Glenohumeral Joint Anatomy, Stabilizer, and Biomechanics

Author: Michael Hughes

Topic updated on 06/09/13 6:52pm

Planes of Motion

Reference
- scapular plane is 30 degrees anterior to coronal plane.
Abduction
- abduction requires external rotation to clear the greater tuberosity from impinging on the acromion.
  - therefore if someone has an internal rotation contracture they can not abduct > 120
- 180° of abduction comes from motion in two joints (2:1 ratio)
  - 120° from the glenohumeral joint
  - 60° from the scapulothoracic joint

Glenohumeral Stability

Static restraints
- glenohumeral ligaments (below)
- glenoid labrum (below)
- articular congruity and version
- negative intraarticular pressure
  - if release head will sublux inferiorly
Dynamic restraints
- rotator cuff muscles
  - the primary biomechanical role of the rotator cuff is stabilizing the glenohumeral joint by compressing the humeral head against the glenoid
- biceps
- periscapular muscles

Glenohumeral Ligaments (static)

Ligamentous Restraints in different Arm Positions
Arm Position	Anterior Res.	Inferior Res.	Posterior Res.
0° (side) and adduction	x	SGHL/CHL	xxx
45° (ER) and 45° abducted	MGHL	x	MGHL
Adduction		SGHL/CHL
90° (ER)	Anterior band IGHL	Anterior band IGHL	Posterior band IGHL
90° (forward flexed, abduction, and IR)	Anterior band IGHL		Posterior band IGHL SGHL/CHL

SGHL
- restraint to inferior translation at 0° degrees of abduction (neutral rotation)
MGHL
- resist anterior and posterior translation in the midrange of abduction (~45°) in ER
IGHL
- posterior band IGHL
  - most important restraint to posterior subluxation at 90° flexion and IR
  - tightness leads to internal impingement and increased shear forces on superior labrum (linked to SLAP lesions)
- anterior band IGHL
  - stability
    - primary restraint to anterior/inferior translation 90° abduction and maximum ER (late cocking phase of throwing)
  - anatomy
    - anchors into anterior labrum
    - forms weak link that predisposes to Bankart lesions
- superior band IGHL
  - most important static stabilizer about the joint
  - 100% increased strain on superior band of IGHL in presence of a SLAP lesion
Coracohumeral ligament (CHL)
- primary stabilizer to posterior subluxation with shoulder in flexion,abduction, and internal rotation
- limits inferior translation and external rotation at adducted position

Glenoid Labrum (static)

Function
- helps create cavity-compression and creates 50% of the glenoid socket depth
Composition
- composed of fibrocartilagenous tissue
Blood supply
- suprascapular artery
- anterior humeral circumflex scapular
- posterior humeral circumflex arteries
- labrum recieves blood from capsule and periosteal vessels and not from underlying bone
- anterior-superior labrum has poorest blood supply
Stability
- anterior labrum
  - anchors IGHL (weak link that leads to Bankart lesion)
- superior labrum
  - anchors biceps tendon (weak link that leads to SLAP lesion)
Anatomic variants
- normal variant
  - the labrum attached to the glenoid rim and a flat/broad middle glenohumeral ligament is the most common “normal” variation. A cord-like middle glenohumeral ligament is often
  - present in 86% of population
- sublabral foramen
  - seen in ~12% if population
- Buford complex
  - seen in ~1.5% of population
  - cordlike middle glenohumeral ligament with attachment to base of biceps anchor and complete absence of the anterosuperior labrum
  - attaching a Buford complex will lead to painful and restricted external rotation and elevation.
- meniscoid appearance (1%)

Soft Tissue Stabilizers

Posterior capsule (static)
- thin (< 1mm) with no ligaments
Rotator Interval
- contracture of the rotator interval is seen with adhesive capsulitis (frozen shoulder)
- laxity of the rotator interval results in a visible sulcus sign with inferior laxity with the shoulder in adduction
- includes the capsule, SGHL, and the coracohumeral ligament that bridge the gap between the supraspinatus and the subscapularis.
- boundaries
  - medially by lateral coracoid base
  - superiorly by anterior edge of supraspinatus
  - inferiorly by superior border of subscapularis
  - lateral apex formed by transverse humeral ligament
Rotator cuff (dynamic)
- subscapularis is an important stabilizer to posterior subluxation in external rotation
Biceps Long Head (dynamic)
- long head of biceps acts as humeral head depressor.
- variable origin from superior labrum
- forms weak links that predisposes to SLAP tear

Osteology

Humeral head
- greater and lesser tuberosities are attachment sites for the rotator cuff
- spheroidal in shape in 90% of individuals
- average diameter is 43 mm
- retroverted 30° from transepicondylar axis of the distal humerus
- articular surface inclined upward 130° from the shaft
Glenoid
- pear-shaped surface with average upward tilt of 5°
- average version is 5° of retroversion in relation to the axis of the scapular body and varies from 7° of retroversion to 10° of anteversion
Coracoid
- serves as an anatomic landmark or "lighthouse" for the deltopectoral approach
- coracobrachialis, pectoralis minor, and short head of the biceps attach to the coracoid
Acromion
- 3 ossification centers
  - meta (base), meso (mid), and pre-acromion (tip)
- acromiohumeral interval is 7-8mm
  - AHI may be normal on Xray but decreased on MRI when pt is supine and weight of arm is removed. This usually signifies multiple tendon tear.
- acromial morphology
  - I=flat
  - II=curved
  - III=hooked

Blood Supply

Humeral head
- ascending branch of anterior humeral circumflex artery and arcuate artery
  - provides blood supply to humeral head
  - vessel runs parallel to lateral aspect of tendon of long head of biceps in the bicipital groove
    - beware not to injure when plating proximal humerus fractures
  - arcuate artery is the interosseous continuation of ascending branch of anterior humeral circumflex artery and penetrates the bone of the humeral head
- posterior humeral circumflex artery
  - most current literature supports this as providing the main blood supply to humeral head

Free Body Analysis of Deltoid

Free body diagram
- assuming A = 3cm and B = 30 cm
- sum of moment M = 0
- (A x D) - (B x 0.5W) = 0
  - 3D = 0.5W (30)
  - D = 5W
Arthrodesis
- optimal position
  - 15-20° of abduction
  - 20-25° of forward flexion
  - 40-50° of internal rotation

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Qbank (5 Questions)

TAG

(SBQ07.47) The superior glenohumeral ligament is under the greatest stress when the humeral head and arm are in which of the following positions? Topic

Review Topic

1. Anteriorly translated with the arm in 90 degrees of abduction and externally rotated
2. Inferiorly translated with the arm in 5 degrees of adduction
3. Anteriorly translated with the arm in 90 degrees of abduction and internally rotated
4. Inferiorly translated with the arm in 45 degrees of abduction and internal rotation
5. Inferiorly translated with the arm in 90 degrees of abduction and neutral rotation

PREFERRED RESPONSE ▶

DISCUSSION: The role of each glenohumeral ligament has been clearly defined by previous cadaveric studies that have sectioned different ligaments during different periods of stress on the glenohumeral joint. These studies have demonstrated that the superior glenohumeral ligament provides the most restraint to the shoulder joint when the arm is at zero degrees of abduction or in adduction and pulled inferiorly.

Warner et al tested 11 cadavers with varying amounts of abduction and rotation to see what ligaments provided specific, directional stability to the shoulder joint. They found that the anterior and posterior bands of the glenohumeral ligament provided the most restraint when the arm was abducted. In addition, they found the superior glenohumeral ligament to provide the most restraint when the arm was at zero degrees of abduction and pulled inferiorly.

Illustration A shows an anatomic representation of the glenohumeral ligaments.

Incorrect answers:
1: The anterior inferior glenohumeral ligament is stressed when the arm is in this position
3: An arm positioned as such does not classically stress any of the glenohumeral ligaments
4 and 5: The arm is more adducted in answer 2

Illustrations: A

REFERENCES:

1. Warner JJ, Deng XH, Warren RF, et al: Static capsuloligamentous restraints to superior-inferior translation of the glenohumeral joint. Am J Sports Med 1992;20:675-685 PMID:1456361 (Link to Abstract)

2. Griffin LY (ed): Orthopaedic Knowledge Update: Sports Medicine. Rosemont, IL, American Academy Orthopaedic Surgeons, 1994, pp 165-177

Question Authors:

Chad Krueger, Dave Marcu MD, Michael Hughes MD,

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(OBQ12.62) A 67-year-old female who sustained a proximal humerus fracture as a result of a fall goes on to develop avascular necrosis (AVN). An injury was most likely sustained to which of the following arteries labeled 1-5 in Figure A? Topic

Review Topic

FIGURES: A

1. Artery labelled 1
2. Artery labelled 2
3. Artery labelled 3
4. Artery labelled 4
5. Artery labelled 5

PREFERRED RESPONSE ▶

DISCUSSION: The artery labelled 4 on the arteriogram is the posterior humeral circumflex artery, which is the primary blood supply to the humeral head, and most likely to lead to AVN when injured.

While previous literature suggested that the anterior humeral circumflex artery provided the main blood supply to the humeral head, more current literature supports the posterior circumflex humeral artery as the predominant blood supply. Despite the anterior humeral circumflex artery being disrupted in approximately 80% of proximal humeral fractures, the occurence of resultant osteonecrosis is still infrequent. This inconsistency suggests a greater role for the posterior humeral circumflex artery.

Hettrich et al. performed a cadaveric study assessing the vascularity of the proximal part of the humerus. They injected gadolinium into the axillary artery proximally, and then either the anterior humeral circumflex artery or the posterior humeral circumflex artery was ligated. MRI was then performed and the specimens were dissected to determine the dominant blood supply. They found that the posterior humeral circumflex artery provided 64% of the blood supply to the humeral head, whereas the anterior humeral circumflex artery supplied 36%. The posterior humeral circumflex artery also provided significantly more of the blood supply in three of the four quadrants of the humeral head.

Hertel et al. assessed predictors of humeral head ischemia after fractures of the proximal humerus. Their results concluded that the most predictive factors for humeral head ischemia included the >8mm length of the dorsomedial metaphyseal extension, disrupted integrity of the medial hinge, and the complicated and communited fracture types.

Crosby et al. used tetracycline labeling as a measure to study humeral head viability after 3- or 4-part proximal humerus fractures taken at the time of hemiarthroplasty. Their findings showed that the vascular supply was preserved in all of the resected specimens including displaced three- and four-part proximal humerus fractures especially in younger patients. They recommended that with intact vascularity to the humeral head, head-preserving techniques utilizing stable, site-specific fixation and minimal dissection should be considered in the treatment of displaced three- and four-part proximal humerus fractures.

Illustration A shows labelled arteriogram of the blood vessels near the shoulder.

Illustrations: A

REFERENCES:

1. Hettrich CM, Boraiah S, Dyke JP, Neviaser A, Helfet DL, Lorich DG. Quantitative assessment of the vascularity of the proximal part of the humerus. J Bone Joint Surg Am. 2010 Apr;92(4):943-8. PubMed PMID: 20360519. PMID: 20360519 (Link to Abstract)

2. Hertel R, Hempfing A, Stiehler M, Leunig M. Predictors of humeral head ischemia after intracapsular fracture of the proximal humerus. J Shoulder Elbow Surg. 2004 Jul-Aug;13(4):427-33. PubMed PMID: 15220884. PMID:15220884 (Link to Abstract)

3. Crosby LA, Finnan RP, Anderson CG, Gozdanovic J, Miller MW. Tetracycline labeling as a measure of humeral head viability after 3- or 4-part proximal humerus fracture. J Shoulder Elbow Surg. 2009 Nov- Dec;18(6):851-8. Epub 2009 Mar 17. PubMed PMID: 19297204. PMID:19297204 (Link to Abstract)

Question Authors:

David Abbasi MD, Patrick McCulloch MD, Michael Hughes MD, Mark Miller MD,

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(OBQ09.64) What structure provides dynamic glenohumeral stability by compressing the humeral head against the glenoid? Topic

Review Topic

1. Superior glenohumeral ligament
2. Middle glenohumeral ligament
3. Teres major muscle
4. Deltoid muscle
5. Rotator cuff muscles

PREFERRED RESPONSE ▶

DISCUSSION: The rotator cuff is the main DYNAMIC stabilizer of the glenohumeral joint. It functions most at midrange motion, not at the extremes of range of motion. The superior glenohumeral ligament is a STATIC stabilizer and resists inferior translation at 0° degrees of abduction. The middle glenohumeral ligament is a STATIC stabilizer and resists anterior translation in the midrange of abduction (~45°) in ER. The teres major adducts and medially rotates arm and is not a significant stabilizer of the glenohumeral joint. The deltoid muscle primarily abducts the arm and is not the major stabilizer of the glenohumeral joint. The Hirashima study used EMG to characterize the sequential activation of musculature during overarm throwing and postulate that the sequence is very effective for the generation of high force and energy in the trunk.

REFERENCES:

1. Garrick JG (ed): Orthopaedic Knowledge Update: Sports Medicine 3. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2004, pp 79-88

2. Hirashima M, Kadota H, Sakurai S, Kudo K, Ohtsuki T. Sequential muscle activity and its functional role in the upper extremity and trunk during overarm throwing. J Sports Sci. 2002 Apr;20(4):301-10. PMID:12003275 (Link to Abstract)

Question Authors:

Doug Nowak MD, Patrick McCulloch MD,

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(OBQ08.261) Besides the biceps tendon, which of the following structures also pass through the rotator interval? Topic

Review Topic

1. The coracohumeral ligament only
2. The coracohumeral and superior glenohumeral ligaments
3. The coracohumeral, superior and middle glenohumeral ligaments
4. The superior and middle glenohumeral ligaments
5. The superior glenohumeral ligament only

PREFERRED RESPONSE ▶

DISCUSSION: The rotator cuff is perforated anterosuperiorly by the coracoid process, which separates the anterior border of the supraspinatus tendon from the superior border of the subscapularis tendon, creating the triangular rotator interval, which is bridged by capsule. The base of the interval is the coracoid process, from which capsular tissue (the coracohumeral ligament) originates. The transverse humeral ligament at the biceps intertubercular sulcus forms the apex of the rotator interval. The coracohumeral and superior glenohumeral ligaments are considered to be structural contents of the rotator interval capsule, but each have separate origins and insertions. These ligaments are considered to be the most constant structures of the fibrous joint capsule.

Arai et al performed cadaver dissections to describe the anatomy as it relates to reconstructing the biceps sling as it exits the interval in cases of biceps subluxation. They note that an intact superior border of subscapularis is needed as well as tension in the SGHL.

Yang et al reported a descriptive anatomy study on the CHL. All were located in the rotator interval, originated from the lateral aspect of the base of the coracoid process, and had histology more consistent with capsule than ligament.

Illustrations A & B show a schematic drawing and a corresponding MRI image of the shoulder that depicts the rotator interval. Boundaries of the rotator interval include the coracoid process (COR) at its base, superiorly by anterior margin of supraspinatus tendon (SST) and inferiorly by superior margin of subscapularis tendon (SSC). Contents of rotator interval include long head of biceps tendon (BT), coracohumeral ligament (CHL), superior glenohumeral ligament (SGHL), and rotator interval capsule. Rotator interval capsule (RIC) is the anterosuperior aspect of glenohumeral joint capsule, which merges with CHL and SGHL insertions medial and lateral to bicipital groove.

Illustration C demonstrates a cadaveric image with the subscapularis tendon (black star), supraspinatus tendon (white star), and rotator interval capsule (asterisk).

Illustration D is an image of a right shoulder in the beachchair position viewed from a posterior portal showing a rotator interval closure for a patient with multidirectional instability of the shoulder.

Illustrations: A

REFERENCES:

1. Yang HF, Tang KL, Chen W, Dong SW, Jin T, Gong JC, Li JQ, Wang HQ, Wang J, Xu JZ.. An anatomic and histologic study of the coracohumeral ligament. J Shoulder Elbow Surg. 2009 Mar-Apr;18(2):305-10. Epub 2008 Dec 18. PMID:19095467 (Link to Abstract)

2. Arai R, Mochizuki T, Yamaguchi K, Sugaya H, Kobayashi M, Nakamura T, Akita K.. Functional anatomy of the superior glenohumeral and coracohumeral ligaments and the subscapularis tendon in view of stabilization of the long head of the biceps tendon. J Shoulder Elbow Surg. 2010 Jan-Feb;19(1):58-64. Epub . PMID:19535271 (Link to Abstract)

3. Netter's Concise Atlas of Orthopaedic Anatomy, Frank H. Netter, John A. Craig.

Question Authors:

Patrick McCulloch MD, Dave Marcu MD, Michael Hughes MD,

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(OBQ04.77) Which of the following is a primary restraint of anterior and posterior humeral translation at the position of a patient's right shoulder as shown in Figure A? Topic

Review Topic

FIGURES: A

1. Inferior glenohumeral ligament (IGHL)
2. Middle glenohumeral ligament (MGHL)
3. Superior glenohumeral ligament (SGHL)
4. Coracohumeral ligament (CHL)
5. Coracoacromial ligament (CA)

PREFERRED RESPONSE ▶

DISCUSSION: Figure A shows a shoulder in 45 degrees of abduction and 45 degrees of external rotation. The MGHL restrains anterior and posterior translation in the midrange of abduction. The CHL limits inferior translation and external rotation when then arm is adducted and limits posterior translation when the arm is flexed, adducted, and internal rotation. The SGHL also restrains inferior translation and external rotation of the adducted shoulder. The IGHL has an anterior band that is the primary restraint to anterior translation at 90 degrees of shoulder abduction. It also has a posterior band to limit posterior translation. The CA ligament prevents superior head migration in rotator cuff deficient shoulders.

The study by Kuhn et al was a cadaveric study of 20 shoulder specimens mounted in a testing apparatus to simulate the thrower's late-cocking position. They found that cutting the entire inferior glenohumeral ligament resulted in the greatest increase in external rotation (approximately 10 degrees).

REFERENCES:

1. Kuhn JE, Bey MJ, Huston LJ, Blasier RB, Soslowsky LJ. Ligamentous restraints to external rotation of the humerus in the late-cocking phase of throwing. A cadaveric biomechanical investigation. Am J Sports Med. 2000 Mar-Apr;28(2):200-5. PMID:10750996 (Link to Abstract)

Question Authors:

Michael Hughes MD, Patrick McCulloch MD, Dave Marcu MD,

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TAG

(OBQ04.89) Which of the following is considered the primary static restraint to anterior gleno-humeral translation with the arm in 90 degrees of abduction? Topic

Review Topic

1. Shape of the bony articulation
2. Negative intra-articular pressure
3. Superior gleno-humeral ligament complex
4. Middle gleno-humeral ligament complex
5. Inferior gleno-humeral ligament complex

PREFERRED RESPONSE ▶

DISCUSSION: The geometry of the bony articulation is inherently unstable. The rotator cuff is a dynamic stabilizer and the capsulolabral tissues are considered static stabilizers. With the arm at 90 degrees abduction, the anterior band of the inferior gleno-humeral ligament complex is the primary static stabilizer to anterior translation. The middle (MGHL) resists anterior translation at 45 degrees of abduction. The superior (SGHL) resists inferior translation with the arm at one's side.

O'Brien et al. describe the functional anatomy of the inferior gleno-humeral complex based on a series of cadaveric dissections. They note that its orientation and design support the functional concept of this single structure as an important anterior and posterior stabilizer of the shoulder joint. The Burra paper is a review of acute upper extremity instability in athletes.

REFERENCES:

1. O'Brien SJ, Neves MC, Arnoczky SP, Rozbruck SR, Dicarlo EF, Warren RF,Schwartz R, Wickiewicz TL. The anatomy and histology of the inferior glenohumeral ligament complex of the shoulder. Am J Sports Med. 1990 Sep-Oct;18(5):449-56. PMID:2252083 (Link to Abstract)

2. Burra G, Andrews JR. Acute shoulder and elbow dislocations in the athlete.Orthop Clin North Am. 2002 Jul;33(3):479-95. Review. PMID:12483945 (Link to Abstract)

Question Authors:

Patrick McCulloch MD, Derek Moore, Guillem Lomas MD,

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ABOS II: Glenohumeral Joint Anatomy, Stabilizer, and Biomechanics

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Evidence & References Show References

Level of Evidence 4 (Case Series)

Warner JJ, Deng XH, Warren RF, et al: Static capsuloligamentous restraints to superior-inferior translation of the glenohumeral joint. Am J Sports Med 1992;20:675-685 PMID:1456361 (Link to Abstract)

Level of Evidence 5 and Other Journal Articles (includes Case Reports, Expert Opinions, Personal Observations, and Biomechanic Studies)

Kuhn JE, Bey MJ, Huston LJ, Blasier RB, Soslowsky LJ. Ligamentous restraints to external rotation of the humerus in the late-cocking phase of throwing. A cadaveric biomechanical investigation. Am J Sports Med. 2000 Mar-Apr;28(2):200-5. PMID:10750996 (Link to Abstract)

Textbooks

Review of Orthopaedics, 6th Edition, Mark D. Miller MD, Stephen R. Thompson MBBS MEd FRCSC, Jennifer Hart MPAS PA-C ATC, an imprint of Elsevier, Philadelphia, Copyright 2012
AAOS Comprehensive Orthopaedic Review, Jay R. Leiberman. Published by American Academy of Orthopaedic Surgeons, Rosemont IL. Copyright 2009
Orthopaedic Knowledge Update 10, John M Flyn. Published by American Academy of Orthopaedic Surgeons, Rosemont IL. Copyright 2011
Hoppenfeld SP. Surgical Exposures in Orthopaedics: The Anatomic Approach. Lipponcott, Williams, and Wilkins, Philadelphia, PA, Copyright 2009
Orthopaedic In-training Examination (OITE) Questions 2004-2012, American Academy of Orthopaedic Surgeons, Rosemont IL. Copyright 2004-2012
Self-Assessment Examination (SAE) Questions 2004-2012, American Academy of Orthopaedic Surgeons, Rosemont IL. Copyright 2004-2012
Griffin LY (ed): Orthopaedic Knowledge Update: Sports Medicine. Rosemont, IL, American Academy Orthopaedic Surgeons, 1994, pp 165-177

Undefined

Arai R, Mochizuki T, Yamaguchi K, Sugaya H, Kobayashi M, Nakamura T, Akita K.. Functional anatomy of the superior glenohumeral and coracohumeral ligaments and the subscapularis tendon in view of stabilization of the long head of the biceps tendon. J Shoulder Elbow Surg. 2010 Jan-Feb;19(1):58-64. Epub . PMID:19535271 (Link to Abstract)
Burra G, Andrews JR. Acute shoulder and elbow dislocations in the athlete.Orthop Clin North Am. 2002 Jul;33(3):479-95. Review. PMID:12483945 (Link to Abstract)
Crosby LA, Finnan RP, Anderson CG, Gozdanovic J, Miller MW. Tetracycline labeling as a measure of humeral head viability after 3- or 4-part proximal humerus fracture. J Shoulder Elbow Surg. 2009 Nov- Dec;18(6):851-8. Epub 2009 Mar 17. PubMed PMID: 19297204. PMID:19297204 (Link to Abstract)
Garrick JG (ed): Orthopaedic Knowledge Update: Sports Medicine 3. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2004, pp 79-88
Hertel R, Hempfing A, Stiehler M, Leunig M. Predictors of humeral head ischemia after intracapsular fracture of the proximal humerus. J Shoulder Elbow Surg. 2004 Jul-Aug;13(4):427-33. PubMed PMID: 15220884. PMID:15220884 (Link to Abstract)
Hettrich CM, Boraiah S, Dyke JP, Neviaser A, Helfet DL, Lorich DG. Quantitative assessment of the vascularity of the proximal part of the humerus. J Bone Joint Surg Am. 2010 Apr;92(4):943-8. PubMed PMID: 20360519. PMID: 20360519 (Link to Abstract)
Hirashima M, Kadota H, Sakurai S, Kudo K, Ohtsuki T. Sequential muscle activity and its functional role in the upper extremity and trunk during overarm throwing. J Sports Sci. 2002 Apr;20(4):301-10. PMID:12003275 (Link to Abstract)
Netter's Concise Atlas of Orthopaedic Anatomy, Frank H. Netter, John A. Craig.
O'Brien SJ, Neves MC, Arnoczky SP, Rozbruck SR, Dicarlo EF, Warren RF,Schwartz R, Wickiewicz TL. The anatomy and histology of the inferior glenohumeral ligament complex of the shoulder. Am J Sports Med. 1990 Sep-Oct;18(5):449-56. PMID:2252083 (Link to Abstract)
Yang HF, Tang KL, Chen W, Dong SW, Jin T, Gong JC, Li JQ, Wang HQ, Wang J, Xu JZ.. An anatomic and histologic study of the coracohumeral ligament. J Shoulder Elbow Surg. 2009 Mar-Apr;18(2):305-10. Epub 2008 Dec 18. PMID:19095467 (Link to Abstract)

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Glenohumeral Joint Anatomy, Stabilizer, and Biomechanics

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