The coracohumeral ligament (CHL) is an important structure of the biceps pulley which also merges with the rotator cuff. Which role it actually plays in the pathogenesis of rotator cuff degeneration (RCD) and rotator cuff tears (RCT) is still a point of discussion. The hypothesis of this study was, that macroscopic injury to the anterosuperior part of the rotator cuff also includes parts of or the whole CHL. Forty fresh-frozen shoulders were dissected and examined, the morphology of the rotator cuff and the coracohumeral ligament were evaluated and existing lesions documented. 27.5% of the shoulder joints showed an anterosuperior full-thickness RCT. 57.5% of all examined shoulder girdles showed at least a partial rupture of the CHL. A highly significant correlation (p < 0.001, rho = 0.529) between the presence of rotator cuff tears and ruptures of the CHL was found. Cartilage damage within the anterosuperior section of the humeral head was observed in 20% cases. In rotator cuff degeneration and atraumatic rotator cuff tears of the elderly population, the pathomechanism of full-thickness RCT is based on repetitive anterosuperior glenoid impingement. This is especially supported by the identification of a higher frequency of CHL lesions compared to RCT reported in this study. No intact CHL was identified in shoulders with damaged rotator cuff tendons.
Introduction Rotator cuff tears are the most common cause for pain and dysfunction in the shoulder girdle. Located in the subacromial space, the small rotators of the shoulder joint merge into a thick tendinous cuff, which shows high relevance in the biomechanics of the shoulder joint. Correlating with age, rotator cuff lesions can be caused by intrinsic and extrinsic factors. There is a wide consent that the coracohumeral ligament itself is a part of the rotator cuff. Its role, in terms of pathogenesis, diagnostic and treatment of rotator cuff tears, is still unknown. Material and Methods 40 fresh frozen shoulders were dissected and examined. The existence of rotator cuff tears was the objective of that process. Lesions as well as the morphology of the cuff and the coracohumeral ligament were photographically documented, measured computer‐assisted and statistically analyzed. Results In 27.5% of all shoulder joints, a rotator cuff tear was observed. In addition, there was an increase of rotator cuff tears with advancing age. Statistical analysis revealed no significant difference in the sex distribution and measured tear‐area in ruptured cuffs and coracohumeral ligament (female: p=0.463, male: p=0.336). A significant connection (p=0.001) between the prevalence of rotator cuff tears and ruptures of the coraohumeral ligament was found. There was no intact coracohumeral ligament in shoulders with a damaged rotator cuff. However, ruptured coracohumeral ligaments were found in joints with uninjured tendons. Conclusion Apart from a significant connection (p=0.001) between the prevalence of rotator cuff tears and ruptures of the coracohumeral ligament this study is the first to suggest that the coracohumeral ligament ist one of the first structures damaged in the degeneration of the rotator cuff. The results presented in this study imply that the degeneration of the rotator cuff occurs from bursal towards the subacromial space, which is contrary to the classic Impingement‐Syndrome‐Theory.
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