Subscribe to RSS
DOI: 10.1055/s-0043-110473
The Rotator Interval – A Link Between Anatomy and Ultrasound
Publication History
received 11 August 2016
revised 24 February 2017
accepted 23 April 2017
Publication Date:
23 August 2017 (online)
Abstract
Shoulder pathologies of the rotator cuff of the shoulder are common in clinical practice. The focus of this pictorial essay is to discuss the anatomical details of the rotator interval of the shoulder, correlate the anatomy with normal ultrasound images and present selected pathologies. We focus on the imaging of the rotator interval that is actually the anterosuperior aspect of the glenohumeral joint capsule that is reinforced externally by the coracohumeral ligament, internally by the superior glenohumeral ligament and capsular fibers which blend together and insert medially and laterally to the bicipital groove. In this article we demonstrate the capability of high-resolution musculoskeletal ultrasound to visualize the detailed anatomy of the rotator interval. MSUS has a higher spatial resolution than other imaging techniques and the ability to examine these structures dynamically and to utilize the probe for precise anatomic localization of the patient’s pain by sono-palpation.
-
References
- 1 Micheroli R, Kyburz D, Ciurea A, Dubs B, Bisig SP, Tamborrini G. Correlation of findings in clinical and high resolution ultrasonography examinations of the painful shoulder. J Ultrason 2015; 15: 29-44
- 2 Hashefi M. Ultrasound in the diagnosis of noninflammatory musculoskeletal conditions. Ann N Y Acad Sci 2009; 1154: 171-203
- 3 Nofsinger C, Konin JG. Diagnostic ultrasound in sports medicine: Current concepts and advances. Sports Med Arthrosc 2009; 17: 25-30
- 4 Yablon CM, Bedi A, Morag Y, Jacobson JA. Ultrasonography of the shoulder with arthroscopic correlation. Clin Sports Med 2013; 32: 391-408
- 5 Teefey SA, Rubin DA, Middleton WD, Hildebolt CF, Leibold RA, Yamaguchi K. Detection and quantification of rotator cuff tears. Comparison of ultrasonographic, magnetic resonance imaging, and arthroscopic findings in seventy-one consecutive cases. J Bone Joint Surg Am 2004; 86-A: 708-16
- 6 Iannotti JP, Ciccone J, Buss DD, Visotsky JL, Mascha E, Cotman K, Rawool NM. Accuracy of office-based ultrasonography of the shoulder for the diagnosis of rotator cuff tears. J Bone Joint Surg Am 2005; 87: 1305-11
- 7 Al-Shawi A, Badge R, Bunker T. The detection of full thickness rotator cuff tears using ultrasound. J Bone Joint Surg Br 2008; 90: 889-92
- 8 van Holsbeeck MT, Kolowich PA, Eyler WR, Craig JG, Shirazi KK, Habra GK, Vanderschueren GM, Bouffard JA. US depiction of partial-thickness tear of the rotator cuff. Radiology 1995; 197: 443-6
- 9 Stegbauer J, Rump LC, Weiner SM. Sites of inflammation in painful rheumatoid shoulder assessed by musculoskeletal ultrasound and power Doppler sonography. Rheumatol Int 2008; 28: 459-65
- 10 Harryman DT, Sidles JA, Harris SL, Matsen FA. The role of the rotator interval capsule in passive motion and stability of the shoulder. J Bone Joint Surg Am 1992; 74: 53-66
- 11 Gaskill TR, Braun S, Millett PJ. Multimedia article. The rotator interval: pathology and management. Arthroscopy 2011; 27: 556-67
- 12 Burkhart SS, Esch JC, Jolson RS. The rotator crescent and rotator cable: an anatomic description of the shoulder’s ‘suspension bridge’. Arthroscopy 1993; 9: 611-6
- 13 Scofienza LM, Orlandi D, Fabbro E, Pucci S, Silvestri E. High-resolution ultrasound (HRUS) evaluation of the rotator cable (RCa) in young and elderly asymptomatic volunteers. ECR Meet 2010;
- 14 Thompson WO, Debski RE, Boardman ND, Taskiran E, Warner JJ, Fu FH, Woo SL. A biomechanical analysis of rotator cuff deficiency in a cadaveric model. Am J Sports Med 24: 286-92
- 15 Malicky DM, Soslowsky LJ, Blasier RB, Shyr Y. Anterior glenohumeral stabilization factors: Progressive effects in a biomechanical model. J Orthop Res 1996; 14: 282-8
- 16 Seibold CJ, Mallisee TA, Erickson SJ, Boynton MD, Raasch WG, Timins ME. Rotator cuff: Evaluation with US and MR imaging. Radiographics 19: 685-705
- 17 Jost B, Koch PP, Gerber C. Anatomy and functional aspects of the rotator interval. J Shoulder Elbow Surg 9: 336-41
- 18 Ho CP. MR imaging of rotator interval, long biceps, and associated injuries in the overhead-throwing athlete. Magn Reson Imaging Clin N Am 1999; 7: 23-37
- 19 Lee JC, Guy S, Connell D, Saifuddin A, Lambert S. MRI of the rotator interval of the shoulder. Clin Radiol 2007; 62: 416-23
- 20 Sethi N, Wright R, Yamaguchi K. Disorders of the long head of the biceps tendon. J Shoulder Elbow Surg 8: 644-54
- 21 Habermeyer P, Magosch P, Pritsch M, Scheibel MT, Lichtenberg S. Anterosuperior impingement of the shoulder as a result of pulley lesions: A prospective arthroscopic study. J Shoulder Elbow Surg 13: 5-12
- 22 Cole BJ, Rodeo SA, O’Brien SJ, Altchek D, Lee D, DiCarlo EF, Potter H. The anatomy and histology of the rotator interval capsule of the shoulder. Clin Orthop Relat Res 2001; 129-37
- 23 Yang H, Tang K, Chen W, Dong S, Jin T, Gong J, Li J, Wang H, Wang J, Xu J. An anatomic and histologic study of the coracohumeral ligament. J Shoulder Elbow Surg 18: 305-10
- 24 Neer CS, Satterlee CC, Dalsey RM, Flatow EL. The anatomy and potential effects of contracture of the coracohumeral ligament. Clin Orthop Relat Res 1992; 182-5
- 25 Keene DR, Sakai LY, Burgeson RE. Human bone contains type III collagen, type VI collagen, and fibrillin: Type III collagen is present on specific fibers that may mediate attachment of tendons, ligaments, and periosteum to calcified bone cortex. J Histochem Cytochem 1991; 39: 59-69
- 26 Franchi M, Trirè A, Quaranta M, Orsini E, Ottani V. Collagen structure of tendon relates to function. ScientificWorldJournal 2007; 7: 404-20
- 27 Arai R, Nimura A, Yamaguchi K, Yoshimura H, Sugaya H, Saji T, Matsuda S, Akita K. The anatomy of the coracohumeral ligament and its relation to the subscapularis muscle. J Shoulder Elbow Surg 2014; 23: 1575-81
- 28 Shankman S, Bencardino J, Beltran J. Glenohumeral instability: evaluation using MR arthrography of the shoulder. Skeletal Radiol 1999; 28: 365-82
- 29 D. AF. Surgery of the Shoulder: 9780397504923: Medicine & Health Science Books
- 30 Krzyżanowski W. The use of ultrasound in the assessment of the glenoid labrum of the glenohumeral joint. Part I: Ultrasound anatomy and examination technique. J Ultrason 2012; 12: 164-77
- 31 Yamaguchi WG, Bindra K. R. Disorders of the biceps tendon. In: Iannotti JP. Complex and Revision Problems in Shoulder Surgery: 9780781746588. Medicine & Health Science Books;
- 32 Braun S, Horan MP, Elser F, Millett PJ. Lesions of the biceps pulley. Am J Sports Med 2011; 39: 790-5
- 33 Bennett WF. Subscapularis, medial, and lateral head coracohumeral ligament insertion anatomy. Arthroscopic appearance and incidence of ‘hidden’ rotator interval lesions. Arthroscopy 2001; 17: 173-80
- 34 Curtis AS, Snyder SJ. Evaluation and treatment of biceps tendon pathology. Orthop Clin North Am 1993; 24: 33-43
- 35 MacDonald K, Bridger J, Cash C, Parkin I. Transverse humeral ligament: Does it exist? Clin. Anat 2007; 20: 663-7
- 36 Moser TP, Cardinal É, Bureau NJ, Guillin R, Lanneville P, Grabs D. The aponeurotic expansion of the supraspinatus tendon: Anatomy and prevalence in a series of 150 shoulder MRIs. Skeletal Radiol 2015; 44: 223-31
- 37 Gleason PD, Beall DP, Sanders TG, Bond JL, Ly JQ, Holland LL, Pasque CB. The transverse humeral ligament: A separate anatomical structure or a continuation of the osseous attachment of the rotator cuff? Am. J Sports Med 2006; 34: 72-7
- 38 Nakata W, Katou S, Fujita A, Nakata M, Lefor AT, Sugimoto H. Biceps pulley: Normal anatomy and associated lesions at MR arthrography. Radiographics 31: 791-810
- 39 Kolts I, Busch LC, Tomusk H, Arend A, Eller A, Merila M, Russlies M. Anatomy of the coracohumeral and coracoglenoidal ligaments. Ann Anat 2000; 182: 563-6
- 40 Denard PJ, Koo SS, Murena L, Burkhart SS. Pseudoparalysis: The importance of rotator cable integrity. Orthopedics 2012; 35: e1353-7
- 41 Morag Y, Jacobson JA, Lucas D, Miller B, Brigido MK, Jamadar DA. US appearance of the rotator cable with histologic correlation: preliminary results. Radiology 2006; 241: 485-91
- 42 Morag Y, Jamadar DA, Boon TA, Bedi A, Caoili EM, Jacobson JA. Ultrasound of the rotator cable: prevalence and morphology in asymptomatic shoulders. AJR Am J Roentgenol 2012; 198: W27-30
- 43 Tamborrini G, Marx C, Müller AM, Szöllösy G, Draghi FSt Bianchi et al. Ultrasound, Anatomy and Arthroscopy of the Shoulder: high resolution sonoanatomy, sonohistology and sonopathology atlas – anatomy and arthroscopy of the shoulder, 3nd ed. 2017;
- 44 Rozin AP, Toledano K, Dagan A, Balbir-Gurman A. Ultrasound investigation of the glenohumeral joint by anterior access in patients with rheumatoid arthritis and healthy controls. Med Sci Monit 2015; 21: 533-41
- 45 Dugas JR, Campbell DA, Warren RF, Robie BH, Millett PJ. Anatomy and dimensions of rotator cuff insertions. J Shoulder Elbow Surg 11: 498-503
- 46 Clark JM, Harryman DT. Tendons, ligaments, and capsule of the rotator cuff. Gross and microscopic anatomy. J Bone Joint Surg Am 1992; 74: 713-25
- 47 Kask K, Kolts I, Lubienski A, Russlies M, Leibecke T, Busch LC. Magnetic resonance imaging and correlative gross anatomy of the ligamentum semicirculare humeri (rotator cable). Clin Anat 2008; 21: 420-6
- 48 Warner JJ, Allen A, Marks PH, Wong P. Arthroscopic release for chronic, refractory adhesive capsulitis of the shoulder. J Bone Joint Surg Am 1996; 78: 1808-16
- 49 Vinson EN, Major NM, Higgins LD. Magnetic resonance imaging findings associated with surgically proven rotator interval lesions. Skeletal Radiol 2007; 36: 405-10
- 50 Rodeo SA, Hannafin JA, Tom J, Warren RF, Wickiewicz TL. Immunolocalization of cytokines and their receptors in adhesive capsulitis of the shoulder. J Orthop Res 1997; 15: 427-36