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This Article Full Text Free Full Text (PDF) Free All Versions of this Article: 34/1/72    most recent 0363546505278698v1 Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Request Reprints Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (4) Citing Articles via Google Scholar Google Scholar Articles by Gleason, P. D. Articles by Pasque, C. B. Search for Related Content PubMed PubMed Citation Articles by Gleason, P. D. Articles by Pasque, C. B. Related Collections Anatomy Histology Imaging Studies

The Transverse Humeral Ligament

A Separate Anatomical Structure or a Continuation of the Osseous Attachment of the Rotator Cuff?

Paul D. Gleason, MD^*, Douglas P. Beall, MD, Timothy G. Sanders, MD, James L. Bond, MD, Justin Q. Ly, MD^||, Lorne L. Holland, MD^¶ and Charles B. Pasque, MD^,#

From the ^* Department of Radiology, Wright-Patterson Air Force Base, Ohio, the Department of Radiology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, National Musculoskeletal Imaging, Weston, Florida, the Department of Orthopaedic Surgery & Rehabilitation, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, the ^|| Department of Radiology, Lackland Air Force Base, Texas, and the ^¶ Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma

^# Address correspondence to Charles B. Pasque, MD, Department of Orthopaedic Surgery and Rehabilitation, University of Oklahoma Health Sciences Center, PO Box 26901, Oklahoma City, OK 73190 (e-mail: charles-pasque{at}ouhsc.edu).

Background: No study to date has isolated the anatomical nature of the transverse humeral ligament and its relationship to the biceps tendon and the anterosuperior portion of the rotator cuff.

Hypothesis: There is no separate identifiable transverse humeral ligament, but rather the fibers covering the intertubercular groove are composed of a sling formed by fibers from the subscapularis and supraspinatus tendons.

Study Design: Descriptive laboratory study.

Methods: A total of 14 shoulder examinations were performed on 7 matched pairs of fresh-frozen cadaveric shoulders. Magnetic resonance imaging scans were performed, followed by gross and microscopic anatomical dissection.

Results: In the location of the transverse humeral ligament, magnetic resonance imaging and gross dissection revealed the continuation of superficial fibers of the subscapularis tendon from the tendon body across the intertubercular groove to attach to the greater tuberosity, whereas deeper fibers of the subscapularis tendon inserted on the lesser tuberosity. Longitudinal fibers of the supraspinatus tendon and the coracohumeral ligament were also noted to travel the length of the groove, deep to the other interdigitating fibers but superficial to the biceps tendon. Histologic studies confirmed these gross dissection patterns of fiber attachment and also revealed the absence of elastin fibers, which are more commonly seen in ligamentous structures and are typically absent from tendinous structures.

Conclusion: There is no identifiable transverse humeral ligament, but rather the fibers covering the intertubercular groove are composed of a sling formed mainly by the fibers of the subscapularis tendon, with contributions from the supraspinatus tendon and the coracohumeral ligament.

Clinical Relevance: According to our findings, dislocations of the long head of the biceps must disrupt at least the deep fibers of the annular sling created mainly by the subscapularis tendon insertion. This finding provides anatomical support for the findings of a positive biceps tendon subluxation or dislocation and subscapularis tear during glenohumeral arthroscopy with a normal-appearing subscapularis during open surgery or subacromial arthroscopy.

Key Words: transverse humeral ligament • subscapularis tears • biceps tendon dislocation

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