Stabilizing mechanisms preventing anterior dislocation of the glenohumeral joint.

Abstract

We investigated the stabilizing mechanism of the glenohumeral joint that prevents anterior dislocation by anatomical dissections of the subscapularis, the shoulder capsule, and the superior, middle, and inferior glenohumeral ligaments in thirty-six shoulders of embalmed cadavera. We also performed roentgenographic studies of ten unembalmed cadaver shoulders in which radiopaque markers were used to demonstrate the position, tightness, and laxity of the subscapularis muscle and of the middle and inferior glenohumeral ligaments during external rotation of the shoulder at zero, 45, and 90 degrees of abduction. The subscapularis muscle and the three glenohumeral ligaments were cut in different sequences to determine their relative contributions to stability (limitation of external rotation). The conclusions from these experiments were that at zero degrees of abduction, the subscapularis muscle stabilizes the joint to a large extent; at 45 degrees of abduction, the subscapularis, middle glenohumeral ligament, and anterosuperior fibers of the inferior glenohumeral ligament provide the stability; and as the shoulder approaches 90 degrees of abduction, the inferior glenohumeral ligament prevents dislocation during external rotation.