Affiliation:
1. Clinique de l'Épaule—Paris—Clinique Maussins‐Nollet Paris France
2. Hôpital Saint Antoine Service de Chirurgie Orthopédique Paris France
3. CHU de Fort de France Guadeloupe France
4. Clinique Bouchard Centre Main Épaule Méditerranée Marseille France
5. Clinique du Sport de Bordeaux Mérignac Mérignac France
Abstract
AbstractPurposeThe inferior glenohumeral ligament (IGHL) is composed of three parts: the anterior branch or band (AB), the axillary pouch and the posterior band (PB). The latter has rarely been studied. We aim to describe the PB of the IGHL and its dynamic behaviour in different arm positions.MethodsTwelve fresh cadaveric shoulders were used and the two bands (AB and PB) of the IGHL were dissected and isolated, taking away all muscle, ligaments and capsule. Characteristics of the bands were studied in five positions: maximum external rotation (ER1), abduction (ABD), internal rotation (IR), ABD external rotation (ER2) and anterior elevation–adduction–IR (Hawkins–Kennedy test position). Progressive and randomized sectioning of the bands and capsule with a scalpel was performed to study its impact on mobility and translation of the glenohumeral joint.ResultsThe bands that tensioned first were in ER1, the AB at 97 ± 9° (80–110); in ER2, the AB at 81 ± 19° (30–100); in IR, the PB at 64 ± 9° (50–80); and in ABD, the PB at 87 ± 10° (70–105). Isolated sectioning of the AB had no effect on ABD, whilst isolated sectioning of the PB allowed greater ABD. In ER2, the AB limited anterior translation. After sectioning the AB, anterior translation remained limited by the PB, which wrapped around the humeral head and locked the joint by pressing the two joint surfaces tightly together. In Hawkins–Kennedy position anterior elevation–adduction–IR, the AB is the first constraint and the posterior translation was limited by the PB alone only in four cases.ConclusionsWhen the IGHL is isolated, ligament limitation of glenohumeral ABD seems to be uniquely dependent on the PB. In the Hawkins and Kennedy position, the AB is the first constraint. In the case of an isolated lesion to the AB, the PB participates in anterior stabilization of the shoulder by wrapping around the humeral head that cannot dislocate. These findings confirm the role of the PB in glenohumeral joint stability.Level of EvidenceLevel IV.