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Kim, Cho, Nam, Han, and Kim: The Size of the Rotator Cuff and the Positional Relationship of Bony Landmarks: An Anatomical Study
Original Article

Korean J Phys Anthropol 2015;28(1):11-17.

Published online: 20 January 2015

DOI: https://doi.org/10.11637/kjpa.2015.28.1.11

The Size of the Rotator Cuff and the Positional Relationship of Bony Landmarks: An Anatomical Study

Gyeong-Jin Kim1, Ho-Jung Cho1, Yong-Seok Nam1, Seung-Ho Han2, In-Beom Kim1

1Department of Anatomy∙ Catholic Institute for Applied Anatomy, College of Medicine, The Catholic University of Korea

2Department of Anatomy∙College of Medicine, The Chung-Ang University of Korea

Correspondence to: In-Beom Kim (Department of Anatomy Catholic Institute for Applied Anatomy, College of Medicine, The Catholic University of Korea) E-mail: ibkimmd@catholic.ac.kr

Copyright © 2015 Korean Association of Physical Anthropologists

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

For treatment of the rotator cuff, locating the structure and position of the rotator cuff is crucial. The aim of this study is to identify the size of each rotator cuff and the locational relationship with bony landmarks, and to provide superficial landmarks for locating the tendon from the surface. Fifty-two shoulders from 26 cadavers were dissected and measured in a supine position. The central point was set as the most protrusive point on the greater tubercle of the humerus. The measurement of angles was described ventral as positive(+) and dorsal as negative(−) placing the long axis of the humeral shaft at 0�. The range of the angle which each rotator cuff tendon is attached to the humerus head was: 53.8∼103.3 degrees for the subscapularis, −17.1∼25.7 degrees for the supraspinatus, −68.4∼-1.9 degrees for the infraspinatus, and −117.1∼-75.7 degrees for the teres minor. The vertical inferior point drawn from the anterior edge of the acromion to the humerus was 7.5±11.7 degrees from the central point. The average position of the point was the midpoint of insertion of the supraspinatus tendon. The lateral horizontal point drawn from the acromial angle to the humerus was −49.4±14.3 degrees away and located at an average of 30% inferior to the infraspinatus tendon. Also the lateral horizontal point drawn from the most protrusive point of the coracoid process to the humerus was 63.1±14.7 degrees away and located at an average of 20% superior to the subscapularis tendon. Lastly, the most protrusive point of the lesser tubercle of the humerus was located at a range of 80.8±11.1 degrees and an average of 60% superior to the insertion of the subscapularis tendon. For the measurements of the size of the rotator cuff, there was no statistical difference between the left and right. However, the four measurements – the proximal width of the teres minor tendon, the proximal and distal (P⁄0.05). width, and the length of the subscapularis tendon – showed statistically significant difference between the sexes Therefore, to identify the location of the tendon structures by palpation for shoulder treatment, using the lesser tubercle for the subscapularis, the anterior edge of the acromion for the supraspinatus, and the acromial angle for the infraspinatus as landmarks is regarded to be effective.

Keywords: Rotator cuff tendon, Bony landmarks, Shoulder injury, Insertional tendon, Humerus

References

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Fig. 1a.
The distance between the proximal end of tendon and the bony landmarks. (A) Superior view of the shoulder joint. (B) Posterior view of the shoulder joint. (C) Anterior view of the shoulder joint. AcA, Anterior edge of acromion; AC, A point vertically drawn down from the AcA; AL, The distance from AcA to AC; AcP, Posterior edge of acromion; PC, A point lateral-horizontally drawn from the AcP; PL, The distance from AcP to PC; CpA, Anterior edge of coracoid process; CC, A point lateral-horizontally drawn from the most protrusive point of the CpA; CL, The distance from CpA to CC.
kjpa-28-11f1.tif
Fig. 1b.
The locational relationship between the rotator cuff and the bony landmarks. Ac, Acromion; HhC, Central point of humeral head; LtA, Anterior edge of lesser tubercle; PAg, Angle of PC-HhC-Y; AAg, Angle of AC-HhC-Y; CAg, Angle of CC-HhC-Y; LAg, Angle of LtA-HhC-Y.
kjpa-28-11f2.tif
Fig. 2.
The range of angles that the rotator cuff tendon attaches to the humerus with respect to the central point. Gray color, The ro-tator cuff tendons; Dark gray color, Overlapping region of the sup-raspinatus tendon and the infraspinatus tendon; SS, tendon of Sub-scapularis; ISP, tendon of Infraspinatus; SSP, tendon of Supraspi-natus; TM, tendon of Teres minor; HhC, central point.
kjpa-28-11f3.tif
Fig. 3.
The locational relationship between the rotator cuff and bony landmarks. (A) Location of the AC on the SSP. (B) Location of the PC on the ISP. (C) Location of the CC on the SS. (D) Location of the LtA on the SS. SSP, Supraspinatus; AC, A point vertically drawn down from the AcA; ISP, Infraspinatus; PC, A point lateral-horizontally drawn from the AcP; SS, Subscapularis; CC, A point lateral-horizontally drawn from the most protrusive point of the CpA; LtA, The most protrusive point of the LtA; Gray color, The rotator cuff tendons.
kjpa-28-11f4.tif
Table 1.
The size of the rotator cuff. (unit: mm)
    Male Female Right Left Total
  SS 26.1±4.1∗ 23.5±2.7∗ 24.8±4.0 24.8±3.3 24.8±3.6
TL SSP ISP 21.8±3.7 30.4±8.3 22.3±4.6 27.7±7.2 22.3±4.7 29.4±6.5 21.8±4.3 28.7±8.8 22.1±4.4 29.1±7.6
  TM 20.9±4.5 19.0±4.4 20.0±4.3 19.9±5.4 20.0±4.8
  SS 26.0±2.0∗ 24.3±2.3∗ 25.5±4.1 24.8±4.3 25.2±4.2
PW SSP 17.1±2.0 15.6±2.0 16.0±2.9 16.7±2.1 16.4±2.5
ISP 19.4±1.8 19.5±2.1 19.8±3.2 19±2.6 19.4±2.9
  TM 13.5±3.4∗ 11.9±2.6∗ 12.6±4.2 12.9±3.4 12.8±3.8
  SS 32.9±4.2∗ 29.2±4.3∗ 31.6±2.4 30.5±1.9 31.1±2.1
DW SSP 18.0±2.6 16.1±2.1 16.7±1.9 17.3±2.2 17.0±2.1
ISP 18.4±2.6 19.2±3.0 18.8±1.9 18.8±1.8 18.8±1.9
  TM 11.0±3.9 10.3±3.3 10.7±2.0 10.6±2.7 10.7±3.4
  SS 3.8±0.6 3.9±0.7 3.9±0.7 3.9±0.5 3.9±0.6
TT SSP 2.7±0.9 2.4±0.4 2.6±0.7 2.5±0.8 2.6±0.7
ISP 3.3±0.9 3.2±0.5 3.3±0.7 3.2±0.9 3.3±0.8
  TM 1.8±0.6 2.1±0.6 2.0±0.6 1.9±0.6 2.0±0.6

∗ P⁄0.05(Student's t-test used)

TL, length of tendon; PW, proximal width of tendon; DW, distal width of tendon; TT, thickness of tendon; SS, subscapularis; SSP, supraspinatus; ISP, infraspinatus; TM, teres minor

Table 2.
The humeral attached angle of the rotator cuff. (unit: �)
  Male Female Right Left Total
SS1 56.5±10.7 51.0±9.4 53.3±11.0 54.2±10.0 53.8±10.9
SS2 104.9±11.1 101.6±8.9 104.7±12.0 101.8±10.2 103.3±11.0
SSP1 24.1±14.7 27.2±10.0 25.2±13.3 26.1±13.9 25.7±13.4
SSP2 –17.7±14.3 –16.5±15.2 –15.1±16.4 –19.2±13.7 –17.1±15.1
ISP1 –5.7±14.1 1.8±15.2 0.7±15.1 –4.5±17.1 –1.9±16.0
ISP2 –69.2±13.6 –67.7±14.3 –68.0±13.1 –68.9±14.3 –68.4±13.5
TM1 –74.6±14.5 –77.0±14.7 –75.7±14.7 –75.8±14.4 –75.7±14.4
TM2 –114.4±18.7 –119.9±12.4 –117.3±15.2 –117.0±20.2 –117.1±17.6

SS, subscapularis; SSP, supraspinatus; ISP, infraspinatus; TM, teres minor

1 anterior or superior insertional angle of the rotator cuff

2 posterior or inferior insertional angle of the rotator cuff

Table 3.
The locational relationship between the rotator cuff and the bony landmarks.
    Male Female Right Left Total
Distance (mm) AL 24.9±5.2 23.6±3.3 24.4±3.2 24.1±4.6 24.3±3.9
PL 45.6±6.3 41.7±7.3 44.8±6.2 42.5±4.8 43.7±5.7
CL 29.5±5.6 27.2±4.8 28.0±5.0 28.6±4.9 28.3±4.9
  AAg 9.6±11.8 5.5±11.2 8.8±10.5 6.2±12.9 7.5±11.7
Angle PAg –47.2±13.3 –51.6±13.4 –48.2±15.2 –50.6±13.7 –49.4±14.3
(�) CAg 63.8±15.9 62.4±13.3 63.8±13.9 62.3±15.7 63.1±14.6
  LAg 83.1±10.6 78.4±9.3 79.5±12.8 82.0±9.1 80.8±11.0

AL, The distance from AcA to AC; PL, The distance from AcP to PC; CL, The distance from CpA to CC; AAg, Angle of AC-HhC-Y; PAg, Angle of PC-HhC-Y; CAg, Angle of CC-HhC-Y; LAg, Angle of LtA-HhC-Y

Table 4.
Comparison of Curtis AS et al. study and this study.
  Measurement Curtis et al., 2006 This study, 2014
SS Circumference 1∼5hr 53.8∼103.3�(1:48∼3:24hr)
Length 40mm(35∼55mm) 25mm(18∼55mm)
  Width 20mm(15∼25mm) 25mm(21∼32mm)
SSP Circumference 11∼1hr –17.1∼25.7�(11:24∼12:54hr)
Length 23mm(18∼33mm) 22mm(13∼33mm)
  Width 16mm(12∼21mm) 16mm(12∼21mm)
ISP Circumference 9∼11hr –68.4∼-1.9�(9:42∼11:54hr)
Length 29mm(20∼45mm) 29mm(15∼55mm)
  Width 19mm(12∼27mm) 19mm(14∼23mm)
TM Circumference 7∼9hr –117.1∼-75.7�(8:06∼9:30hr)
Length 29mm(20∼40mm) 20mm(9∼30mm)
  Width 21mm(10∼33mm) 13mm(8∼24mm)

SS, subscapularis; SSP, supraspinatus; ISP, infraspinatus; TM, teres minor; Circumference, Humeral attached position of the rotator cuff

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