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An Arthroscopic Technique for Release of the Middle Glenohumeral Ligament and the Effect on External Rotation of the Shoulder.

ABSTRACT: The middle glenohumeral ligament (MGHL) is well recognized as a primary stabilizer of the shoulder. Its role in shoulder pathologies such as adhesive capsulitis, subscapularis tendon tear, and glenohumeral arthritis is less understood. Biomechanically, the MGHL plays an important role in range of motion, specifically involving normal and pathologic external rotation in less than 45° of abduction. In this Technical Note, we present a technique for arthroscopic release of the MGHL in the setting of a stable shoulder with preoperative loss of external rotation and a patient at risk for postoperative restriction of external rotation.

SUBMITTER: Tipton CC

PROVIDER: S-EPMC8417305 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BackgroundThe middle glenohumeral ligament (MGHL) is one of the three ligaments that stabilize the anterior capsule of the shoulder. Recent work suggests that it inserts distally into the deep layer of the subscapularis tendon. The role of the MGHL remains debated. The hypothesis of this study was that the MGHL plays a significant functional role in limiting external rotation of the shoulder while allowing a wide range of motion through its distal insertion into the subscapularis rather than directly onto the humerus.MethodsIn a cadaveric study performed on 20 shoulders (10 subjects), the MGHL and the other anterior structures of the shoulder were successively cut according to a standardized protocol. At each stage, the external rotation range of the shoulder was measured with the arm at the side (ER 1) and in 90° abduction (ER 2) using a goniometer. After dissection, the structure of the MGHL and its distal insertion were analyzed.ResultsCutting the MGHL led to significant increases in ER 1 but not in ER 2. Shoulder range of motion in ER 1 increased on average by 15 ± 5° (P < .001) after cutting the MGHL and by 21 ± 11° (P < .001) after subscapularis peel. The range of motion in ER 2 increased by 3 ± 4° (P = .048) after cutting the MGHL, by 4 ± 6° (P = .02) after subscapularis peel and by 25 ± 8° (P < .001) after cutting the inferior glenohumeral ligament. The MGHL was present in all dissected shoulders. It was leaf-like in 12 cases, cord-like in 6 cases and had a vestigial appearance in 2 cases. The distal insertion was in all cases in the deep layer of the subscapularis in a thickening of the anterior capsule in the superior part of the muscle, except for two cases in which the tendinous part of the subscapularis was also involved.ConclusionThe MGHL limited shoulder external rotation by a similar amount as the subscapularis muscle. Further studies are required to understand the clinical relevance of these findings, notably for the treatment of shoulder stiffness.

Project description:BackgroundThe cross-body and the modified sleeper stretch have been used to improve posterior shoulder soft tissue flexibility and to increase glenohumeral joint internal rotation (GHJ IR) in overhead athletes. However, due to the inability to stabilize patient's scapula and control GHJ rotation with the cross-body stretch and the potential for subacromial impingement or symptoms' aggravation with the modified sleeper stretch, a new stretching technique (Passive Glenohumeral Internal Rotation with Clam Shell Bridging) was developed as an alternative to these commonly used stretches that may allow for greater stability of the scapula without reproducing symptoms. Thus, the current study aimed to examine and compare a novel stretching technique to the traditional modified sleeper stretch to determine the effect on glenohumeral IR range of motion (ROM) and self-reported pain in overhead athletes with glenohumeral internal rotation deficits (GIRD).MethodsForty-two overhead athletes with GIRD [mean age 25.9 ± 2.6 years, 20 males and 22 females] participated in this study. Participants were randomly assigned into either novel stretching group or modified sleeper stretching group. IR ROM was measured with a digital inclinometer before, immediately, and at week 4 post intervention, while pain was measured with Numeric Pain Rating Scale before and at week 4 post intervention.ResultsThere was no significant group by time interaction effect for IR ROM (p = 0.27); however, there was a significant change over time (p < 0.001, η2 = 0.77). Both groups demonstrated a significant increase in IR from baseline to immediate and week 4, and from immediate to week 4 (p < 0.001). There was a significant group by time interaction for pain intensity (p < 0.001, η2 = 0.72). Results showed a significant reduction in pain intensity over time in the novel group (p = 0.001, d = 2.18), but not in the traditional group (p = 0.231, d = 0.46).ConclusionBoth stretches appear to be effective at improving IR ROM in overhead athletes with GIRD. However, the novel stretching might be more effective at reducing shoulder pain and thus may be more appropriate for symptomatic patients.Trial registrationProspectively registered in February 6, 2017 under Clinical Trial Registry # NCT03044236 .

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An Arthroscopic Technique for Release of the Middle Glenohumeral Ligament and the Effect on External Rotation of the Shoulder.

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