Diagnostic shoulder arthroscopy: incidence of physiologic variants of joint structures
Abstract
Background: Shoulder arthroscopy first described by Burman already in 1930, has evolved only in last 15 years to become a common accepted diagnostic and therapeutic procedure in treatment of different shoulder conditions. Parallely to the advances in arthroscopic operative techniques also our knowledge about arthroscopic shoulder anatomy expanded and many physiologic variants in anatomical structures have been identified in glenohumeral joint. It is very important to be familiar with those when performing shoulder arthroscopy, since in some cases they can easily be mistaken for pathologic lesions which can lead to unnecessary and potentially harmful operative procedures.
Methods: We prospectively evaluated arthroscopic shoulder anatomy in 54 consecutive shoulder arthroscopies performed for different shoulder conditions in our practice. In all patients diagnostic arthroscopy was performed following the SCOI protocol described by Snyder. With regard to the anatomy variants described in literature and its importance in shoulder arthroscopy, special attention was focused on three regions of glenohumeral joint: long head of biceps tendon with its anchor and adjacent superior labrum, anterior joint capsule with glenohumeral ligaments and subscapularis tendon and on anterior labrum. The incidence of the observed anatomical variants was calculated. The most common combinations of anatomy variants were described and schematically presented.
Results: The most significant anatomical variant observed in the region of long head of biceps tendon, biceps anchor and superior labrum was sublabral sulcus that was observed in 17% of shoulders. The region of anterior capsule with glenohumeral ligaments and subscapularis tendon showed greatest anatomical variability, especially the MGHL and the IGHL were very variably expressed and in some cases also absent. In the region of anterior labrum two significant anatomical variants were observed, one of them sublabral hole that was present in 21% of shoulders and the other absent anterosuperior labrum noted in 5% of examinations, which was typically associated with the cord like MGHL to form the socalled Buford complex.
Conclusions: Glenohumeral joint structures show significant variability. Familiarity with presented anatomic variants and attention to described details that distinguish them from pathologic lesions are of crucial importance in decision making during shoulder arthroscopy.
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References
Burman MS. Arthroscopy or the direct visualization of joints: an experimental cadaver study. JBJS 1931; 93B(8): 669.
Johnson LL. Shoulder arthroscopy. In: Arthroscopic surgery: principles and practice. St. Louis: Mosby; 1984. p. 1301–445.
Matthews LS, Vetter WL, Helfet DL. Arthroscopic surgery of the shoulder. Adv Orthop Surg 1984; 8: 203.
Andrews JR, Carson WG. Operative arthroscopy of the shoulder: a preliminary report. Orthop Trans 1984; 8: 403.
Andrews JR, Heckman MM, Guerra JJ. Diagnostic arthroscopy of the shoulder. In: McGinty JB, Caspari RB, Jackson RW, Poehling GG, eds. Operative arthroscopy, 2nd ed. Philadelphia: Lippincott-Raven Publishers; 1996. p. 647–61.
Hulstyn MJ, Fedale PD. Arthroscopic anatomy of the shoulder. Orthop Clin North Am 1995; 26(4): 597–612.
Ilahi OA, Labbe MR, Cosculluela P. Variants of the anterosuperior glenoid labrum and associated pathology. Arthroscopy 2002; 18(8): 882–6.
Rao AG, Kim TK, Chronopoulos E, McFarland EG. Anatomical variants in the anterosuperior aspect of the glenoid labrum: a statistical analysis of seventy-three cases. JBJS 2003; 85A(4): 653–9.
Snyder SJ. Diagnostic arthroscopy of the shoulder: normal anatomy and variations. In: Snyder SJ. Shoulder arthroscopy. 2nd ed. Philadelphia: Lippincott Williams & Wilkins; 2003. p. 22–38.
Gartsman GM. Diagnostic arthroscopy and normal anatomy. In: Gartsman GM. Shoulder arthroscopy. Philadelphia: Saunders; 2003. p. 48–78.
Lashgari CJ, Galatz LM, Yamaguchi K. Arthroscopic shoulder anatomy. In: Tibone JE, Savoie FH, Shaffer BS, eds. Shoulder arthroscopy. New York: Springer; 2003. p. 17–34.
Savoie FH, Field LD, Atchinson S. Anterior superior instability with rotator cuff tearing: SLAC lesion. Orthop Clin North Am 2001; 32(3): 457–61.
Field LD, Savoie FH. Anterosuperior instability and the rotator interval. Operative Techniques in Sports Medicine 1997; 5(4): 257–63.
Vangsness CT, Jorgenson SS, Watson T, Johnson DL. The origin of the long head of the biceps from the scapula and glenoid labrum. An anatomical study of 100 shoulders. JBJS 1994; 76B: 951–4.
Wahl CJ, Warren RF, Altchek DW. Shoulder arthroscopy. In: Rockwood CA, Matsen FA, Wirth MA, Lippitt SB, eds. The shoulder. 3rd ed. Philadelphia: Elsevier; 2004. p. 283–354.
Moseley HF, Overgaard B. The anterior capsular mechanism in recurrent anterior dislocation of the shoulder. JBJS 1962; 44-B: 913–27.
Williams MM, Snyder SJ, Buford DJ. The Buford complex – the »cord-like« middle glenohumeral ligament and absent anterosuperior labrum complex: A normal anatomic capsulolabral variant. Arthroscopy 1994; 10: 241–7.
Ide J, Maeda S, Takagi K. Normal variations of the glenohumeral ligament complex: an anatomic study for arthroscopic Bankart repair. Arthroscopy 2004; 20: 164–8.
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