Association of damage to the coracohumeral ligament with anterosuperior rotator cuff degeneration revealed by anatomical dissection

Figures

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  Figure 1. (A) Exemplary full-thickness SSP-lesion in a left shoulder, view from above. Asterix marks the full-thickness tear, the SSP is mobilized towards lateral. The LHB was visible through the tear. (B) After removal of the fibrous capsule and careful dissection of the CHL, a rupture of the posterolateral band was identified. Arrowheads mark the remnants of the posterolateral band (B) and its location before further dissection (A) for better orientation. (A′) and (B′) Approximation of the photographs as an overlay on humerus and scapula. HH humeral head, CP coracoid process, ScSp scapular spine, SSP supraspinatus muscle, SSC subscapularis muscle, LHB long head of biceps brachii muscle.

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  Figure 2. (A) Large partial SSC-lesion in a right shoulder, view from anterior. In this shoulder, also a large cartilage-defect was identified. Dashed line delineates the size of the SSC-lesion, dotted line delineates the cartilage-defect. Arrowheads demarcate the degenerated joint capsule. (A′) Approximation of the photographs as an overlay on humerus and scapula. HH humeral head, CP coracoid process, SSC remainder of the supscapularis muscle.

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  Figure 3. (A) Exemplary full-thickness SSP-lesion in a right shoulder, view from superior. The lesion was classified as Bateman III. In addition to the tendon tear, also a complete rupture of the CHL and of the LHB was identified. (A′) Approximation of the photographs as an overlay on humerus and scapula. Dashed line delineates an anterosuperior cartilage defect. Dotted line identifies the ruptured tendon of the LHB. HH humeral head, CP coracoid process, ScSp scapular spine, GT greater tubercle, LT lesser tubercle, SSP supraspinatus muscle, SSC subscapularis muscle, LHB long head of the biceps brachii muscle.

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  Figure 4. (A) Exemplary lesion to the posterolateral band of the CHL in a right shoulder, view from superior. (A′) Approximation of the photographs as an overlay on humerus and scapula. Dashed line delineates the size of the lesion, dotted line delineates the correlating partial tear of the SSP. HH humeral head, CP coracoid process, GT greater tubercle, LT lesser tubercle, SSP supraspinatus muscle, LHB long head of biceps brachii muscle.

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  Figure 5. Exemplary view of a right shoulder with partial full-thickness tear of the supraspinatus tendon. (A) As the supraspinatus muscle was reflected, the extent of the defect in the underlying capsuloligamentous layer was observed. (B) A complete rupture of the CHL was identified, only the SGHL was left intact. Also, the LHB was ruptured. (A′) and (B′) Approximation of the photographs as an overlay on humerus and scapula. Asterix mark remnants of the fibrous capsule. HH humeral head, CP coracoid process, GT greater tubercle, LT lesser tubercle, IS intertubercular sulcus, SGHL superior glenohumeral ligament, SSP supraspinatus muscle, SSC subscapularis muscle.

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  Figure 6. Exemplary view of the morphology of the CHL in a right shoulder. (A) view from anterosuperior, (B) view from anterior. The two bands—anteromedial (blue arrowheads) and posterolateral (green arrowheads) attached to the lesser and greater tubercle, respectively, are clearly distinguished. The LHB (extracted from the intertubercular sulcus) courses between those bands from its origin at the supraglenoidal tubercle towards the intratubercular sulcus. (C) The osseous attachments at the coracoid process and the humerus were marked in the photograph after removal—anteromedial band with blue markings, posterolateral band with green markings. CP coracoid process, ScSp scapular spine, GT greater tubercle, LT lesser tubercle, SSP supraspinatus muscle, SSC subscapularis muscle, LHB long head of the biceps brachii muscle.

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  Figure 7. Exemplary view of the osseous morphology before (A, A′) and after (B, B′) removal of the acromion of the scapula in a right shoulder. View from anterior (A, B) and from superior (A′, B′). AC acromion, CP coracoid process, ScSp scapular spine, GT greater tubercle, LT lesser tubercle, IS intertubercular sulcus.