists was determined. Student's t-tests, Chi-squared, and Fisher's exact tests, and 4-fold table test were used. The IRA was calculated using Kappa statistics. A P-value <0.05 was considered statistically significant. The sensitivity, specificity, and accuracy of nonarthrographic MRI for detecting BP lesions were 65.6%-78.1%, 90.4%-92.3%, and 81%-86.9%, respectively. The highest accuracy was noticed for the LHB displacement sign (84.5%-86.9%), and the highest sensitivity was registered for the LHB tendinopathy sign (87.5%). Furthermore, the highest specificity was observed for the LHB displacement sign and LHB subluxation/dislocation sign (98.1%-100%). The IRA regarding final MRI diagnosis and MRI signs of BP lesions was good to very good (κ = 0.76-0.98). Nonarthrographic shoulder MRI may show good diagnostic accuracy for detecting BP lesions. The LHB displacement sign could serve as the most accurate and specific sign for diagnosis of BP lesions. 3 TECHNICAL EFFICACY: Stage 2.

Comparison of the spread pattern of medial-to-lateral and lateral-to-medial rotator interval injections: A cadaveric study

ObjectiveRotator interval (RI) corticosteroid injections are used to alleviate pain associated with adhesive capsulitis, though the pattern of injectate spread remains unclear. The purpose of this anatomical study was to assess the staining patterns of intra-articular, intracapsular/extrasynovial, and pericapsular structures of the glenohumeral joint following medial-to-lateral and lateral-to-medial RI injections. DesignTen cadaveric specimens were injected with a methylene blue dye injectate: five using a medial-to-lateral RI injection technique and five using a lateral-to-medial RI injection technique. Serial dissection was performed to assess the staining of intra-articular, intracapsular/extrasynovial, and pericapsular structures. The frequency of capture and degree of staining were compared between injection groups. ResultsThe lateral-to-medial injection resulted in the capture of all intra-articular; intracapsular/extrasynovial; and pericapsular structures, whereas the medial-to-lateral injection did not consistently stain all structures. Intracapsular/extrasynovial structures (superior glenohumeral ligament and the long head of biceps tendon) were more darkly stained in the lateral-to-medial group, and pericapsular structures (supraspinatus tendon and coracohumeral ligament) were more darkly stained in the medial-to-lateral group. ConclusionThe frequency of capture and degree of staining of intra-articular, intracapsular/extrasynovial, and pericapsular structures of the glenohumeral joint differed between medial-to-lateral and lateral-to-medial RI injection techniques, which may influence outcomes in pain management for adhesive capsulitis.

Rare case of intra-articular biceps incarceration following traumatic massive rotator cuff tear

Rare case of intra-articular biceps incarceration following traumatic massive rotator cuff tear

Anchoring Apparatus of Long Head of the Biceps Tendon: Ultrasonographic Anatomy and Pathologic Conditions.

The long head of the biceps tendon (LHBT) has been recognized as an important generator of anterior shoulder pain, causing a significant reduction in the shoulder flexion range. Various tendinous and ligamentous structures form the anchoring apparatus of the LHBT along its course to maintain its appropriate location during shoulder movements, including the coracohumeral ligament (CHL), superior glenohumeral ligament (SGHL), subscapularis (SSC) tendon and supraspinatus (SSP) tendon as well as the less recognized tendons of pectoralis major (PM), latissimus dorsi (LD) and teres major (TM). Lesions of this stabilizing apparatus may lead to an instability of the LHBT, resulting in pain at the anterior shoulder. Ultrasonography (US) has been increasingly used in the assessment of shoulder injuries, including the anchoring apparatus of the LHBT. An accurate diagnosis of these injuries is often challenging, given the complex anatomy and wide spectrum of pathologies. In this review article, US anatomy and common pathologic conditions that affect the anchoring apparatus of the LHBT are discussed, including biceps pulley lesions, adhesive capsulitis, chronic pathology of SSC and SSP tendons, tears in the PM tendon and injuries to the LD and TM. Knowledge of a normal anatomy, an appropriate scanning technique and US findings of common pathologic conditions are the keys to accurate diagnoses.

Arthroscopic diagnosis of long head of biceps tendon instability in refractory anterior shoulder pain: A comparison study between pulley tear and non-tear lesions

BackgroundLong head of the biceps tendon (LHBT) instability and biceps reflection pulley (BRP) lesions are common cause of refractory anterior shoulder pain. We described a technique using dynamic arthroscopy to determine associated intraarticular pathologies. MethodsPatients with refractory anterior shoulder pain and arthroscopically-diagnosed LHBT instability were enrolled. LHBT instability and the integrity of BRP and concomitant intra-articular lesions were investigated by ramp test. Demographics and arthroscopic findings were compared between patients with and without BRP tear. ResultsForty patients were enrolled. BRP tear was noted in 25 patients (group A) and superior glenohumeral ligament (SGHL) insufficiency through ramp test in 15 patients (group B). Concomitant intraarticular pathologies were noted in 27 patients, including 19 in group A (76%) and eight in group B (53%), without significant group-wise difference (p = 0.138). The incidence of articular-side subscapularis tear was significantly higher in group A (p = 0.021), and those of the other intraarticular pathologies were similar between groups A and B. Fraying at the articular side of the subscapularis and supraspinatus tendons was frequent in group B, without difference of incidence as compared to group A (p = 0.5 and p = 0.084, respectively). ConclusionsLHBT instability was a common disorder in patients with refractory shoulder pain. In those patients, dynamic assessment of BRP lesions and SGHL insufficiency and meticulous survey of associated intra-articular pathologies, including subscapularis tear are necessary for making accurate diagnosis and treatment decision.

Ultrasound Features of Adhesive Capsulitis.

IntroductionAdhesive capsulitis (AC), which is characterised by shoulder pain and a limited range of motion (ROM), is usually diagnosed on the basis of clinical suspicion, with imaging only being used to exclude other causes of similar symptoms. The aim of this study was to identify and describe the typical ultrasound (US) features of AC in a group of patients with shoulder pain and stiffness.MethodsThis was a cross-sectional study of 1486 patients with AC in which two experienced US specialists examined the axillary pouch (AP), the coracohumeral ligament (CHL), the superior glenohumeral ligament (SGHL), and the long head of the biceps tendon (LHBT), and dynamically visualised the infraspinatus tendon during passive external rotation (PER) during a US evaluation of shoulder ROM.ResultsAC was confirmed in 106 patients (7.1%). Thickening of the AP of more than 4 mm was observed in 93.4% of the patients, whereas 6.6% showed AP thickening of less than 4 mm but more than 60% of the thickening in the contralateral shoulder. Effusion within the LHBT sheath was detected in 71% of the patients, and thickening of the CHL or SGHL in 88%. The dynamic study of the infraspinatus tendon showed reduced sliding with folding towards the joint capsule in 73% of cases, thus changing the tendon’s profile from flat to concave during PER. The reduced tendon sliding was associated with a bouncing movement that returned the tendon to its baseline resting position in 41.5% of cases.ConclusionsWe believe a sufficiently experienced US specialist can confirm a clinical diagnosis of AC by carrying out a comparative study of APs, evaluating the thickness of the CHL and SGHL, and detecting reduced sliding of the infraspinatus tendon.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40744-021-00413-w.

Superior capsule reconstruction: anatomy, biomechanics, indications, and graft treatment.

Superior capsule reconstruction: anatomy, biomechanics, indications, and graft treatment.

The Comma Sign: The Coracohumeral Ligament and Superior Glenohumeral Ligament Exhibit Similar Quantitative Characteristics With Terminal Confluence at the Subscapularis Insertion

PurposeThe purpose of this morphologic cadaveric study was to quantitatively define the composition of the previously described comma tissue along with its relation to the subscapularis tendon insertion.MethodsFresh frozen cadaveric shoulder specimens were included for analysis. The coracohumeral ligament (CHL) was exposed at its origin along the base of the coracoid process and freed laterally along its course to the lesser tuberosity adjacent to the bicipital groove. The superior glenohumeral ligament (SGHL) was identified and traced along its course deep to the CHL within the rotator interval with insertion onto the superior aspect of the lesser tuberosity. The midpoint diameters of the SGHL and CHL and their composite insertional diameters on the subscapularis tendon insertion and lesser tuberosity were measured with digital calipers. The mean diameter was determined from 3 measurements taken of each ligament.ResultsEight specimens were included. With the use of digital calipers, the mean midpoint diameters of the SGHL and CHL were identified as 5.99 mm (range, 5.25-6.91 mm) and 5.13 mm (range, 4.28-5.72 mm), respectively. The composite insertional diameter of the SGHL and CHL on both the lesser tuberosity and humeral insertion of the subscapularis tendon was 9.93 mm (range, 6.69-12.05 mm). At its insertion, the SGHL and CHL comprised 54% and 46% of the comma tissue, respectively. Additionally, all specimens were identified as showing a confluence of the SGHL and CHL composite insertion with the subscapularis tendon at the point of its humeral head insertion.ConclusionsThe comma tissue is a pivotal structure for the identification, mobilization, and repair of retracted subscapularis tendon tears. Therefore, quantitative knowledge of the midpoint diameter, insertional diameter, and composite distribution of the CHL and SGHL provided by this morphologic cadaveric analysis may aid surgeons in their efforts to restore the native anatomy.Clinical RelevanceSubscapularis tendon tears have often been under-addressed during rotator cuff repair. The comma tissue has been described as an anatomic structure that can aid in the identification, mobilization, and repair of retracted subscapularis tendon tears. Therefore, quantitative knowledge of this important arthroscopic landmark may aid surgeons in their efforts to restore the native anatomy.

Diagnosis value of MRI in acute rotator interval injury

To compare clinical application of 1.5 T MRI in acute rotator interval injury. Totally 160 patients with acute rotator cuff tear by clinical diagnosis were retrospectively analyzed by MRI examination and arthroscopy from March 2016 to February 2019, including 122 males and 38 females, aged from 22 to 71 years old with an average of (42.35±3.48) years old. Based on the results of arthroscopy as the gold standard, the shape and signal changes of rotator cuff, rotator interval, peripheral bursa, bone and soft tissue were observed by MRI on axial, oblique coronal and oblique sagittal imagese. The direct MRI signs of acute rotator interval injury displayed thickening, diminution, distortion, interruption of the coracohumeral ligament and superior glenohumeral ligament complex with highsignal intensity on fat-suppression by proton weighted sequence. The indirect MRI signs displayed rotator cuff, peripheral bone and soft tissue injury. The consistency of the results between the two methods was quite satisfactory (Kappa=0.85), and the concordance rate of the two methods has statistically significant (Z=10.75, P<0.00). There was no statistical difference in the inconsistent parts between two methods (χ2= 0.400, P>0.05). The true positive rate, true negative rate, false positive rate and false negative rate of MRI diagnosis of rotator interval injury were 93.75%, 91.30%, 94.74%, 5.26%, 8.70% respectively. MRI could clearly display acute rotator interval, and could accurately diagnose acute rotator interval injury, which provide more accurate imaging basis for clinical diagnosis and treatment.

Biceps Pulley: Normal Anatomy and Associated Lesions at MR Arthrography

The biceps pulley or "sling" is a capsuloligamentous complex that acts to stabilize the long head of the biceps tendon in the bicipital groove. The pulley complex is composed of the superior glenohumeral ligament, the coracohumeral ligament, and the distal attachment of the subscapularis tendon, and is located within the rotator interval between the anterior edge of the supraspinatus tendon and the superior edge of the subscapularis tendon. Because of its superior depiction of the capsular components, direct magnetic resonance arthrography is the imaging modality of choice for demonstrating both the normal anatomy and associated lesions of the biceps pulley. Oblique sagittal images and axial images obtained with a high image matrix are valuable for identifying individual components of the pulley system. Various pathologic processes occur in the biceps pulley as well as the rotator interval. These processes can be traumatic, degenerative, congenital, or secondary to injuries to the surrounding structures. The term hidden lesion refers to an injury of the biceps pulley mechanism and is derived from the difficulty in making clinical and arthroscopic identification. Pathologic conditions associated with pulley lesions include anterosuperior impingement, instability of the biceps tendon, biceps tendinopathy or tendinosis, superior labrum anterior and posterior lesions, and adhesive capsulitis. It is important to be familiar with the normal appearance of the biceps pulley so that abnormalities can be correctly assessed and effectively managed.

Quantitative and Qualitative Analyses of the Glenohumeral Ligaments: An Anatomic Study

Background: While several studies have qualitatively described the anatomy of the glenohumeral ligaments, there remains a lack of consensus regarding their quantitative humeral and glenoid attachment sites. Purpose: To quantitatively and qualitatively describe the anatomic humeral and glenoid attachment sites of the glenohumeral ligaments and their relationship to well-established anatomic landmarks. Study Design: Descriptive laboratory study. Methods: A total of 10 nonpaired, fresh-frozen human cadaveric shoulders were included in this study. A 3-dimensional coordinate measuring device was used to quantify the location of pertinent bony landmarks and soft tissue attachment areas. All subcutaneous tissues and musculature were removed, with the exception of the rotator cuff (respective muscle bellies cut at their musculotendinous junctions) and the long head of the biceps tendon. The superior glenohumeral ligament (SGHL), middle glenohumeral ligament (MGHL), anteroinferior glenohumeral ligament (AIGHL), posteroinferior glenohumeral ligament (PIGHL), and coracohumeral ligament (CHL) were then transected. Coordinates of points along the perimeters of attachment sites were used to calculate areas, while coordinates of center points were used to determine distances between surgically relevant attachment sites and pertinent bony landmarks. Results: The mean length of the SGHL humeral attachment along the intra-articular cartilage margin was 9.5 ± 3.2 mm, spanning from 12:55 to 1:40, while the SGHL glenoid attachment to the labrum was 1.9 ± 1.2 mm medial to the most lateral extent of the labral rim, spanning from 12:30 to 12:45. The mean length of the MGHL attachment along the intra-articular cartilage margin was 16.4 ± 3.0 mm, equating to 2:10 to 3:35 on the humeral head clockface, and the glenoid attachment was confluent with the labrum, attaching 1.5 ± 1.0 mm medial to the most lateral extent of the labral rim and thus extending from 1:50 to 2:35 on the glenoid clockface. The mean length of the AIGHL attachment along the intra-articular cartilage margin was 12.0 ± 3.0 mm, spanning from 4:05 to 5:10 on the humeral head clockface. The AIGHL bony footprint on the glenoid neck was 48.4 ± 24.5 mm2. The confluent attachment of the AIGHL to the labrum was 1.2 ± 0.9 mm medial to the most lateral extent of the labral rim, corresponding to 3:30 to 4:05 on the glenoid clockface. The mean length of the PIGHL attachment along the intra-articular cartilage margin was 12.0 ± 1.4 mm, spanning from 7:40 to 8:50 on the humeral head clockface. The PIGHL attachment to the labrum was 1.2 ± 0.5 mm medial to the most lateral extent of the labral rim. This attachment to the labrum was calculated to span from 7:35 to 8:50 on the glenoid clockface. The mean length of the CHL origin from the coracoid was 12.9 mm, with its most anterior point located a mean of 14.1 mm from the tip of the coracoid. The mean length of the CHL attachment along the intra-articular cartilage margin was 10.0 ± 4.0 mm, spanning from 11:55 to 12:40 on the humeral head clockface. Conclusion: Glenohumeral ligaments were consistently identified in all specimens with minor anatomic variability for the SGHL, MGHL, AIGHL, and PIGHL. Important landmarks including the cartilage surface of the humerus, the bicipital groove, and the clockface can be utilized intraoperatively when attempting anatomic repair of these structures. Clinical Relevance: There are multiple open and arthroscopic shoulder procedures that rely on anatomic restoration of these static stabilizers to provide optimal shoulder function and prevent recurrent instability. The qualitative descriptions are comparable with current literature; however, this study is the first to quantify the glenohumeral capsular and ligamentous attachments. The data provided allow for reliable landmarks to be established from known bony and soft tissue structures.

Lesions of the biceps pulley: a prospective study and classification update

HypothesisThe purpose of the study was to investigate which anatomic structures are affected in a series of patients with pulley lesions and whether all lesions can be classified according to the Habermeyer classification.MethodsOne hundred consecutive patients with pulley lesions were prospectively studied. During arthroscopy, lesions of the superior glenohumeral ligament (SGHL), medial coracohumeral ligament (MCHL) and/or lateral coracohumeral ligament (LCHL), adjacent rotator cuff, and biceps (long head of the biceps) were recorded. All lesions were then classified according to the Habermeyer classification. The χ2 test was used for statistical analysis.ResultsThere were 3 lesions in group 1, 20 in group 2, 6 in group 3, and 35 in group 4 according to the Habermeyer classification. Thirty-six lesions were not classifiable because of an intact SGHL. A lateral pulley sling (LCHL) lesion was found in 95% of the patients, and a medial pulley sling (MCHL-SGHL) lesion was noted 64%. An isolated lesion of the MCHL and/or SGHL was present in 5%, and an isolated lesion of the LCHL was found in 36%. Combined medial-lateral sling lesions were correlated with complete subscapularis tears and biceps fraying.ConclusionThe lateral pulley sling is more often affected than the medial sling. The SGHL is not always affected, and isolated lesions of the medial sling are rare. Lesions of both slings correlated with complete subscapularis tears and fraying of the long head of the biceps. An updated classification of direct pulley lesions is proposed: type 1, lesion of the medial pulley (MCHL and/or SGHL); type 2, lesion of the lateral pulley (LCHL); and type 3, lesion of the medial and lateral pulley slings. Concomitant lesions of the indirect pulley stabilizers can be mentioned additionally according to the well-known classifications.

The Ramp Test: An Arthroscopic Technique for Confirming Intra-articular Subluxation and Instability of the Long Head of the Biceps Tendon Within the Shoulder

Shoulder arthroscopy in expert hands is now a tool for diagnosis and treatment. Diagnostic shoulder arthroscopy begins with a systematic review of the shoulder. This review should include the ramp test for confirming normal superior glenohumeral ligament (SGHL) integrity and function. The ramp test uses manipulation of the biceps tendon to achieve this. A negative ramp test finding means that the SGHL is intact and the biceps tendon moves freely down in a V-type pattern. A positive ramp test finding results when the biceps tendon subluxates through a failed SGHL and therefore presents with a U-shaped pattern indicating pathology. Intra-articular biceps tendon instability occurs due to SGHL tearing, which can lead to upper subscapularis rotator cuff partial tears or complete tears either acutely or over time.

Anatomy of the glenohumeral ligaments

For many years, there has been controversy regarding the presence of the glenohumeral ligaments; the aim of the present study was to evaluate the detailed anatomy of these ligaments. 140 shoulders were dissected and examined. The detailed anatomy of glenohumeral ligaments was recorded. Data were doubled-entered into the Statistical Package for Social Sciences version 21. Kruskal-Wallis and one way analysis for variance on ranks tests were used: statistical significance was set at p<0.05. The superior glenohumeral ligament was present in all specimens originating from the glenoid labrum anterosuperior aspect, inserting into the lesser tubercle (mean thickness 5.06 mm). The middle glenohumeral ligament was present in 98.57% of specimens arising from the glenoid labrum anterior aspect, inserting into the lesser tubercle (mean thickness 5.97 mm). The inferior glenohumeral ligament anterior band was present in all specimens arising from the glenoid labrum anteroinferior aspect, inserting into the humeral neck anteroinferior aspect (mean thickness 4.41 mm). The inferior glenohumeral ligament posterior band was observed in 79.28% of specimens arising from the posteroinferior aspect of the glenoid labrum, inserting into the humeral neck posteroinferior aspect: its mean thickness was 3.45 mm. this study concludes that the superior glenohumeral ligament was observed in all specimens. The middle glenohumeral ligament was seen in 98.57%. An anterior band of the inferior glenohumeral ligament was present in all specimens, while a posterior band was present in 79.28%. A tuberculohumeral ligament was seen in 54.83% of specimens. The present observations should encourage evaluation of the function of this ligament.

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.

Life Lessons, Leadership, and Enduring Friendships

Life Lessons, Leadership, and Enduring Friendships

Rotator cuff tendon connections with the rotator cable

The literature currently contains no descriptions of the rotator cuff tendons, which also describes in relation to the presence and characteristics of the rotator cable (anatomically known as the ligamentum semicirculare humeri). The aim of the current study was to elucidate the detailed anatomy of the rotator cuff tendons in association with the rotator cable. Anatomic dissection was performed on 21 fresh-frozen shoulder specimens with an average age of 68years. The rotator cuff tendons were dissected from each other and from the glenohumeral joint capsule, and the superior glenohumeral, coracohumeral, coracoglenoidal and semicircular (rotator cable) ligaments were dissected. Dissection was performed layer by layer and from the bursal side to the joint. All ligaments and tendons were dissected in fine detail. The rotator cable was found in all specimens. It was tightly connected to the supraspinatus (SSP) tendon, which was partly covered by the infraspinatus (ISP) tendon. The posterior insertion area of the rotator cable was located in the region between the middle and inferior facets of the greater tubercle of the humerus insertion areas for the teres minor (TM), and ISP tendons were also present and fibres from the SSP extended through the rotator cable to those areas. The connection between the rotator cable and rotator cuff tendons is tight and confirms the suspension bridge theory for rotator cuff tears in most areas between the SSP tendons and rotator cable. In its posterior insertion area, the rotator cable is a connecting structure between the TM, ISP and SSP tendons. These findings might explain why some patients with relatively large rotator cuff tears can maintain seamless shoulder function.

Correlation of the Rotator Interval on Direct CT Arthrography in Shoulder Instability Patients with External Rotation Stress Radiographs

The rotator interval (RI) is defined as the space between the anterior aspect of the supraspinatus tendon (SST) and superior aspect of the subscapularis tendon (SSC), covered by rotator interval capsule (RIC) (1, 2). It represents a region of capsule that is not reinforced by overlying rotator cuff tendon (1) and its components, coracohumeral ligament (CHL) and superior glenohumeral ligament (SGHL), are suggested to have a role in glenohumeral joint (GHJ) stability. The role of different shoulder stabilizers vary according to different shoulder position. For example, the CHL is shown to be a stabilizer in superior-inferior directions with arm in external rotation, whereas, the intra-articular pressure that is maintained by the intact RIC is suggested to act as a stabilizer in superior-inferior directions with the arm in internal and neutral rotations (3). The role of the RI in shoulder mechanopathology remains a much debated subject, with some authors advocating its role as a negative articular pressure inducer (3), whereas others, in resisting posteroinferior glenohumeral translation (4-7). Correlation of the Rotator Interval on Direct CT Arthrography in Shoulder Instability Patients with External Rotation Stress Radiographs 견관절 불안정 환자의 CT 관절 조영술상 회전근개 간격과 외회전 부하 영상과의 연관성