Basic Science
Functional anatomy of the superior glenohumeral and coracohumeral ligaments and the subscapularis tendon in view of stabilization of the long head of the biceps tendon

https://doi.org/10.1016/j.jse.2009.04.001Get rights and content

Background

Various findings in the lateral rotator interval to support the long head of the biceps tendon have been reported. The purpose of this study was to clarify the functional anatomy regarding the stabilization of the biceps tendon.

Material and methods

Twenty embalmed shoulders were used for anatomic study, and 5 specimens of the anterosuperior part of the glenohumeral joint were histologically studied.

Results

Anatomically, the most superior part of the subscapularis tendon was attached to the upper margin of the lesser tuberosity and extended as a thin tendinous slip to the fovea capitis of the humerus. The superior glenohumeral ligament ran spirally along the biceps tendon. Histologically, the superior glenohumeral ligament was attached to the tendinous slip. There was no clear boundary between the superior glenohumeral and coracohumeral ligament.

Conclusion

To keep the biceps tendon in place and stabilized, tension in the superior glenohumeral ligament and the buttress support of the most superior insertion point of the subscapularis from behind the ligament may be necessary.

Level of Evidence

Basic Science

Section snippets

Materials and methods

This study used specimens from deceased donors who provide full consent for the study. Approval of an Investigational Review Board was not required

This anatomic study used 20 specimens from 10 deceased donors (5 men, 5 women) who were a mean age of 73.3 years. All cadavers were fixed in 8% formalin and preserved in 30% ethanol. There was no macroscopic abnormality in the rotator cuff or LHB, although a history of shoulder problems was not available.

The clavicle and humerus were cut at the

Results

The anatomic study demonstrated that the CHL, which was a bundle of connective tissue attached to the dorsal side of the coracoid process, spread laterally and covered the most external layer of the glenohumeral joint. A wide portion of the most superior insertion point of the subscapularis attached to the uppermost margin of the lesser tuberosity. This insertion constituted a tendinous wall that continued from the osseous medial wall of the intertubercular groove. Moreover, this insertion sent

Discussion

Several important soft-tissue structures retain the LHB at the superior portion of the intertubercular groove.4 The most important structure to serve as a restraint to keep the LHB from dislocating is the most superior insertion point of the subscapularis. This study found the surface of the superior-most insertion continued from the osseous medial wall of the intertubercular groove and supported the LHB from the inferior side. The tendinous slip of the subscapularis insertion did not extend in

References (24)

  • V. Cervilla et al.

    Medial dislocation of the biceps brachii tendon: Appearance at MR imaging

    Radiology

    (1991)
  • J.M. Clark et al.

    Tendons, ligaments, and capsule of the rotator cuff. Gross and microscopic anatomy

    J Bone Joint Surg Am

    (1992)
  • Cited by (0)

    View full text