TENDONS, LIGAMENTS, AND CAPSULE OF THE ROTATOR CUFF - GROSS AND MICROSCOPIC ANATOMY

We investigated the structure of the myotendinous rotator cuff in thirty-two grossly intact cuffs from thirty fresh cadavera of subjects who had been seventeen to seventy-two years old at the time of death. We studied the gross anatomy of the capsule and ligaments of the cuff, as well as histological sections of the tendons of the subscapularis, supraspinatus, and infraspinatus muscles. The tendons were found to splay out and interdigitate to form a common, continuous insertion on the humerus. The biceps tendon was ensheathed by interwoven fibers derived from the subscapularis and supraspinatus tendons. The anterior margin and bursal surface of the supraspinatus tendon were enveloped by a thick sheet of fibrous tissue derived from the coracohumeral ligament. Fibers from the coracohumeral and glenohumeral ligaments were found concentrated in a plane between the capsule and the tendons of the cuff. Microscopically, in the region of the supraspinatus and infraspinatus tendons, the cuff was composed of five layers defined by the attachments and orientations of the fibrous elements in each of these layers. CLINICAL RELEVANCE: In the rotator cuff, which is a composite of the capsule, the ligaments, and the tendons around the shoulder, the supraspinatus tendon is reinforced by fibers of the coracohumeral ligament and fibers from adjacent tendons. Therefore, lesions in the area of the supraspinatus tendon may involve one or more of these elements, and the evolution of a tear in this area may be determined by the location of the initial lesion.