Friday, May 2, 2014

The stabilizing effect of the coracohumeral ligament - the science behind the rotator interval plication

The anatomy of the coracohumeral ligament and its relation to the subscapularis muscle.

One of the keys to achieving a balance between mobility and stability in shoulder arthroplasty is understanding the role of the coracohumeral ligament and the rotator interval.
On the basis of their anatomical studies, these authors concluded that the coracohumeral ligament (CHL) originated from the horizontal limb and base of the coracoid process (C) and enveloped the cranial part of the subscapularis muscle (SSC) as well as the anterior aspect of the supraspinatus (SSP). As such it "seems to function as a kind of holder for the subscapularis and supraspinatus muscles".

Comment: This article further reinforces the role of the superior aspect of the shoulder capsule, the coracoacromial ligament and rotator interval in shoulder stability. By holding the inseritional tendons to this anchoring point, translation of the humeral head (HH) with elevation of the arm is controlled. When this mechanism is deficient, a rotator interval plication can restore this function. We have found that rotator interval plication is a powerful tool for managing excessive posterior translation in shoulder arthroplasty.


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