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The main aim of this study was to evaluate the performance of magnetic resonance imaging (MRI) and interobserver agreement in the identification of the comma sign. The second objective was to look for a correlation between the comma sign and the detachment of the superficial fascia of the subscapularis. Two radiologists, blinded to the arthroscopic findings, retrospectively assessed the magnetic resonance images of 110 shoulders and were asked to assess the presence of the comma sign and the intact subscapularis fascia. The inter-reader agreement and the MRI performance values for detection of the comma sign were calculated. In addition, the association between the intact superficial subscapularis fascia and the comma sign was evaluated. The agreement between the 2 radiologists was perfect. The following values were obtained: sensitivity, 90.9%; specificity, 98.8%; positive predictive value, 95.2%; negative predictive value, 97.7%; and accuracy, 97.2%. No association between the comma sign and subscapularis fascia lesions was found. MRI appears to be a reliable method for preoperative assessment of the comma sign. The comma sign appears not to be formed by the detached subscapularis fascia. [ABSTRACT FROM AUTHOR]

Introduction: The area encompassing the long head of the biceps (LHB) can be represented as a rectangular parallelepiped. This geometric view can be likened to a box, the "biceps box", where the sides are the extrinsic structures and the LHB is the intrinsic structure. Since these structures are mobile in relation to each other, a dynamic "biceps box" model can modify assessments of the LHB, in its healthy or pathological state, and make the therapeutic approach to treating LHB lesions less arbitrary., Material and Method: In order to describe the different sides of the "biceps box", and to understand their possible physiological and pathological consequences, a literature review using PRISMA methodology was used., Results: The supraspinatus (SSP) has expansions on its anterior aspect that project anteriorly and cross the coracohumeral ligament (CHL). The most functionally important expansion is the fasciculus obliquus, which extends perpendicular to the axis of the tendon fibers of the SSP, divides the CHL into a deep and a superficial layer, and terminates on the superficial aspect of the subscapularis. The humeral insertion of the SSP may be binary, making a bridge over the LHB, with a posterior branch inserting on the greater tuberosity and an anterior branch on the lesser tuberosity. The superior glenohumeral ligament (SGHL) has a twisted course, downward and forward, and ends at the proximal opening of the bicipital groove with a flap on which the LHB rests. The bicipital pulley is not an independent structure but an arciform structure resulting from the fusion of several tissues., Discussion: The presence of structures linked together by common expansions in the 3 planes of space validates the relevance of a "biceps box" as a functional geometric model. The structure that acts as a crossroads through which all expansions pass is the CHL. An extrinsic SSP lesion can be compensated for by other "biceps box" structures, whereas an extrinsic SGHL lesion rarely exists without the presence of an intrinsic LHB lesion. The CHL constitutes a connective tissue crossed by a vasculonervous pedicle from the lateral pectoral nerve, which may explain some anterior shoulder pain attributed to the biceps., Conclusion: The LHB can be likened to an intrinsic structure contained in a box whose sides are made up of different interconnected stabilizing structures defining the extrinsic structures. The concept of a dynamic "biceps box" allows LHB lesions to be accurately classified, separating extrinsic and intrinsic lesions, and thus potentially modifying therapeutic approaches to the LHB., Level of Evidence: IV; systematic review., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

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. [ABSTRACT FROM AUTHOR]

Purpose: There is a little information on the early fetal development of the rotator interval region of the shoulder, particularly with regard to whether topographical relationships among the ligaments and tendons change during development. Methods: We examined the histological sections (transverse or frontal) of right or left shoulder in 20 mid-term human fetuses (7-15 weeks of gestation). Results: The biceps tendon had an accompanying bursa-like cavity before the joint cavitation. The bursa for the tendon remained open to the joint cavity until 12 weeks. When reaching the glenoid, the biceps tendon involved and carried mesenchymal tissue around the coracoid process (the future coracohumeral ligament) toward the infraspinatus tendon. Until 10 weeks, the primitive glenohumeral ligament was established as simple collateral ligaments on the inner or humeral side of the rotator cuff tendons and the biceps long tendon. However, the subscapularis tendon crossed, attached to, and reformed the upper structure of the superior glenohumeral ligament. Conclusions: The early development of the coracohumeral ligament suggests that it is a primitive and basic structure. However, we hypothesize that mechanical demands from the subscapularis tendon and biceps long tendon are likely to change the primitive form of the rotator interval to the adult morphology, including the superior glenohumeral ligament. The significant modification evident during early fetal development suggests that anatomical reconstruction after rotator cuff tears should not be based on the 'ideal' anatomy, especially that of the superior glenohumeral ligament, but on individual requirements. Level of evidence: III or IV (this is my opinion, please choose only 1) [ABSTRACT FROM AUTHOR]

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 [Copyright &y& Elsevier]

Abstract: The purpose of this article is to review the key imaging findings in major categories of pathology affecting the shoulder joint including hydroxyapatite deposition disease, rotator cuff interval pathology, acromioclavicular joint pathology, glenohumeral osteoarthrosis, and synovial inflammatory processes, with specific emphasis on findings that have associated pitfalls in imaging diagnosis. The pathophysiology and clinical manifestations of the above mentioned categories of pathology will be reviewed, followed in each section by a detailed pictorial review of the key imaging findings in each category including plain film, computed tomography, and magnetic resonance imaging findings as applicable. Imaging challenges that relate to both diagnosis and characterization will be addressed with each type of pathology. The goal is that after reading this article, the reader will be able to recognize the key imaging findings in major categories of pathology affecting the shoulder joint and will become familiar with the potential pitfalls in their imaging diagnosis. [Copyright &y& Elsevier]

The purpose of this review was to demonstrate magnetic resonance (MR) arthrography findings of anatomy, variants, and pathologic conditions of the superior glenohumeral ligament (SGHL). This review also demonstrates the applicability of a new MR arthrography sequence in the anterosuperior portion of the glenohumeral joint. The SGHL is a very important anatomical structure in the rotator interval that is responsible for stabilizing the long head of the biceps tendon. Therefore, a torn SGHL can result in pain and instability. Observation of the SGHL is difficult when using conventional MR imaging, because the ligament may be poorly visualized. Shoulder MR arthrography is the most accurately established imaging technique for identifying pathologies of the SGHL and associated structures. The use of three dimensional (3D) volumetric interpolated breath-hold examination (VIBE) sequences produces thinner image slices and enables a higher in-plane resolution than conventional MR arthrography sequences. Therefore, shoulder MR arthrography using 3D VIBE sequences may contribute to evaluating of the smaller intraarticular structures such as the SGHL.