Middle GHL

 This ligament courses from the anterior/superior aspect of the glenoid and passes obliquely across the subscapularis bursa to the lesser tuberosity. [1,7,9] Variations in the origin of this ligament have been described [9-10,18,27,29,45,48]. Its prevalence ranges between 63.1% and 100% [8-9,18,26-29,40,42,47].

The width and diameter of the ligament vary considerably, being reported to be an average of 18 mm (range 6-25mm) and 3.6 mm (range 2-5mm) respectively. [40] It was reported to be rudimentary in 11.5% of cases and originate between the 1 to 3 o’clock positions on the glenoid labrum in 28.8% of cadaveric specimens. [40]

The middle gleno-humeral ligament has a highly variable appearance, [1] most commonly appearing (in approximately 70% of cases) as a thickened fold in the anterior capsule. [6] The intra-articular appearance of this ligament is determined by variation in the synovial recesses found in the shoulder joint. [10]

The cord-like appearance is the most common variant, and when seen through an arthroscope, it appears to have rolled up edges [6,25-26,29,49]. It may be associated with antero-superior labral variants - Buford Complex.

Other variants of this ligament include it appearing as a few fibrous bands or a thin fibrous sheet, [6,26] a bifid structure [26-27,50-51] or being absent. [6,8,18,26-27,40]

Snyder [6] reported a thin veil or an absent middle glenohumeral ligament to occur in about 10% of shoulders and be associated with “…a very hypertrophic inferior glenohumeral ligament”. A separate arthroscopic study [26] reported a thin sheet middle gleno-humeral ligament in 70.4% of arthroscopies, and only one case of a bifid middle ligament.

From our study:
Similar to other studies, the prevalence of the middle gleno-humeral ligament in our study was noted to be 87.1% [Table 24]. [16,22,27-28,30,34-39] No other arthroscopic study has commented on the prevalence of this ligament.
 No new variations were noted with respect to the origin of the middle gleno-humeral ligament. In agreement with Snyder [6], a thickened ligament was the most common appearance. The prevalence of a cord-like middle gleno-humeral ligament as noted in this study is similar to that mentioned in the literature [Table 25]. [6,34-35,40] Three examples of a poorly described bifid middle gleno-humeral ligament were also found. No other study has commented on the shape and size of the middle gleno-humeral ligament.

Table 24 – Prevalence and absence of the middle gleno-humeral ligament

Prevalence %

Absent %

Type of study



Cadaveric study [16]



MR Arthrography [36]



Cadaveric study [35]



Cadaveric study [39]

68% - “well formed” [8]

16% - “poorly defined” [8]


Cadaveric study [27]



MR Arthrography [22]



Cadaveric study [38]



MR Arthrography [37]



Arthroscopic study



Arthroscopic study [34]



Cadaveric study [28]



Cadaveric study [30]

Table 25 – Prevalence of a cord-like middle glenohumeral ligament, a variant of the middle glenohumeral ligament.

% Prevalence

Type of study

17.9 %

Cadaveric study [35]

19 %

Cadaveric study [40]

20 %

Arthroscopic study [6]


Arthroscopic study [34]


Arthroscopic study

This website is certified by Health On the Net Foundation. Click to verify. This site complies with the HONcode standard for trustworthy health information:
verify here.

ShoulderDoc.co.uk satisfies the INTUTE criteria for quality and has been awarded 'editor's choice'.

The material on this website is designed to support, not replace, the relationship that exists between ourselves and our patients. Full Disclaimer