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Soft Tissue Structures

Anatomy and pathology of the glenohumeral capsule, subacromial bursa, and rotator interval, focusing on their roles in joint stability and pain generation.

Overview

Recognizing complex soft tissue injuries is critical to restore anatomic attachments and prevent chronic instability in global elbow instability [1]. Open reduction of interposed tissues can yield good short-term functional outcomes in irreducible isolated anteromedial radial head dislocation caused by ruptured anterior capsule and annular ligament interposition [2]. However, current evidence remains insufficient to clearly define the relationship between the structural integrity of repaired cuffs and long-term clinical outcomes [5].

Establishment of normative values for soft-tissue redundancy may enable surgeons to explain lack of progress after surgical joint release, determine progress with hand therapy, and select the optimal timing of surgical intervention once soft-tissue equilibrium is achieved [6]. Understanding the current evidence and appropriate indications of emerging technologies in orthopaedic trauma is of critical importance for their utilization [29]. Long-term outcomes beyond five years and high-quality comparative or randomized trials are needed to define durability, refine indications, and position long head of the biceps-based dynamic anterior stabilization within the broader algorithm for anterior shoulder instability management [7].

Many treatment techniques for periscapular tendon transfers remain in their infancy and require further follow-up before universal adoption [12]. Revision total shoulder arthroplasty is technically challenging with inferior results compared to primary arthroplasty, particularly when soft-tissue problems are the indication [14]. The biomechanical consequence of biceps adhesions may limit range of motion and clinical outcomes in situations where the biceps is at risk for scarring [15]. SLAP repairs are generally favored in younger, active patients, whereas treating the biceps is preferred in lower-demand patients aged greater than 30 years [34]. Although anatomic restoration of the shoulder can be accomplished using subscapularis-sparing total shoulder arthroplasty, retained osteophytes and significant mismatch of the humeral head depth raise concerns regarding long-term outcomes [37]. Based on results of a series on deltoid flap reconstruction for massive rotator cuff tears, the authors no longer use nor recommend this technique [72].

Anatomy & Pathophysiology

Ligamentous and Capsular Structures

The glenoid labrum possesses defined embryology, anatomy, microscopy, biomechanical properties, and clinical lesions [3]. The glenocapsular ligament is a constant anatomical structure consisting of one or two different parts [17], and both this ligament and the posterosuperior part of the joint capsule are well vascularized [17]. The superior shoulder capsule acts as a critical stabilizer, as its tear or defect significantly increases glenohumeral translation and subacromial contact pressure [52]. Posterior glenohumeral joint capsule contracture alters humeral head translations and/or the humeral axis of rotation during movement, creating conditions that lead to joint pathology [50]. Posterior and posterior superior labral (PPS) injuries produce alterations in glenohumeral kinematics with implications for joint instability, increased joint loading, and potential joint damage [51]. On average, laxity is restored to baseline tension after 10-mm plication, but this determination varies depending on shoulder position [48].

Kinematics and Scapular Mechanics

Subjective mechanical symptoms are a common complaint in patients with suspected rotator cuff pathology [18]. Specific alterations of scapular muscular activation and kinematics are found in different patterns of scapular dyskinesis [40], and scapular dysfunction may contribute to symptoms in patients with neck pain [41]. Posterior shoulder tightness results in scapular malposition, with muscular and capsular components affecting scapular position differently [44]. Simulated isolated supraspinatus cord and strap tears significantly reduce shoulder abduction force, with cord tears causing a larger decline than strap tears [49]. In the setting of an irreparable supraspinatus tear, superior capsular reconstruction restores key biomechanical parameters of the shoulder to intact levels [38]. Resurfacing the undersurface of the acromion using the Bursal Acromial Reconstruction (BAR) technique leads to significantly improved glenohumeral superior translation, maximum abduction angle, cumulative deltoid force, and subacromial contact pressure compared with an irreparable rotator cuff tear [42].

Osseous and Fracture Stability

A posterior acromial bone block is biomechanically effective at restoring the force required to translate the humeral head posteriorly in a cadaveric, posterior glenohumeral instability model [43]. The studied construct for three-part humeral head fractures allows micromovements that are not able to cause humeral head rotation and translation [39].

Operative Outcomes and Repair Modalities

Both open and arthroscopic repair of anterosuperior rotator cuff tears with subscapularis involvement significantly improve shoulder function and are relatively safe procedures [45]. Early surgical treatment seems to be a relevant factor allowing good shoulder function after arthroscopic repair of isolated subscapularis tears [46]. Arthroscopic and open repair methods for rotator cuff tears are biomechanically equivalent [47].

Classification

Soft Tissue Injury Recognition: Complex soft tissue injuries in global elbow instability require recognition to restore anatomic attachments and prevent chronic instability [1]. Updated reviews of anatomy, mechanics, pathomechanics, and treatment are essential for understanding the disabled throwing shoulder [8]. Detailed anatomy and anatomical variations of the glenohumeral joint are essential for understanding pathology, diagnosing instability, and selecting treatment options [21].

Glenoid Labrum: The glenoid labrum is characterized by specific embryology, anatomy, microscopy, biomechanical properties, and clinical lesions [3]. Anatomic regions of the glenoid labrum differ in extracellular matrix composition, vascularity, and cell composition [60].

Glenocapsular Ligament: The glenocapsular ligament is a constant anatomical structure consisting of one or two different parts [17]. The glenocapsular ligament and the posterosuperior part of the joint capsule of the shoulder are well vascularized [17].

Tendon Enthesis Interface: A zone exhibiting a gradient in mineral relative to collagen is detected at the leading edge of the hard-soft tissue interface as early as postnatal day 7 [27]. Development of the graded mineralized interface at the tendon enthesis is linked to endochondral bone formation near the tendon insertion [27].

Subscapularis Muscle and Tendon: The most common type of subscapularis muscle classification is the muscle with three bellies, consistent with Larson's model [58]. The subscapularis tendon is composed of two distinct fibrous layers [62]. The two distinct fibrous layers of the subscapularis tendon are arranged differently than those of the supraspinatus tendon [62].

Bicipital Tunnel and Long Head of Biceps: The bicipital tunnel is a closed space with three anatomically and histologically distinct zones [59]. Zones 1 and 2 of the bicipital tunnel differ from zone 3 [59]. A classification of 12 variations of the intra-articular portion of the long head of the biceps tendon has been proposed [65]. Congenital variations of the intra-articular portion of the long head of the biceps tendon may acquire pathologic significance due to partial detachment from the mesothelial or synovial fusion with the inferior surface of the capsule [65].

Coracohumeral Ligament: The coracohumeral ligament is composed of irregular and sparse fibers containing relatively rich type III collagen [67]. The composition of irregular and sparse fibers with rich type III collagen in the coracohumeral ligament suggests flexibility [67]. The coracohumeral ligament is more capsular than ligamentous based on its histologic features [68].

Other Considerations: Minor variations in the overall anatomical pattern were found in the supporting structures and layers on the medial side of the knee [10].

Clinical Presentation

Recognition of complex soft tissue injuries is critical to restore anatomic attachments and prevent chronic instability in global elbow instability [1]. Open reduction of interposed tissues can yield good short-term functional outcomes in irreducible isolated anteromedial radial head dislocation [2]. In the shoulder, understanding detailed glenohumeral anatomy and variations is essential for diagnosing instability and selecting treatment options [21]. Updates on thrower's shoulder anatomy, mechanics, pathomechanics, and treatment remain essential for clinicians [8].

Inspection and Palpation: Scapular muscle detachment presents as a clinically identifiable syndrome with a homogeneous set of history and physical findings [4]. Fibrous bands are a common cadaveric finding in the quadrilateral space, suggesting they are a normal variant rather than a pathological cause [9]. A septum between the long head biceps tendon and intra-articular supraspinatus may be recognized to guide arthroscopic therapeutic decisions based on patient symptoms [11]. Nuchal fibromas, typically superficial, may involve deep skeletal muscle and fascia and present as difficult-to-resect lesions [19].

Range of Motion and Symptoms: Subjective mechanical symptoms are a common complaint in patients with suspected rotator cuff pathology [18]. The procedure for deltoid muscle contracture resolved pain, skin dimpling, palpable fibrous bands, and scapular winging without infection or neuromuscular complications [23]. Nonsurgical treatment is a viable option for spontaneous resolution of spinoglenoid ganglion cysts if there is no suprascapular nerve involvement or superior labrum anterior and posterior-related physical findings [26].

Stability and Special Tests: Ligamentous laxity is clinically significant in the context of patellofemoral instability [54]. Minor variations in the overall anatomical pattern were found regarding supporting structures and layers on the medial side of the knee [10]. The glenoid labrum review summarizes embryology, anatomy, microscopy, biomechanical properties, and clinical lesions to aid clinician understanding of its function and pathology [3].

Red-Flag Patterns and Prognosis: An extensive subscapularis tear is a negative prognosis factor for ten-year clinical and anatomic follow-up after repair of anterosuperior rotator cuff tears [55]. Recognition of atypical presentations of calcific tendinitis with bone erosion may prevent unnecessary biopsy and overtreatment [20]. The most dramatic feature of the failed healing response at the tendon-to-bone interface is the lack of a transitional tissue between the healing tendon and bone [13]. Literature reviews have been unable to link uncommon congenital variations of the long head of the biceps tendon to a common pathoanatomic presentation or suggest a universally accepted treatment algorithm [24]. Arthroscopic surgery allows for complete resection of soft tissue tumours causing coracoid impingement syndrome [56]. Treatment techniques for periscapular tendon transfers provide a novel means of addressing difficult-to-treat and complex shoulder girdle pathologies, though further follow-up is necessary before universal adoption [12].

Investigations

Plain radiography: Radiographic methods including 3-D CT and MRI as well as intraoperative findings of the labrum cannot be considered an accurate and reliable basis for the diagnosis and treatment of subspine impingement in FAI patients [71]. Recognition of atypical presentations of calcific tendinitis with bone erosion may prevent unnecessary biopsy and overtreatment [20].

MRI: Magnetic resonance imaging indicates that the donor site after autologous osteochondral mosaicplasty is resurfaced with fibrous tissue [61]. Bioinductive repair enabled a robust healing response evident through MRI and biopsy evaluation, demonstrating superior tendon quality and healing compared to sutured repair for full-thickness rotator cuff tears [30]. Multi-photon imaging revealed a clear three-dimensional structure of human muscle in satellite cells from rotator cuff tears with or without fatty infiltration [75].

Other Considerations: Complex soft tissue injuries must be recognized to restore anatomic attachments and prevent chronic instability in global elbow instability [1]. Open reduction of interposed tissues can result in a good functional outcome in the short term for irreducible isolated anteromedial radial head dislocation [2]. The glenoid labrum review summarizes embryology, anatomy, microscopy, biomechanical properties, and clinical lesions to aid clinician understanding of its function and pathology [3]. Fibrous bands are a common finding in the quadrilateral space in cadavers, suggesting they are a normal finding rather than a pathological cause [9]. Recognizing the persistence of a septum between the long head biceps tendon and intra-articular supraspinatus may help arthroscopic surgeons decide the best therapeutic options depending on patient symptoms [11]. Improved histology at the tendon-to-bone interface was correlated with improved final construct strength at the 12-week time point in a sheep model using an interposition bioresorbable scaffold [16]. Nuchal fibromas, typically superficial lesions, may involve deep skeletal muscle and fascia and can be difficult to resect [19]. Conservative treatment was useless for idiopathic extension contracture of the little metacarpophalangeal joint [22]. The presence of chondrosis at the time of surgery is an important prognosticator of functional outcome at intermediate follow-up in late multiple ligament and posterolateral corner-reconstructed knees [28]. Medialization provides less tension to the tendon, which leads to a more effective healing process and improves clinical outcome postoperatively for postero superior retracted cuff tears [32]. The arthroscopic approach offers a unique advantage in diagnosing and treating occult intra-articular pathology compared to open distal clavicle excision [73]. Neither the critical shoulder angle nor the acromial index influenced the functional outcomes of massive posterosuperior tears after repair [74]. Inspecting and excising Cleland's ligaments during digital fasciectomy is recommended to avoid residual disease and suboptimal correction [76]. Synovial chondromatosis should be considered when a periarticular mass is evident due to its rarity [77].

Treatment

Non-Operative

Initial management of posterior capsular contracture should be nonsurgical, emphasizing range-of-motion stretching [53]. Nonsurgical management of adhesive capsulitis of the hip is often successful but can take a protracted amount of time and requires patient compliance [66]. Nonsurgical treatment may be a viable option for spontaneous resolution of spinoglenoid ganglion cysts in the absence of suprascapular nerve involvement or superior labrum anterior and posterior-related physical findings [26]. Conservative treatment was useless for idiopathic extension contracture of the little metacarpophalangeal joint [22].

Operative

Indications: SLAP repairs are generally favored in younger, active patients, whereas treating the biceps is preferred in lower-demand patients aged greater than 30 years [34]. Open reduction of interposed tissues can result in a good functional outcome in the short term for irreducible isolated anteromedial radial head dislocation [2]. Manipulation under anaesthetic is recommended in post-traumatic stiffness cases where conservative methods have failed [63]. Operative treatment resulted in greater improvement in Constant scores and significantly decreased pain scores compared to nonoperative management for full-thickness rotator cuff tears [57].

Surgical Approach / Technique: Recognizing the persistence of a septum between the long head biceps tendon and intra-articular supraspinatus may help arthroscopic surgeons decide the best therapeutic options depending on each patient's symptoms [11]. Treatment techniques for periscapular tendon transfers provide a novel means of addressing difficult-to-treat and complex shoulder girdle pathologies, though many remain in their infancy and further follow-up is necessary before universal adoption [12]. Repair of large rotator cuff tears structurally reinforced with xenograft ECM resulted in improved functional outcomes scores and strength [33]. Bioinductive repair enabled a robust healing response evident through MRI and biopsy evaluation, demonstrating superior tendon quality and healing compared to sutured repair for full-thickness rotator cuff tears at 2 years [30]. Medialization provides less tension to the tendon, which leads to a more effective healing process and improves clinical outcome postoperatively for postero superior retracted cuff tears [32].

Adjuncts: Improved histology at the tendon-to-bone interface was correlated with improved final construct strength at the 12-week time point when using an interposition bioresorbable scaffold with a vented anchor for primary rotator cuff repair in sheep [16].

Other Considerations: Recognizing complex soft tissue injuries is important to restore anatomic attachments and prevent chronic instability in global elbow instability [1]. Scapular muscle detachment appears to be a clinically identifiable syndrome with a homogeneous set of history and physical findings [4]. Current evidence is insufficient to clearly define the relationship between structural integrity of repaired cuffs and long-term clinical outcome [5]. Establishment of normative values for soft-tissue redundancy may enable surgeons to explain lack of progress after surgical joint release, determine progress with hand therapy, and choose optimal timing of surgical intervention once soft-tissue equilibrium is achieved [6]. Long-term outcomes beyond five years and high-quality comparative or randomized trials are needed to define durability, refine indications, and position long head of biceps-based dynamic anterior stabilization within the broader algorithm for anterior shoulder instability management [7]. Revision total shoulder arthroplasty is technically challenging with inferior results compared to primary arthroplasty, particularly when soft-tissue problems are the indication [14]. Not all patients with healed rotator cuffs experience good outcomes despite good healing rates [64]. Clinical results for arthroscopic surgery of rotator cuff retear showed improvements in scores and decreased pain, especially in patients treated with a new repair [69]. Understanding current evidence and appropriate indications of emerging technologies is of critical importance for their utilization [29].

Complications

Instability: Complex soft tissue injuries must be recognized to restore anatomic attachments and prevent chronic instability [1]. Open reduction of interposed tissues can result in a good functional outcome in the short term for irreducible isolated anteromedial radial head dislocation [2]. The sole assessment of recurrent dislocation to define natural history and treatment rationale is inadequate, and conclusions regarding treatment recommendations cannot be made from a study that did not compare treatment methods [35].

Stiffness / Arthrofibrosis: Normative values for soft-tissue redundancy may enable surgeons to explain lack of progress after surgical joint release, determine progress with hand therapy, and choose optimal timing of surgical intervention once soft-tissue equilibrium is achieved [6]. Biomechanical consequences of biceps adhesions may limit range of motion and clinical outcomes in situations where the biceps is at risk for scarring [15].

Nerve palsy: Clinical outcomes of reverse total shoulder arthroplasty at a minimum follow-up of 1 year were similar in high- and lower-risk groups regarding iatrogenic suprascapular neuropathy by screw violation [31].

Other Considerations: Scapular muscle detachment appears to be a clinically identifiable syndrome with a homogeneous set of history and physical findings [4]. Current evidence is insufficient to clearly define the relationship between structural integrity of repaired rotator cuffs and long-term clinical outcome [5]. Long-term outcomes beyond five years and high-quality comparative or randomized trials are needed to define durability and refine indications for dynamic anterior stabilization of the long head of the biceps [7]. Fibrous bands are a common finding in the quadrilateral space in cadavers, suggesting they are a normal finding rather than a pathological cause [9]. Only minor variations in the overall anatomical pattern of the supporting structures and layers on the medial side of the knee were found [10]. The most dramatic feature of the failed healing response at the tendon-to-bone interface is the lack of a transitional tissue between the healing tendon and bone [13]. Revision total shoulder arthroplasty is technically challenging with inferior results compared to primary arthroplasty, particularly when soft-tissue problems are the indication [14]. Literature reviews have been unable to link uncommon congenital variations of the long head of the biceps tendon to a common pathoanatomic presentation or suggest a universally accepted treatment algorithm [24]. Further studies with long-term follow-up are needed to determine whether the grafted area will maintain structural and functional integrity over time after autologous matrix-induced chondrogenesis for focal cartilage defects in the knee [25]. Remodeling following chronic tendon tear leads to a degenerative replacement of muscle with connective tissue rather than an active infiltrative process [36]. Although anatomic restoration of the shoulder can be accomplished using subscapularis-sparing total shoulder arthroplasty, retained osteophytes and significant mismatch of the humeral head diameter raise concerns regarding long-term outcomes [37]. Despite major primary complications and a high incidence of radiographic signs of degenerative changes after 8.8 years, mainly good clinical results were achieved with Judet's bipolar prosthesis for radial head arthroplasty [70].

Recovery

Light activity (weeks): Evidence does not specify a discrete week range for light activity or driving; however, recognition of complex soft tissue injuries is critical to restore anatomic attachments and prevent chronic instability in global elbow instability [1]. Open reduction of interposed tissues can result in a good functional outcome in the short term for irreducible isolated anteromedial radial head dislocation [2].

Full activity (months): The evidence does not provide a specific month range for full activity or return to sport. Improved histology was correlated with improved final construct strength at the 12-week time point in a study comparing tendon-to-bone interface healing using an interposition bioresorbable scaffold with a vented anchor [16]. In situations where the biceps is at risk for scarring, the biomechanical consequence of biceps adhesions may limit range of motion and clinical outcomes [15].

Complete recovery / outcome plateau (months): Long-term outcomes beyond five years and high-quality comparative or randomized trials are needed to define durability, refine indications, and position long head of biceps-based dynamic anterior stabilization within the broader algorithm for anterior shoulder instability management [7]. Further studies with long-term follow-up are needed to determine whether the grafted area will maintain structural and functional integrity over time for mid-term results of autologous matrix-induced chondrogenesis for treatment of focal cartilage defects in the knee [25]. Current evidence is insufficient to clearly define the relationship between structural integrity of repaired cuffs and long-term clinical outcome [5].

Rehabilitation protocol: Establishment of normative values for soft-tissue redundancy may enable surgeons to explain the lack of progress after surgical joint release, determine progress with hand therapy, and choose the optimal timing of surgical intervention once soft-tissue equilibrium is achieved [6]. The procedure for contracture of the deltoid muscle resolved pain, skin dimpling, palpable fibrous bands, and winging of the scapula, with no infections or neuromuscular complications [23].

Functional milestones: Clinical outcomes of reverse total shoulder arthroplasty at a minimum follow-up of 1 year were similar in the high- and lower-risk groups for iatrogenic suprascapular neuropathy by screw violation [31]. Repair of large rotator cuff tears structurally reinforced with xenograft ECM resulted in improved functional outcomes scores and strength [33]. The presence of chondrosis at the time of surgery is an important prognosticator of functional outcome at intermediate follow-up in late multiple ligament and posterolateral corner-reconstructed knee [28].

Other Considerations: The most dramatic feature of the failed healing response at the tendon-to-bone interface is the lack of a transitional tissue between the healing tendon and bone [13]. Remodeling following chronic tendon tear leads to a degenerative replacement of muscle with connective tissue rather than an active infiltrative process [36]. Scapular muscle detachment appears to be a clinically identifiable syndrome with a homogeneous set of history and physical findings [4]. A zone exhibiting a gradient in mineral relative to collagen was detected at the leading edge of the hard-soft tissue interface as early as postnatal day 7, and development of the graded mineralized interface is linked to endochondral bone formation near the tendon insertion [27]. The sole assessment of recurrent dislocation to define natural history and treatment rationale is inadequate, and conclusions regarding treatment recommendations cannot be made from a study that did not compare treatment methods [35].

Key Evidence

  • [Case_report] The authors highlight the importance of recognizing complex soft tissue injuries to restore anatomic attachments and prevent chronic instability. (10.1016/j.xrrt.2022.08.005)
  • [Case_report] Open reduction of interposed tissues can result in a good functional outcome, at least in the short term. (10.1177/17585732211039459)
  • [L5] This review presents a concise summary of the embryology, anatomy, microscopy, biomechanical properties and clinical lesions involving the glenoid labrum to aid the clinician in understanding its function and pathology. (10.1111/j.1758-5740.2010.00050.x)
  • [L4] Scapular muscle detachment appears to be a clinically identifiable syndrome with a homogeneous set of history and physical findings. (10.1016/j.jse.2013.05.008)
  • [L4] Current evidences are insufficient to clearly define the relationship between structural integrity of repaired cuffs and long-term clinical outcome. (10.1007/s00167-014-3234-8)
  • [L3] Establishment of normative values may enable surgeons to explain the lack of progress after surgical joint release, determine progress with hand therapy, and choose the optimal timing of surgical intervention once soft-tissue equilibrium is achieved. (10.1016/j.jhsg.2025.100748)
  • [L4] Long-term outcomes beyond five years and high-quality comparative or randomized trials are needed to define durability, refine indications, and position LHB-based DAS within the broader algorithm for anterior shoulder instability management. (10.5397/cise.2025.00752)
  • [L5] Updates on the thrower's shoulder, including anatomy, mechanics, pathomechanics, and treatment, are essential for clinicians and researchers treating or investigating the shoulder. (10.1016/j.arthro.2022.02.024)
  • [L5] Fibrous bands are a common finding in the quadrilateral space in cadavers, suggesting they are a normal finding rather than a pathological cause. (10.1016/j.jse.2007.05.013)
  • [L5] Only minor variations in the overall anatomical pattern were found. (10.2106/00004623-197961010-00011)
  • [L4] Recognizing this entity may help arthroscopic surgeons decide the best therapeutic options depending on each patient's symptoms. (10.1016/j.jse.2011.10.019)
  • [L5] Although many treatment techniques remain in their infancy and further follow-up is necessary before universal adoption, they provide a novel means of addressing difficult-to-treat and complex shoulder girdle pathologies. (10.1016/j.jhsa.2015.06.123)
  • [L5] Revision total shoulder arthroplasty is technically challenging with inferior results compared to primary arthroplasty, particularly when soft-tissue problems are the indication. (10.5435/jaaos-21-01-23)
  • [L5] In situations where the biceps is at risk for scarring, the biomechanical consequence of biceps adhesions may limit ROM and clinical outcomes. (10.1016/j.jse.2012.07.003)
  • [L5] Improved histology was correlated with improved final construct strength at the 12-week time point. (10.1016/j.jse.2019.05.024)
  • [L5] The glenocapsular ligament is a constant anatomical structure that consists of one or two different parts. (10.1007/s00167-017-4603-x)
  • [L2] Subjective mechanical symptoms in the affected shoulder are a common complaint in patients with suspected rotator cuff pathology. (10.1016/j.jse.2024.02.024)
  • [L4] The findings demonstrate that nuchal fibromas, typically superficial lesions, may involve deep skeletal muscle and fascia and can be difficult to resect. (10.2106/00004623-199811000-00017)
  • [L5] Recognition of atypical presentations of calcific tendinitis with bone erosion may prevent unnecessary biopsy and overtreatment. (10.1016/j.jse.2009.02.009)
  • [L5] Understanding of the detailed anatomy and anatomical variations of the glenohumeral joint is essential for surgeons to understand pathology, make correct diagnoses of instability, and select proper treatment options. (10.1007/s00167-015-3892-1)
  • [L4] Conservative treatment was useless for this entity. (10.1016/j.jhsa.2012.08.041)
  • [L3] The procedure resolved pain, skin dimpling, palpable fibrous bands, and winging of the scapula, with no infections or neuromuscular complications. (10.2106/00004623-199802000-00010)
  • [L4] The authors present three patients with congenital variations of the long head of the biceps tendon, noting that literature reviews have been unable to link these uncommon lesions to a common pathoanatomic presentation or suggest a universally accepted treatment algorithm. (10.1016/j.jse.2006.10.020)
  • [L4] However, further studies with long-term follow-up are needed to determine whether the grafted area will maintain structural and functional integrity over time. (10.1007/s00167-010-1042-3)
  • [L4] Nonsurgical treatment may be a viable option in the absence of suprascapular nerve involvement or superior labrum anterior and posterior-related physical findings. (10.1016/j.jse.2023.11.025)
  • [L5] A zone exhibiting a gradient in mineral relative to collagen was detected at the leading edge of the hard-soft tissue interface as early as postnatal day 7, and development of the graded mineralized interface is linked to endochondral bone formation near the tendon insertion. (10.1371/journal.pone.0048630)
  • [L4] The presence of chondrosis at the time of surgery is an important prognosticator of functional outcome at intermediate follow-up. (10.1177/0363546507311091)
  • [L1] The IBR enabled a robust healing response evident through MRI and biopsy evaluation, demonstrating superior tendon quality and healing. (10.1016/j.jse.2024.03.043)
  • [L3] However, the clinical outcomes of RTSA at a minimum follow-up of 1 year were similar in the high- and lower-risk groups. (10.1016/j.jse.2021.10.024)
  • [L4] The study aimed to evaluate functional and radiological outcomes, noting that medialization provides less tension to the tendon which leads to a more effective healing process and improves clinical outcome postoperatively. (10.1016/j.jse.2021.03.122)
  • [L4] Repair of large rotator cuff tears structurally reinforced with xenograft ECM resulted in improved functional outcomes scores and strength. (10.1016/j.jse.2016.02.029)
  • [L5] SLAP repairs are generally favored in younger, active patients, whereas treating the biceps is preferred in lower-demand patients aged >30 years. (10.1016/j.jse.2024.09.040)
  • [Letter] The sole assessment of recurrent dislocation to define natural history and treatment rationale is inadequate, and conclusions regarding treatment recommendations cannot be made from a study that did not compare treatment methods. (10.1177/0363546510379343)
  • [L4] Remodeling following chronic tendon tear leads to a degenerative replacement of muscle with connective tissue rather than an active infiltrative process. (10.1016/j.jse.2016.07.070)
  • [L2] Although anatomic restoration of the shoulder can be accomplished using subscapularis-sparing TSA, retained osteophytes and significant mismatch of the HHD raise concerns regarding long-term outcomes. (10.1016/j.jse.2015.03.009)
  • [L5] In the setting of an irreparable supraspinatus tear, superior capsular reconstruction restores key biomechanical parameters of the shoulder to intact levels. (10.1016/j.jse.2020.03.007)
  • [Abstract] The studied construct is biomechanically valid; it only allows micromovements that are not able to cause humeral head rotation and translation. (10.1016/j.jse.2022.01.037)
  • [L4] Specific alterations of scapular muscular activation and kinematics were found in different patterns of scapular dyskinesis. (10.1016/j.jse.2014.12.022)
  • [L1] The study implies that physical therapy practices should consider assessing and addressing scapular kinematics in patients with neck pain, as scapular dysfunction may contribute to their symptoms. (10.1186/s12891-025-08916-1)
  • [L5] In a dynamic biomechanical cadaveric shoulder simulator, resurfacing the undersurface of the acromion using the BAR technique leads to significantly improved glenohumeral superior translation, maximum abduction angle, cumulative deltoid force, and subacromial contact pressure compared with the irreparable rotator cuff tear. (10.1016/j.arthro.2021.07.021)
  • [L5] A posterior acromial bone block is biomechanically effective at restoring the force required to translate the humeral head posteriorly in a cadaveric, posterior glenohumeral instability model. (10.1016/j.arthro.2024.01.014)
  • [L5] Posterior shoulder tightness resulted in scapular malposition, with muscular and capsular components affecting scapular position differently. (10.1016/j.jse.2019.05.040)
  • [L3] Both techniques significantly improved shoulder function and are relatively safe procedures. (10.1016/j.jse.2019.09.035)
  • [L4] Early surgical treatment seems to be a relevant factor allowing good shoulder function. (10.1177/0363546516676261)
  • [L5] This is the first biomechanical study of human rotator cuff repair to show equivalence of arthroscopic and open repair methods. (10.1177/0363546509336260)
  • [L5] On average, laxity was restored to baseline tension after 10-mm plication, but this determination varied depending on shoulder position. (10.1016/j.jse.2017.10.019)
  • [L5] Simulated isolated supraspinatus cord and strap tears significantly reduced shoulder abduction force, with cord tears causing a larger decline than strap tears. (10.1016/j.jse.2023.07.003)
  • [L5] Posterior glenohumeral joint capsule contracture alters humeral head translations and/or the humeral axis of rotation during movement, creating conditions that lead to joint pathology. (10.1111/j.1758-5740.2012.00180.x)
  • [L5] The PPS injury produces alterations in GH kinematics with implications for GH joint instability, increased GH joint loading, and potential joint damage. (10.1016/j.jse.2024.12.023)
  • [L5] The superior shoulder capsule is a critical stabilizer of the glenohumeral joint, as its tear or defect significantly increases glenohumeral translation and subacromial contact pressure. (10.1016/j.jse.2013.09.025)
  • [L5] Initial management of posterior capsular contracture should be nonsurgical, emphasizing range-of-motion stretching. (10.5435/00124635-200605000-00002)
  • [L3] LAX, which is clinically significant. (10.1177/2325967116s00127)
  • [L3] An extensive subscapularis tear is a negative prognosis factor. (10.1016/j.jse.2017.03.037)
  • [L4] Arthroscopic surgery allowed for complete resection of the lesions in patients with coracoid impingement caused by soft tissue tumours. (10.1007/s00167-014-3048-8)
  • [L1] Operative treatment resulted in greater improvement in Constant scores and significantly decreased pain scores compared to nonoperative management. (10.1016/j.jse.2017.09.032)
  • [L5] The most common type was the subscapularis muscle with three bellies, in line with Larson's model of the division of the subscapularis muscle into three parts. (10.1155/2021/7450000)
  • [L5] The bicipital tunnel is a closed space with 3 anatomically and histologically distinct zones, where zones 1 and 2 differ from zone 3. (10.1016/j.jse.2014.09.026)
  • [L5] Anatomic regions of the glenoid labrum differ in extracellular matrix composition, vascularity, and cell composition. (10.1177/03635465231171680)
  • [L4] However, magnetic resonance imaging indicates that the donor site is resurfaced with fibrous tissue. (10.1177/0363546507306465)
  • [L5] The subscapularis tendon is composed of 2 distinct fibrous layers, just like the supraspinatus tendon, but arranged differently. (10.1016/j.jse.2018.11.045)
  • [L3] The authors recommend MUA in post-traumatic stiffness cases where conservative methods have failed. (10.1177/1758573217693974)
  • [L3] Despite good healing rates, not all patients with healed rotator cuffs experience good outcomes. (10.1016/j.jse.2021.03.112)
  • [L4] The authors propose a classification of 12 variations of the intra-articular portion of the long head of the biceps tendon and suggest that these congenital conditions may acquire pathologic significance due to partial detachment from the mesothelial or synovial fusion with the inferior surface of the capsule. (10.1016/j.jse.2009.03.006)
  • [L5] Nonsurgical management is often successful but can take a protracted amount of time and requires patient compliance. (10.5435/00124635-201312000-00005)
  • [L5] The ligament is composed of irregular and sparse fibers containing relatively rich type III collagen, suggesting flexibility. (10.1016/j.jse.2014.02.009)
  • [L5] The coracohumeral ligament is more capsular than ligamentous based on its histologic features. (10.1016/j.jse.2008.07.012)
  • [L4] Clinical results showed improvements in scores and decreased pain, especially in patients treated with a new repair. (10.1016/j.jse.2021.03.121)
  • [L4] Despite major primary complications and high incidence of radiographic signs of degenerative changes after 8.8 years, mainly good clinical results were achieved with Judet's bipolar prosthesis. (10.1016/j.jse.2010.05.022)
  • [L4] Radiographic methods including 3-D CT and MRI as well as the intraoperative findings of the labrum cannot be considered an accurate and reliable basis for the diagnosis and treatment of SSI in FAI patients. (10.1186/s12891-022-06045-7)
  • [L4] Based on the results of this series, the authors no longer use nor recommend this technique. (10.1016/j.jse.2009.06.005)
  • [L1] The arthroscopic approach offers a unique advantage in diagnosing and treating occult intra-articular pathology. (10.1016/j.jse.2006.10.006)
  • [L3] Neither of these radiographic parameters influenced the functional outcomes of massive posterosuperior tears after repair. (10.1016/j.jisako.2024.07.008)
  • [L4] Multi-photon imaging revealed a clear three-dimensional structure of the human muscle. (10.1016/j.jse.2018.05.005)
  • [L4] The authors recommend inspecting and excising these ligaments during digital fasciectomy to avoid residual disease and suboptimal correction. (10.1177/1753193413510440)
  • [L4] The case is presented due to its rarity, with only one similar case found in the literature, suggesting that synovial chondromatosis should be considered when a periarticular mass is evident. (10.2106/00004623-197355080-00020)

See Also

References

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[22] Idiopathic Extension Contracture of the Little Metacarpophalangeal Joint. The Journal of Hand Surgery. 2013. DOI: 10.1016/j.jhsa.2012.08.041

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[26] Spontaneous resolution of spinoglenoid ganglion cyst: a case series. Journal of Shoulder and Elbow Surgery. 2024. DOI: 10.1016/j.jse.2023.11.025

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[30] An isolated bioinductive repair vs sutured repair for full-thickness rotator cuff tears: 2-year results of a double blinded, randomized controlled trial. Journal of Shoulder and Elbow Surgery. 2024. DOI: 10.1016/j.jse.2024.03.043

[31] Three-dimensional analysis of baseplate screw penetration in reverse total shoulder arthroplasty: risk of iatrogenic suprascapular neuropathy by screw violation. Journal of Shoulder and Elbow Surgery. 2022. DOI: 10.1016/j.jse.2021.10.024

[32] Functional and Radiological Outcome of Medialization Repair for a Postero Superior Retracted Cuff Tear. Journal of Shoulder and Elbow Surgery. 2021. DOI: 10.1016/j.jse.2021.03.122

[33] A prospective, multicenter study to evaluate clinical and radiographic outcomes in primary rotator cuff repair reinforced with a xenograft dermal matrix. Journal of Shoulder and Elbow Surgery. 2016. DOI: 10.1016/j.jse.2016.02.029

[34] Principles of the superior labrum and biceps complex: an expert consensus from the NEER Circle. Journal of Shoulder and Elbow Surgery. 2025. DOI: 10.1016/j.jse.2024.09.040

[35] Letter to the Editor. The American Journal of Sports Medicine. 2010. DOI: 10.1177/0363546510379343

[36] Histological quantification of chronic human rotator cuff muscle degeneration. Journal of Shoulder and Elbow Surgery. 2016. DOI: 10.1016/j.jse.2016.07.070

[37] Total shoulder arthroplasty using a subscapularis-sparing approach: a radiographic analysis. Journal of Shoulder and Elbow Surgery. 2015. DOI: 10.1016/j.jse.2015.03.009

[38] Biomechanical effects of superior capsular reconstruction in a rotator cuff–deficient shoulder: a cadaveric study. Journal of Shoulder and Elbow Surgery. 2020. DOI: 10.1016/j.jse.2020.03.007

[39] Three-Part Humeral Head Fractures Treated With A Definite Construct Of Blocked Threaded Wires: Finite Element And Parametric Optimization Analysis. Journal of Shoulder and Elbow Surgery. 2022. DOI: 10.1016/j.jse.2022.01.037

[40] Specific kinematics and associated muscle activation in individuals with scapular dyskinesis. Journal of Shoulder and Elbow Surgery. 2015. DOI: 10.1016/j.jse.2014.12.022

[41] Is chronic neck pain related to scapular dyskinesia? A systematic review. BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-025-08916-1

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[43] A Posterior Acromial Bone Block Augmentation Is Biomechanically Effective at Restoring the Force Required To Translate the Humeral Head Posteriorly in a Cadaveric, Posterior Glenohumeral Instability Model. Arthroscopy. 2024. DOI: 10.1016/j.arthro.2024.01.014

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[51] 2025 Basic Science Neer Award Winner: The impact of posterior and posterior superior labral injuries and the effect of their treatment on glenohumeral kinematics in the deceleration and follow-through phase of throwing: a biomechanical study. Journal of Shoulder and Elbow Surgery. 2025. DOI: 10.1016/j.jse.2024.12.023

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[64] Arthroscopic Rotator Cuff Repair: Is Healing Enough?. Journal of Shoulder and Elbow Surgery. 2021. DOI: 10.1016/j.jse.2021.03.112

[65] Variations of the intra-articular portion of the long head of the biceps tendon: A classification of embryologically explained variations. Journal of Shoulder and Elbow Surgery. 2009. DOI: 10.1016/j.jse.2009.03.006

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a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

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