Arthroscopic Anatomy of the Shoulder

Authors: Amit Gupta, Lennard Funk

References: Student Research Symposium, Royal College of Surgeons of Edinburgh - 13 April 2005

Shoulder arthroscopy is a useful diagnostic and surgical tool for the orthopaedic surgeon. It relies on a fluent and confident technique combined with a thorough knowledge of the normal anatomy and its variants. The arthroscopic anatomy of the shoulder has only been defined over the last 10 years and there is still some confusion amongst surgeons. No single reference has provided a comprehensive review of the normal anatomy and anatomical variants of the shoulder joint. AIMS: To describe the arthroscopic anatomy and anatomical variants of the shoulder. METHODS: In a retrospective study, an independent researcher reviewed 132 shoulder arthroscopies. Only normal glenohumeral arthroscopies were included. RESULTS: The humeral head bare area was found to be present in 54% of cases. The superior labrum had a variable shape and attachment, with a bumper type labrum being most frequently encountered. Antero-superior labral variants were found collectively in 21% of cases. Six cases of a previously undescribed arc shaped superior gleno-humeral ligament were found. The middle gleno-humeral ligament had a highly variable appearance, appearing as a thickened fold, thin veil, cord like and bifid structure. Variations involving the biceps tendon were present in seven cases. Three examples of a bifid subscapularis were noted along with examples of previously undescribed double and triple subscapularis tendons. The rotator cuff ridge or cable, a commonly overlooked and not well-described entity, was found in over a third of cases. CONCLUSIONS: The anatomy of the shoulder joint is highly variable with numerous previously undescribed anatomical variations existing. Our findings should assist the shoulder arthroscopist, who requires a thorough knowledge of the normal anatomy and its variants.

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