Anatomy And Clinical Study Of The Inferior Glenohumeral Ligament

Objective : The purpose of this study was to observe the basic structures of the glenohumeral ligaments of the shoulder joint in Chinese adults through anatomy,including the characteristics of the glenohumeral ligaments at the glenoid and humeral attachment points.The position and attachment characteristics of the anterior band of the inferior glenohumeral ligament were observed through histological staining,which is adjoined to the joint capsule,the labrum and the glenoid structure,so as to provide a more accurate anatomical basis for the repair of the common anterior instability of the shoulder joint.Methods:In this study,all of 20 shoulder specimens,fixed by formalin,were collected from 10 cadavers(4 males and 6 females,provided by anatomy department,from Qingdao University),aged from 52 to 75 years,with an average age of 62.2 years.In the measurement,we set the glenohumeral ligament attachment as the starting point,the end point of the humeral attachment was fixed,and the length between the starting and ending points was the length of the ligament,and the tissue of the glenohumeral ligament connected with the glenohumeral cavity was retained for histological staining.Magnetic resonance imaging(mri)was performed on the shoulder joint of 20 healthy volunteers to observe the attachment between the anterior band of the inferior glenohumeral ligament and the glenoid.In addition,the intraoperative image data of84 patients undergoing shoulder arthroscopic surgery were collected to observe the anatomical morphology of the inferior glenohumeral ligament and the types of common injuries in clinic.Result:1.Anatomical characteristics and measurement of the inferior glenohumeral ligament The inferior glenohumeral ligament was found in all 20 samples,including anterior band,axillary and posterior band.The anterior band arises from the position between 3and 5 o 'clock of the glenoid,across the glenohumeral joint and attached to the anatomical neck below the Lesser tubercle of humerus;The posterior band arises from the position of the glenoid at about 7 o 'clock and ends at the posterior part of the anatomical neck,much weaker than the anterior band;The axillary is a "hammock-looking" stracture connecting the anterior and posterior bands,looser but wider than the anterior and posterior bands.Ligaments are closely connected on the glenoid side and arranged in a more "orderly" manner.Thicker than the side of the humerus,the ligaments extend to the side of the humerus and attach to the humerus at the stop flabellataly.Ligaments are closely attached to the capsule,which is difficult to be distinguished by the naked eye.In front of the anterior buand,the anterior capsule and the tendon of subscapularis muscle are located,while the posterior bundle is closely attached to the posterior joint capsule,the infraspinatus muscle and teres minor muscle.Anterior band of inferior glenohumeral ligament: length(33.86±3.29)mm,glenoid thickness(3.10±0.74)mm,glenoid width(12.13±1.06)mm,humeral lateral width(13.29±1.07)mm.Posterior band of inferior glenohumeral ligament: length(36.15±3.42)mm,glenoid thickness(2.04±0.21)mm,glenoid width(11.48±1.26)mm,humeral lateral width(12.50±1.14)mm.2.Arthroscopic observation of the inferior glenohumeral ligament3.The injuries of the inferior glenohumeral ligament were divided into four types.(1)Only edema contracture and thickening of the inferior glenohumeral ligament,44%(37/84),(2)Tear from lateral humerus,29.8%(25/84),(3)Axillary capsule tear,13.1%(11/84),(4)Lateral glenoid tear,13.1%(11/84).4.Histological staining and magnetic resonance imaging analysis of anterior band of subglenohumeral ligament The anterior bundle of the inferior glenohumeral ligament is a dense connective tissue composed of a large number of collagen fibers arranged in parallel and a small amount of elastic fibers.There are two types of origin of the anterior band of inferior glenohumeral ligament from glenoid,.Type I origin,where the ligament arises from the glenoid rim,labrum and neck.Type II origin,where the ligament arises entirely from the glenoid neck.Among them,6 cases(30%)had type I attachment.In 14 cases(60%),the attachment modes of type I and type II existed simultaneously.Type I mainly appears at 3-4 o 'clock.Conclusion:1.In our study,the occurrence rate of the inferior glenohumeral ligament was100%.No significant anatomical variation was found.The anterior corset arises from the 3-5 o 'clock position of the glenoid pelvis,across the glenohumeral joint and attached to the anatomical neck below the tuberosity;The posterior band arises from the position around 7 o 'clock of the glenoid cavity and ends at the anatomical posterior part of the neck,which is very weak compared with the anterior fasciculus.The connecting belt between the anterior and posterior bundles of the axillary sac looks like a "hammock",looser and larger than the anterior and posterior bundles.Under the stereoscopic microscope,ligaments are closely connected on the glenoid side and arranged in a more "orderly" manner.Thicker than the side of the humerus,the ligaments extend to the side of the humerus and attach to the humerus at the stop flabellataly.2.Injuries of the inferior glenohumeral ligament are common in various common shoulder joint lesions.In patients with dislocation of shoulder joint,tears of the inferior glenohumeral ligament are more likely to be observed,while edema and thickening of the inferior glenohumeral ligament are more obvious in patients with frozen shoulder.3.The anterior bundle of the inferior glenohumeral ligament is a ligament independent of the capsule.There are two types of origin of the anterior band of inferior glenohumeral ligament from glenoid,.Type I origin,where the ligament arises from the glenoid rim,labrum and neck.Type II origin,where the ligament arises entirely rom the glenoid neck.Type I is more common,mainly occurring at 3-4 o 'clock.