Skip to main content
SpringerLink
Log in

Anatomy of the capsulolabral complex and rotator interval related to glenohumeral instability

  • Shoulder
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

The glenohumeral joint with instability is a common diagnosis that often requires surgery. The aim of this review was to present an overview of the anatomy of the glenohumeral joint with emphasis on instability based on the current literature and to describe the detailed anatomy and anatomical variants of the glenohumeral joint associated with anterior and posterior shoulder instability. A review was performed using PubMed/MEDLINE using key words: Search terms were “glenohumeral”, “shoulder instability”, “cadaver”, “rotator interval”, “anatomy”, and “anatomical study”. During the last decade, the interest in both arthroscopic repair techniques and surgical anatomy of the glenohumeral ligament (superior, middle, and inferior), labrum, and rotator interval has increased. Understanding of the rotator interval and attachment of the inferior glenohumeral ligament on the glenoid or humeral head have evolved significantly. The knowledge of the detailed anatomy and anatomical variations is essential for the surgeon in order to understand the pathology, make a correct diagnosis of instability, and select proper treatment options. Proper understanding of anatomical variants can help us avoid misdiagnosis.

Level of evidence V.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Andary JL, Petersen SA (2002) The vascular anatomy of the glenohumeral capsule and ligaments: an anatomic study. J Bone Joint Surg Am 84:2258–2265

    PubMed  Google Scholar 

  2. Antoniou J, Duckworth DT, Harryman DT 2nd (2000) Capsulolabral augmentation for the management of posteroinferior instability of the shoulder. J Bone Joint Surg Am 82:1220–1230

    CAS  PubMed  Google Scholar 

  3. Arai R, Mochizuki T, Yamaguchi K, Sugaya H, Kobayashi M, Nakamura T, Akita K (2010) Functional anatomy of the superior glenohumeral and coracohumeral ligaments and the subscapularis tendon in view of stabilization of the long head of the biceps tendon. J Shoulder Elbow Surg 19:58–64

    Article  PubMed  Google Scholar 

  4. Baker CL, Uribe JW, Whitman C (1990) Arthroscopic evaluation of acute initial anterior shoulder dislocations. Am J Sports Med 18:25–28

    Article  CAS  PubMed  Google Scholar 

  5. Bankart ASB (1938) The pathology and treatment of recurrent anterior dislocation of the shoulder joint. Br J Surg 26:23–29

    Article  Google Scholar 

  6. Bey MJ, Hunter SA, Kilambi N, Butler DL, Lindenfeld TN (2005) Structural and mechanical properties of the glenohumeral joint posterior capsule. J Shoulder Elbow Surg 14:201–206

    Article  PubMed  Google Scholar 

  7. Bigliani LU, Pollock RG, Soslowsky LJ, Flatow EL, Pawluk RJ, Mow VC (1992) Tensile properties of the inferior glenohumeral ligament. J Orthop Res 10:187–197

    Article  CAS  PubMed  Google Scholar 

  8. Bokor DJ, Conboy VB, Olson C (1999) Anterior instability of the glenohumeral joint with humeral avulsion of the glenohumeral ligament. A review of 41 cases. J Bone Joint Surg Br 81:93–96

    Article  CAS  PubMed  Google Scholar 

  9. Boyd HB, Sisk TD (1972) Recurrent posterior dislocation of the shoulder. J Bone Joint Surg Am 54:779–786

    CAS  PubMed  Google Scholar 

  10. Burkart AC, Debski RE (2002) Anatomy and function of the glenohumeral ligaments in anterior shoulder instability. Clin Orthop Relat Res 400:32–39

    Article  PubMed  Google Scholar 

  11. Carreira DS, Mazzocca AD, Oryhon J, Brown FM, Hayden JK, Romeo AA (2006) A prospective outcome evaluation of arthroscopic Bankart repairs: minimum 2-year follow-up. Am J Sports Med 34:771–777

    Article  PubMed  Google Scholar 

  12. Castagna A, Markopoulos N, Conti M, Delle Rose G, Papadakou E, Garofalo R (2010) Arthroscopic Bankart suture-anchor repair: radiological and clinical outcome at minimum 10 years of follow-up. Am J Sports Med 38:2012–2016

    Article  PubMed  Google Scholar 

  13. Cooper DE, Arnoczky SP, O’Brien SJ, Warren RF, DiCarlo E, Allen AA (1992) Anatomy, histology, and vascularity of the glenoid labrum. An anatomical study. J Bone Joint Surg Am 74:46–52

    CAS  PubMed  Google Scholar 

  14. Dashottar A, Borstad J (2012) Posterior glenohumeral joint capsule contracture. Shoulder Elbow 4:1–13

    Article  Google Scholar 

  15. DePalma AF, Callery G, Bennett GA (1949) Variational anatomy and degenerative lesions of the shoulder joint. Instr Course Lect 6:225–281

    Google Scholar 

  16. Eberly VC, McMahon PJ, Lee TQ (2002) Variation in the glenoid origin of the anteroinferior glenohumeral capsulolabrum. Clin Orthop Relat Res 400:26–31

    Article  PubMed  Google Scholar 

  17. Field LD, Bokor DJ, Savoie FH 3rd (1997) Humeral and glenoid detachment of the anterior inferior glenohumeral ligament: a cause of anterior shoulder instability. J Shoulder Elbow Surg 6:6–10

    Article  CAS  PubMed  Google Scholar 

  18. Flatow EL, Warner JI (1998) Instability of the shoulder: complex problems and failed repairs: Part I. Relevant biomechanics, multidirectional instability, and severe glenoid loss. Instr Course Lect 47:97–112

    CAS  PubMed  Google Scholar 

  19. Flood V (1829) Discovery of a new ligament of the shoulder joint. Lancet 1:672–673

    Google Scholar 

  20. Garber AC, Argintar E, Shin SJ, McGarry MH, Tibone JE, Lee TQ (2013) Kinematic effect of MGHL incorporation into Bankart repair. Orthopedics 36:653–658

    Article  PubMed  Google Scholar 

  21. Gaskill TR, Braun S, Millett PJ (2011) Multimedia article. The rotator interval: pathology and management. Arthroscopy 27:556–567

    Article  PubMed  Google Scholar 

  22. Gohlke F, Essigkrug B, Schmitz F (1994) The pattern of the collagen fiber bundles of the capsule of the glenohumeral joint. J Shoulder Elbow Surg 3:111–128

    Article  CAS  PubMed  Google Scholar 

  23. Habermeyer P, Gleyze P, Rickert M (1999) Evolution of lesions of the labrum-ligament complex in posttraumatic anterior shoulder instability: a prospective study. J Shoulder Elbow Surg 8:66–74

    Article  CAS  PubMed  Google Scholar 

  24. Harris JD, Gupta AK, Mall NA, Abrams GD, McCormick FM, Cole BJ, Bach BR Jr, Romeo AA, Verma NN (2013) Long-term outcomes after Bankart shoulder stabilization. Arthroscopy 29:920–933

    Article  PubMed  Google Scholar 

  25. Harryman DT 2nd, Sidles JA, Harris SL, Matsen FA 3rd (1992) The role of the rotator interval capsule in passive motion and stability of the shoulder. J Bone Joint Surg Am 74(1):53–66

    PubMed  Google Scholar 

  26. Howell SM, Galinat BJ, Renzi AJ, Marone PJ (1988) Normal and abnormal mechanics of the glenohumeral joint in the horizontal plane. J Bone Joint Surg Am 70:227–232

    CAS  PubMed  Google Scholar 

  27. Ide J, Maeda S, Takagi K (2004) Normal variations of the glenohumeral ligament complex: an anatomic study for arthroscopic Bankart repair. Arthroscopy 20:164–168

    Article  PubMed  Google Scholar 

  28. Ilahi OA, Labbe MR, Cosculluela P (2002) Variants of the anterosuperior glenoid labrum and associated pathology. Arthroscopy 18:882–886

    Article  PubMed  Google Scholar 

  29. Itoigawa Y, Itoi E, Sakoma Y, Yamamoto N, Sano H, Kaneko K (2012) Attachment of the anteroinferior glenohumeral ligament-labrum complex to the glenoid: an anatomic study. Arthroscopy 28:1628–1633

    Article  PubMed  Google Scholar 

  30. Jost B, Koch PP, Gerber C (2000) Anatomy and functional aspects of the rotator interval. J Shoulder Elbow Surg 9:336–341

    Article  CAS  PubMed  Google Scholar 

  31. Kaltsas DS (1983) Comparative study of the properties of the shoulder joint capsule with those of other joint capsules. Clin Orthop Relat Res 173:20–26

    PubMed  Google Scholar 

  32. Kask K, Poldoja E, Lont T, Norit R, Merila M, Busch LC, Kolts I (2010) Anatomy of the superior glenohumeral ligament. J Shoulder Elbow Surg 19:908–916

    Article  PubMed  Google Scholar 

  33. Kim SH, Ha KI, Cho YB, Ryu BD, Oh I (2003) Arthroscopic anterior stabilization of the shoulder: two to six-year follow-up. J Bone Joint Surg Am 85:1511–1518

    Article  PubMed  Google Scholar 

  34. Kim SH, Ha KI, Park JH, Kim YM, Lee YS, Lee JY, Yoo JC (2003) Arthroscopic posterior labral repair and capsular shift for traumatic unidirectional recurrent posterior subluxation of the shoulder. J Bone Joint Surg Am 85:1479–1487

    Article  PubMed  Google Scholar 

  35. Kim SH, Ha KI, Yoo JC, Noh KC (2004) Kim’s lesion: an incomplete and concealed avulsion of the posteroinferior labrum in posterior or multidirectional posteroinferior instability of the shoulder. Arthroscopy 20:712–720

    Article  PubMed  Google Scholar 

  36. Kim SH, Kim HK, Sun JI, Park JS, Oh I (2004) Arthroscopic capsulolabroplasty for posteroinferior multidirectional instability of the shoulder. Am J Sports Med 32:594–607

    Article  PubMed  Google Scholar 

  37. Kim KC, Rhee KJ, Shin HD, Kim YM (2008) Arthroscopic separate labral repair and capsular plication with a suture anchor. Arch Orthop Trauma Surg 128:535–538

    Article  PubMed  Google Scholar 

  38. Lintner SA, Speer KP (1997) Traumatic anterior glenohumeral instability: the role of arthroscopy. J Am Acad Orthop Surg 5:233–239

    PubMed  Google Scholar 

  39. Lintner SA, Levy A, Kenter K, Speer KP (1996) Glenohumeral translation in the asymptomatic athlete’s shoulder and its relationship to other clinically measurable anthropometric variables. Am J Sports Med 24:716–720

    Article  CAS  PubMed  Google Scholar 

  40. Lippitt SB, Vanderhooft JE, Harris SL, Sidles JA, Harryman DT 2nd, Matsen FA 3rd (1993) Glenohumeral stability from concavity-compression: a quantitative analysis. J Shoulder Elbow Surg 2:27–35

    Article  CAS  PubMed  Google Scholar 

  41. Luime JJ, Verhagen AP, Miedema HS, Kuiper JI, Burdorf A, Verhaar JA, Koes BW (2004) Does this patient have an instability of the shoulder or a labrum lesion? JAMA 292:1989–1999

    Article  CAS  PubMed  Google Scholar 

  42. Magit DP, Tibone JE, Lee TQ (2008) In vivo comparison of changes in glenohumeral translation after arthroscopic capsulolabral reconstructions. Am J Sports Med 36:1389–1396

    Article  PubMed  Google Scholar 

  43. Mazzocca AD, Brown FM Jr, Carreira DS, Hayden J, Romeo AA (2005) Arthroscopic anterior shoulder stabilization of collision and contact athletes. Am J Sports Med 33:52–60

    Article  PubMed  Google Scholar 

  44. Mc LH (1952) Posterior dislocation of the shoulder. J Bone Joint Surg Am 24:584–590

    Google Scholar 

  45. McMahon PJ, Dettling J, Sandusky MD, Tibone JE, Lee TQ (1999) The anterior band of the inferior glenohumeral ligament. Assessment of its permanent deformation and the anatomy of its glenoid attachment. J Bone Joint Surg Br 81:406–413

    Article  CAS  PubMed  Google Scholar 

  46. Mohammed KD, Sonnabend DH, Goldberg JA, Hutabarat S, Walker P, Walsh WR (1998) Biomechanical performance of Bankart repairs in a human cadaveric shoulder model. Am J Sports Med 26:831–835

    CAS  PubMed  Google Scholar 

  47. Moseley H, Overgaard B (1962) The anterior capsular mechanism in recurrent anterior dislocation of the shoulder: morphological and clinical studies with special reference to the glenoid labrum and glenohumeral ligaments. J Bone Joint Surg Br 44:913–927

    Google Scholar 

  48. Mueller MB, Fredrich HH, Steinhauser E, Schreiber U, Arians A, Imhoff AB (2005) Biomechanical evaluation of different suture anchors for the stabilization of anterior labrum lesions. Arthroscopy 21:611–619

    Article  PubMed  Google Scholar 

  49. Nho SJ, Frank RM, Van Thiel GS, Wang FC, Wang VM, Provencher MT, Verma NN (2010) A biomechanical analysis of anterior Bankart repair using suture anchors. Am J Sports Med 38:1405–1412

    Article  PubMed  Google Scholar 

  50. Nobuhara K, Ikeda H (1987) Rotator interval lesion. Clin Orthop Relat Res 223:44–50

    PubMed  Google Scholar 

  51. O’Brien SJ, Neves MC, Arnoczky SP, Rozbruck SR, Dicarlo EF, Warren RF, Schwartz R, Wickiewicz TL (1990) The anatomy and histology of the inferior glenohumeral ligament complex of the shoulder. Am J Sports Med 18:449–456

    Article  PubMed  Google Scholar 

  52. O’Connell PW, Nuber GW, Mileski RA, Lautenschlager E (1990) The contribution of the glenohumeral ligaments to anterior stability of the shoulder joint. Am J Sports Med 18:579–584

    Article  PubMed  Google Scholar 

  53. Ovesen J, Nielsen S (1985) Stability of the shoulder joint: cadaver study of stabilizing structures. Acta Orthop Scand 56:149–151

    Article  CAS  PubMed  Google Scholar 

  54. Owens BD, Harrast JJ, Hurwitz SR, Thompson TL, Wolf JM (2011) Surgical trends in Bankart repair: an analysis of data from the American Board of Orthopaedic Surgery certification examination. Am J Sports Med 39:1865–1869

    Article  PubMed  Google Scholar 

  55. Petchprapa CN, Beltran LS, Jazrawi LM, Kwon YW, Babb JS, Recht MP (2010) The rotator interval: a review of anatomy, function, and normal and abnormal MRI appearance. AJR Am J Roentgenol 195:567–576

    Article  PubMed  Google Scholar 

  56. Petrera M, Patella V, Patella S, Theodoropoulos J (2010) A meta-analysis of open versus arthroscopic Bankart repair using suture anchors. Knee Surg Sports Traumatol Arthrosc 18:1742–1747

    Article  CAS  PubMed  Google Scholar 

  57. Pfahler M, Haraida S, Schulz C, Anetzberger H, Refior HJ, Bauer GS, Bigliani LU (2003) Age-related changes of the glenoid labrum in normal shoulders. J Shoulder Elbow Surg 12:40–52

    Article  CAS  PubMed  Google Scholar 

  58. Pouliart N, Gagey O (2005) Reconciling arthroscopic and anatomic morphology of the humeral insertion of the inferior glenohumeral ligament. Arthroscopy 21:979–984

    Article  PubMed  Google Scholar 

  59. Reeves B (1968) Experiments on the tensile strength of the anterior capsular structures of the shoulder in man. J Bone Joint Surg Br 50:858–865

    CAS  PubMed  Google Scholar 

  60. Rhee YG, Ha JH, Cho NS (2006) Anterior shoulder stabilization in collision athletes: arthroscopic versus open Bankart repair. Am J Sports Med 34:979–985

    Article  PubMed  Google Scholar 

  61. Rowe CR, Zarins B (1981) Recurrent transient subluxation of the shoulder. J Bone Joint Surg Am 63:863–872

    CAS  PubMed  Google Scholar 

  62. Soslowsky LJ, Flatow EL, Bigliani LU, Mow VC (1992) Articular geometry of the glenohumeral joint. Clin Orthop Relat Res 285:181–190

    PubMed  Google Scholar 

  63. Soslowsky LJ, Malicky DM, Blasier RB (1997) Active and passive factors in inferior glenohumeral stabilization: a biomechanical model. J Shoulder Elbow Surg 6:371–379

    Article  CAS  PubMed  Google Scholar 

  64. Steinbeck J, Liljenqvist U, Jerosch J (1998) The anatomy of the glenohumeral ligamentous complex and its contribution to anterior shoulder stability. J Shoulder Elbow Surg 7:122–126

    Article  CAS  PubMed  Google Scholar 

  65. Sugalski MT, Wiater JM, Levine WN, Bigliani LU (2005) An anatomic study of the humeral insertion of the inferior glenohumeral capsule. J Shoulder Elbow Surg 14:91–95

    Article  PubMed  Google Scholar 

  66. Ticker JB, Bigliani LU, Soslowsky LJ, Pawluk RJ, Flatow EL, Mow VC (1996) Inferior glenohumeral ligament: geometric and strain-rate dependent properties. J Shoulder Elbow Surg 5:269–279

    Article  CAS  PubMed  Google Scholar 

  67. Tirman PF, Feller JF, Palmer WE, Carroll KW, Steinbach LS, Cox I (1996) The Buford complex—a variation of normal shoulder anatomy: MR arthrographic imaging features. AJR Am J Roentgenol 166:869–873

    Article  CAS  PubMed  Google Scholar 

  68. Turkel SJ, Panio MW, Marshall JL, Girgis FG (1981) Stabilizing mechanisms preventing anterior dislocation of the glenohumeral joint. J Bone Joint Surg Am 63:1208–1217

    CAS  PubMed  Google Scholar 

  69. Uhthoff HK, Piscopo M (1985) Anterior capsular redundancy of the shoulder: congenital or traumatic? An embryological study. J Bone Joint Surg Br 67:363–366

    CAS  PubMed  Google Scholar 

  70. Warner JJ, Deng XH, Warren RF, Torzilli PA (1992) Static capsuloligamentous restraints to superior-inferior translation of the glenohumeral joint. Am J Sports Med 20:675–685

    Article  CAS  PubMed  Google Scholar 

  71. Williams MM, Snyder SJ, Buford D Jr (1994) The Buford complex—the “cord-like” middle glenohumeral ligament and absent anterosuperior labrum complex: a normal anatomic capsulolabral variant. Arthroscopy 10:241–247

    Article  CAS  PubMed  Google Scholar 

  72. Yang HF, Tang KL, Chen W, Dong SW, Jin T, Gong JC, Li JQ, Wang HQ, Wang J, Xu JZ (2009) An anatomic and histologic study of the coracohumeral ligament. J Shoulder Elbow Surg 18:305–310

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopedics, Juntendo University Urayasu Hospital, 2-1-1, Tomioka, Chiba, Urayasu, 2790021, Japan

    Yoshiaki Itoigawa

  2. Department of Orthopaedic Surgery, Tohoku University School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Miyagi, Sendai, 9808574, Japan

    Eiji Itoi

Authors
  1. Yoshiaki Itoigawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Eiji Itoi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Eiji Itoi.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Itoigawa, Y., Itoi, E. Anatomy of the capsulolabral complex and rotator interval related to glenohumeral instability. Knee Surg Sports Traumatol Arthrosc 24, 343–349 (2016). https://doi.org/10.1007/s00167-015-3892-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-015-3892-1

Keywords

Search

Navigation