This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow [Supplementary Material]
Right arrow Letters to the Editor: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when Letters to the Editor are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrowReprints and Permissions
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Andary, J. L.
Right arrow Articles by Petersen, S. A.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Andary, J. L.
Right arrow Articles by Petersen, S. A.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us   Add to Technorati  
What's this?
The Journal of Bone and Joint Surgery (American) 84:2258-2265 (2002)
© 2002 The Journal of Bone and Joint Surgery, Inc.

Scientific Article

The Vascular Anatomy of the Glenohumeral Capsule and Ligaments: An Anatomic Study

John L. Andary, MD, MBA and Steve A. Petersen, MD

Investigation performed at the Department of Orthopaedic Surgery, Wayne State University, Detroit, Michigan, and the Laboratory for Comparative Orthopaedic Research, College of Human Medicine and Veterinary School, Michigan State University, East Lansing, Michigan

John L. Andary, MD, MBA
Shoulder and Knee Center, 2035 East 17th Street, Idaho Falls, ID 83404. E-mail address: andary{at}cableone.net

Steve A. Petersen, MD
Hutzel Hospital, Suite One South, 4707 St. Antoine, Detroit, MI 48201

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Background: A detailed description of the vascular anatomy of the shoulder capsule is lacking, yet surgical procedures may put this capsular blood supply at risk. We hypothesized that a hypovascular area is present in the capsule. The purpose of the present study was to describe the vascular anatomy of the human glenohumeral capsule and ligaments and its relevance to surgical treatment of the shoulder.

Methods: In twenty-four fresh adult cadaveric shoulders, the axillary artery proximal to the thoracoacromial branch and the suprascapular artery were injected with India ink. The specimens were sectioned and then cleared with a modified Spalteholz technique.

Results: The glenohumeral capsule demonstrates consistent arterial contributions from the anterior circumflex, posterior circumflex, circumflex scapular, and suprascapular arteries. The arterial supply is centripetal in nature. The contributing vessels enter the capsule both laterally and medially and arborize toward the middle of the capsule. The rotator cuff provides additional blood supply to the capsule through perforating vessels. The dominant capsular vessels run horizontally and form intracapsular anastomoses via vertical branches. The anterior and posterior bands of the inferior glenohumeral ligament complex are vascularized by adjacent parallel vessels. In five of twelve specimens, a hypovascular zone was located near the humeral insertion of the anterior aspect of the capsule. In these five specimens, there was an associated hypovascular zone in the underlying capsule.

Conclusion: The glenohumeral capsule is a well-vascularized structure with direct predictable contributions from four named arteries. These arteries send branches that enter the capsule superficially and from the periphery. These dominant vessels run horizontally toward the midcapsule and to deeper layers of the capsule. Vessels originating from the rotator cuff provide additional blood supply to the capsule.

Clinical Relevance: Surgical approaches to the shoulder that separate the rotator cuff from the capsule may disrupt the perforating blood supply from the overlying rotator cuff. Horizontal capsular incisions run parallel to the dominant vessels of the capsule, while vertical incisions are likely to cross these vessels. Laterally based capsular incisions may traverse the hypovascular zone when it is present.


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Technorati Technorati    What's this?