上腕二頭筋長頭腱の安定化機構

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The long head of the biceps tendon (LHB) tends to dislocate anteromedially due to its change of direction beyond the most proximal portion of the intertubercular groove. The purpose of this study was to clarify the comprehensive stabilization system of the LHB by investigating the most proximal insertion of the subscapularis tendon (SSC), the superior glenohumeral ligament (SGHL) and the coracohumeral ligament (CHL). 20 embalmed shoulder girdles were used in an anatomical study, and in order to clarify the structural continuity, 5 anterosuperior parts of the glenohumeral joint were histologically observed. Anatomically, the most proximal portion of the SSC tendon inserted on the superior surface of the lesser tuberosity and extended a thin tendinous slip to the fovea capitis of the humerus. The SGHL was like an anterior-inferior spiral sling supporting the LHB and attached to the tendinous slip. Histologically, the CHL and internal wall of the anterosuperior glenohumeral joint were involved in the identical loose connective tissue. The SGHL was discriminated from it due to density of tissue fibers at the lateral part but the difference between them was unclear in the medial part. The SGHL was considered to be a fold extended from the medial part of anterosuperior loose connective tissue and formed a spiral half sling along the LHB. The most lateral part of the loose connective tissue wound around the SGHL to form a membranous structure to support the LHB, which attached to the thin tendinous slip of the SSC. These results suggested that the full thickness and articular side SSC tear might lead to loss of the LHB support because of disruption of both the semitubular structure which consisted of the most proximal insertion of the SSC and the tendinous slip and the membranous structure of the loose connective tissue including the SGHL and CHL.
日本肩関節学会の論文

上腕二頭筋長頭腱の安定化機構

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