Clinicians › Shoulder

Skeletal Anatomy

Osseous geometry of the shoulder girdle, focusing on the glenohumeral, AC, and SC joints and the concavity-compression mechanism of the glenoid.

90 citationsUpdated Oct 2026

Overview

Accurate and reproducible anatomical knowledge is a prerequisite for executing orthopaedic procedures with minimal functional disturbance [1]. This principle is particularly emphasized in the management of upper extremity trauma, where detailed preparation and anatomic understanding are critical to surgical success [3]. The scope of conventional surgical treatment for skeletal osteoarthritis encompasses arthroscopy, preservation, arthrodesis, and replacement [81]. An abridged summary of selected orthopaedic trauma studies published mainly in 2015 provides methods, results, and take-home points across various anatomical regions and treatment modalities [14].

The osseous anatomy of the shoulder requires precise analysis to avoid complications such as notching after reverse total shoulder arthroplasty, which is influenced by patient anatomy [5, 8]. Confusion in the literature regarding acromial architecture has arisen from the use of multiple descriptive terminologies [84]. A comprehensive review of the shoulder, arm, and elbow anatomy includes ossification patterns and joint mechanics [86]. Regarding soft tissue, the glenocapsular ligament is a constant anatomical structure consisting of one or two parts that are well vascularized [18]. Understanding rotator cuff anatomy and surrounding structures is essential for treating rotator cuff disease, with recent advances in basic science and surgical technology improving this knowledge to guide management [90]. Additionally, improved understanding of the fascial anatomy and innervation of the teres minor muscle may aid in treating symptomatic isolated atrophy [92].

In the clinical and functional context, the long thoracic nerve is the most common aetiological factor in scapular winging [88]. The choice of surgical technique for proximal humerus reconstruction in oncological patients depends on patient age, clinical picture, functional demands, and potential sacrifice of muscles or nerves, though consensus on the best technique is not established [89]. Current studies summarize the characteristics and usefulness of popular upper-limb functional tests [85].

Osseous Anatomy

Glenohumeral Joint

The osseous anatomy of the glenohumeral joint exhibits no significant side-dependent differences in elderly patients [27]. While humeral head size parameters differ significantly between men and women, anatomic relationships remain consistent across genders [22]. In the context of bony-mediated shoulder instability, accurate imaging and assessment of bone defect size and relations are crucial for treatment planning [20]. The combined outer and inner circle ratio provides a foundation for appreciating paleo-glenoid morphology and estimating bone loss more reliably [25]. Surgeons must account for osseous adaptations at the glenohumeral joint when evaluating and treating injured baseball players [26].

Scapula

A clear and standardized definition of scapular anatomical landmarks is necessary to ensure consistency across measurements [6]. An extensive reference for normal 3D scapular morphology offers a valuable foundation for future research [19]. When analyzing scapular morphology, sex-related and generational differences in global shape may be considered [21]. Acromial morphology appears to be a primary anatomic characteristic that is independent of age [28]. Patient anatomy plays a significant role in the occurrence of scapular notching after reverse total shoulder arthroplasty [8]. Implants designed from Western anatomical data may not fit the Japanese scapula and humerus well [29].

Humerus

With the exception of the bare area at the proximal end, measured values of the subscapularis footprint were significantly larger in male specimens than in female specimens [7].

Pediatric Considerations

Orthopedic surgeons must be familiar with the normal anatomy of the growing shoulder, its secondary ossification centers, and growth plates to avoid errors when interpreting imaging tests in the pediatric shoulder [30].

Ligaments and Joint Capsule

Anatomical Structure and Histology

The coracohumeral ligament is more capsular than ligamentous based on its histologic features [64]. Corpuscular receptors of different morphology were found both in the joint capsule and the coracoacromial ligament but in different distributions [63, 72].

Biomechanical Function

The coracohumeral ligament is the main restrain of the external rotation [55]. Allografts are anchored to the glenoid and humeral head in a sling configuration, restoring capsular restraint and stability [53].

Surgical Considerations and Pathology

Accurate anatomical knowledge is required to carry out the contemplated procedure with the least possible disturbance of function [1]. When performing complex procedures about the coracoid where anatomy may be altered, risks are heightened and not accounted for in studies of intact specimens; it is paramount to identify and protect neurovascular structures rather than relying on safe distances [4]. Aberrant structures may be encountered in the vicinity of the coracoid during surgery, potentially prolonging the procedure or influencing technique [13].

Operative Techniques: A combination of ligament-preserving approaches enables viewing the entirety of the joint surface and may represent an alternative to ligament-releasing approaches [37]. The "Pinch-and-Tuck" arthroscopic technique for capsular laxity in posterior shoulder instability offers advantages including efficient individualized plication, greater confidence in reduction of capsular laxity, and reduced risk to neurovascular structures due to control of soft tissue penetration depth [67].

Pathology and Repair: Coracoacromial morphology is a pathologic anatomy that is not addressed by current soft-tissue stabilization procedures and may contribute to instability recurrence [17]. Repair of anterior capsulolabral lesions combined with supraspinatus tendon tears successfully restored range of motion and increased the force required for dislocation [75]. Recognizing complex soft tissue injuries is important to restore anatomic attachments and prevent chronic instability in global elbow instability [12].

Muscles and Tendons

Subscapularis

Measured values of the subscapularis insertion are significantly larger in male specimens than in female specimens, with the exception of the bare area at the proximal end [7]. The tendon footprint is divided into facets, where the first facet constitutes approximately 1/3 of the entire footprint area [91]. The first two facets together comprise 60% of the total footprint [91]. Surgical visualization of this structure is approach-dependent. The deltopectoral approach allows 100% visualization of the myotendinous junction, compared to zero visualization with the anterolateral acromial approach [95]. Similarly, the deltopectoral approach permits 100% visualization of the medial anatomic neck, whereas the anterolateral acromial approach achieves only 20% visualization [95].

Rotator Cuff and Superior Capsule

Prior studies overestimated rotator cuff footprint width due to a lack of discrimination between the actual cuff insertion and the capsule [97]. The capsulolabral footprint contributes significantly to the glenoid face, inserts directly adjacent to the articular cartilage, and extends medially along the glenoid neck [93]. Shoulder anatomy influences the mechanisms of rotator cuff tear formation. Specifically, glenoid tilt angle (GTA), coracoacromial space angle (CSA), acromial index (AI), lateral acromial angle (LAA), and footprint dimensions play a more significant role in L-shaped tears compared to other tear shapes [102]. Regarding prosthetic design, an unconstrained implant approaching normal anatomy permits better function and endurance than an implant with a fixed fulcrum, provided there is meticulous reconstruction and rehabilitation of the rotator-cuff and deltoid muscles [99].

Infraspinatus and Teres Minor

The infraspinatus does not need to be released from its humeral footprint; rather, it can be split in line with its muscle and tendon fibers, which has a high potential for a benign postoperative healing process [94]. The posterior ridge of the greater tuberosity serves as a suitable landmark to locate the internervous plane between the infraspinatus and teres minor muscles and should not be crossed distally [101].

Supraspinatus

Innate anatomical features of the scapula, such as lateral overhang and coracoacromial arch angle, may predispose individuals to extrinsic lesions of the supraspinatus tendon by reducing the subcoracoacromial canal's surface area [98].

Biceps Tendon

Tenodesis performed between the midpoint of the pectoralis major insertion and more distal points involves a significant portion of muscle, which may not be optimal [100].

Trapezius

A specific landmark allows for accurate differentiation of the lower trapezius from the middle trapezius during tendon harvest [103]. Maximal scapular protraction increases the safety distance of the spinal accessory nerve during lower trapezius tendon harvest [103].

Surgical Exposure and General Considerations

Functional anatomical aspects and correct incision placement are critical for adequate visualization and satisfactory postoperative scarring in anterior, posterior, and superolateral surgical exposures of the shoulder [16]. When a bone graft extends into the subcutaneous space, it causes persistent inflammation and painful bursitis. In contrast, shortening the graft to a position deeply recessed in muscle allows for limited function [104].

Neurovascular Anatomy

Complex procedures about the coracoid carry heightened risks when anatomy is altered, a factor not accounted for in studies of intact specimens [4]. In these scenarios, it is paramount to identify and protect neurovascular structures rather than relying on safe distances [4]. The deltoid lift technique offers comparatively excellent direct visualization of the proximal humerus and all key anatomic landmarks while preserving the main neurovascular supply to the deltoid [66]. The anterior division of the axillary nerve innervates all three deltoid segments in most instances, accounting for 85% of the deltoid by weight [74]. The subscapular sling procedure can be performed without altering the anatomy of the axillary nerve [76] or the musculocutaneous nerve [76].

A posterior surgical approach to the proximal humerus exposes at least eight centimeters of the proximal part of the posterior aspect of the humeral diaphysis without endangering major blood vessels [10]. The osseous origins of the lateral head of the triceps are utilized to protect the axillary and radial nerves during this approach [10]. An at-risk zone exists between the medial quarter and midpoint of the clavicle where neurovascular structures lie beneath the bone [11]. Potential neurovascular compromises, even if seemingly subtle, should be thoroughly investigated in the context of displaced midshaft clavicle fractures [62].

The blood supply to the inferior portion of the serratus anterior muscle comes from the subscapular artery via the inferior angle of the scapula [51]. Similarly, the blood supply to the lower part of the long thoracic nerve comes from the subscapular artery via the inferior angle of the scapula [51]. Recognition of characteristic clinical features and understanding of the anatomical course of the dorsal scapular nerve are essential for accurate diagnosis [50]. In muscle transfer, neurovascular pedicle vessels are the predictable limiting factor for translation due to their shorter length compared to the nerve [57]. Few sites can spare a length of nerve plus its accompanying artery and vein for transplantation as a free graft [40].

Biomechanics and Function

Human throwing capabilities largely result from derived anatomical features that enable elastic energy storage and release at the shoulder [59]. Anthropometric studies of the scapula have considered the spatial location and biomechanical importance of the coracoid process [65]. Small but significant asymmetries exist between the dominant and nondominant shoulders in terms of kinematics [83]. Kinematic values from whole cadaver studies can be used when investigating scapulothoracic kinematics during normal and pathologic situations [56]. However, a precise, easy to use and low-cost non-invasive method able to draw and analyze the kinematics of the shoulder complex has not been developed yet [58]. In-vivo measurement techniques provide clinically relevant information by calculating joint contact patterns during dynamic conditions and overcome many limitations associated with conventional techniques for quantifying joint mechanics [68].

Biomechanical Modeling and Prosthetic Design: Rigid-body theory overestimated the experimental load in shoulder prosthesis subluxation models, but provides a framework to highlight the relevant design parameters [60, 61]. Experimental and computational studies provide biomechanical insights on sternoclavicular joint biomechanics and suggest a validated methodology for further analyses [54].

Surgical Biomechanics and Reconstruction: The trapezius transfer demonstrated biomechanical advantages in restoring compressive forces and kinematics compared to the latissimus dorsi transfer in a cadaveric model for irreparable massive posterosuperior rotator cuff tears [77]. Alternative surgical approaches leading to normal joint biomechanics may reduce implant wear in the context of subscapularis deficiency [78]. The Triple Anatomical Technique for acromioclavicular joint reconstruction enables early recovery and return to sports by biologically restoring joint anatomy and kinematics [9].

Glenoid Bone Loss and Measurement: Clinicians should be aware of the measurement methods used in biomechanical studies when making surgical decisions regarding glenoid bone loss [80]. Advanced measurement techniques that take glenoid concavity into account are more accurate in determining the biomechanical relevance of glenoid bone loss than manually performed, more complex measurements, which demonstrated moderate reliability [82]. Future research should focus on biomechanical outcomes to show the reliability of arthroscopic iliac crest bone grafting for shoulder glenoid defect augmentation [79].

Latarjet Procedure: There is insufficient evidence to support changing surgical techniques to preserve soft tissues based on kinematic concerns regarding scapular dyskinesia after the Latarjet procedure [73]. Further biomechanical and clinical studies are needed to validate the long-term and versatile utility of the extra-articular soft arthroscopic Latarjet technique [71].

Common Sites of Injury

Proximal humeral fractures present with specific injury frequencies detailed in a new classification system [23]. In the pediatric population, traumatic subluxation of the radial head is a rather frequent injury in young children [24]. Elbow injuries include open antero-lateral dislocation, which can result from minor injury with extensive soft tissue damage [42].

Injuries to the coracoid process are closely associated with sports activities [36]. The majority of physeal injuries of the coracoid process can be successfully treated nonoperatively [36]. An avulsion fracture of the coracoid process at the coracoclavicular ligament attachment can be associated with a distal clavicle fracture [33].

Clavicle and acromioclavicular joint injuries may present with concurrent pathologies. Ipsilateral Rockwood type IV acromioclavicular joint dislocation can occur with a midshaft clavicle fracture [45].

Surgical Anatomy

General Principles

Preparation and detailed anatomic knowledge are essential for surgical procedures involving upper extremity trauma [3]. In shoulder exposures, functional anatomical aspects and correct incision placement are critical for adequate visualization and satisfactory postoperative scarring [16].

Clavicle and Supraclavicular Region

Two or three branches of the supraclavicular nerve cross the clavicle 97% of the time [48]. Outside of safe zones, there is wide variability in the location of these supraclavicular nerve branches [48].

Coracoid Process and Surrounding Structures

Risks are heightened when performing complex procedures about the coracoid where anatomy may be altered, as these risks are not accounted for in studies of intact specimens [4]. It is paramount to identify and protect neurovascular structures rather than relying on safe distances when operating around the coracoid [4]. Aberrant structures may be encountered in the vicinity of the coracoid during surgery [13]. These aberrant structures near the coracoid may potentially prolong the procedure or influence technique [13]. The previously described safe zone of 5 cm below the coracoid process may not be reliable to protect the musculocutaneous nerve or its twigs [32]. Specifically, 91.7% of specimens had musculocutaneous nerve entry points within 5 cm below the coracoid process when twigs were accounted for [32].

Humerus and Posterior Approach

A posterior surgical approach can expose at least eight centimeters of the proximal part of the posterior aspect of the humeral diaphysis without endangering major blood vessels [10]. The osseous origins of the lateral head of the triceps are utilized to protect the axillary and radial nerves during posterior humeral approaches [10]. Cerclage passage medial to lateral from the latissimus dorsi proximally to the area just distal to the inferior pectoralis major insertion distally is a safe zone for cerclage passage [49]. Minimally invasive surgeries can be performed using palpable landmarks to reduce torsional deformities without the need for fluoroscopy [52].

Scapula and Nerve Safety Zones

Knowledge of the safe zone for avoiding suprascapular nerve injury is important [47]. Gender and specific scapular dimensions should be evaluated as they influence the dimensions of the safe zone for the suprascapular nerve [47].

Ligaments and Pathologic Anatomy

Anatomic placement of repair or reconstruction grafts or devices may help to prevent many of the common problems encountered in shoulder ligament injuries [15]. Pathologic anatomy regarding coracoacromial morphology is not addressed by current soft-tissue stabilization procedures [17]. Coracoacromial morphology may contribute to instability recurrence [17].

Key Evidence

• [L5] Accurate anatomical knowledge is required to carry out the contemplated procedure with the least possible disturbance of function. [1] (10.2106/00004623-194931020-00002)
• [L5] The issue emphasizes the importance of preparation and detailed anatomic knowledge in surgical procedures for upper extremity trauma, providing comprehensive descriptions of exposures and coverage with clinical examples. [3] (10.1016/j.hcl.2014.08.004)
• [L5] When performing complex procedures about the coracoid where anatomy may be altered, risks are heightened and not accounted for in studies of intact specimens; it is paramount to identify and protect neurovascular structures rather than relying on safe distances. [4] (10.1016/j.arthro.2018.11.007)
• [L5] An accurate/reproducible system for the precise analysis of the osseous anatomy of the human shoulder has been developed. [5] (10.1016/s1058-2746(97)90030-6)
• [L4] However, a clear and standardized definition of these landmarks is needed to ensure consistency across measurements. [6] (10.1016/j.jseint.2024.09.027)
• [L5] With the exception of the bare area at the proximal end, the measured values were significantly larger in male specimens than in female specimens. [7] (10.1016/j.arthro.2008.02.009)
• [L4] There is a high degree of significance that patient anatomy does play a role in the occurrence of notching. [8] (10.1016/j.jse.2013.09.003)
• [L5] It enables early recovery and return to sports by biologically restoring joint anatomy and kinematics. [9] (10.1016/j.eats.2025.103595)
• [L4] The described approach exposes at least eight centimeters of the proximal part of the posterior aspect of the humeral diaphysis without endangering major blood vessels, utilizing the osseous origins of the lateral head of the triceps to protect the axillary and radial nerves. [10] (10.2106/00004623-198971030-00015)
• [L5] The study defines the anatomic relationship of the axillary artery and vein to the clavicle, identifying an at-risk zone between the medial quarter and midpoint of the clavicle where neurovascular structures lie beneath the bone. [11] (10.1016/j.jse.2009.01.021)
• [Case_report] The authors highlight the importance of recognizing complex soft tissue injuries to restore anatomic attachments and prevent chronic instability. [12] (10.1016/j.xrrt.2022.08.005)
• [L4] Aberrant structures may be encountered in the vicinity of the coracoid during surgery, potentially prolonging the procedure or influencing technique. [13] (10.1111/j.1758-5740.2011.00168.x)
• [L5] This article provides an abridged summary of selected orthopaedic trauma studies published mainly in 2015, presenting methods, results, and take-home points across various anatomical regions and treatment modalities. [14] (10.2106/jbjs.16.00378)
• [Paper] Anatomic placement of repair or reconstruction grafts or devices may help to prevent many of the common problems encountered. [15] (10.1016/j.csm.2017.12.002)
• [L5] The article presents anatomical considerations and techniques for anterior, posterior, and superolateral surgical exposures of the shoulder, emphasizing that functional anatomical aspects and correct incision placement are critical for adequate visualization and satisfactory postoperative scarring. [16] (10.2106/00004623-196749030-00017)
• [L3] This pathologic anatomy is not addressed by current soft-tissue stabilization procedures and may contribute to instability recurrence. [17] (10.1016/j.jse.2019.01.009)
• [L5] The glenocapsular ligament is a constant anatomical structure that consists of one or two different parts. [18] (10.1007/s00167-017-4603-x)
• [L5] The authors conclude that the study provides an extensive reference for normal 3D scapular morphology, offering a valuable foundation for future research. [19] (10.2106/jbjs.25.01596)
• [L4] Accurate imaging and assessment of the size and relations of bone defects are crucial for further treatment planning. [20] (10.1302/2058-5241.5.200049)
• [L4] These differences may be considered when analyzing scapular morphology. [21] (10.1016/j.xrrt.2025.04.001)
• [L4] Although there are significant differences in size parameters of the humeral head between men and women, there do not seem to be differences in anatomic relationships between genders. [22] (10.1016/j.jse.2011.03.018)
• [L2] The frequency of each type of injury in this new classification is presented and a technique for viewing 3D images is suggested which maximizes their usefulness. [23] (10.1016/j.jse.2009.03.001)
• [L4] The injury is apparently a rather frequent one and a description should be available to all orthopaedic surgeons. [24] (10.2106/00004623-195436030-00018)
• [L4] This study sets the base for the use the combined outer and inner circle and its ratio to better appreciate the paleo-glenoid morphology and thus obtain a more reliable bone loss estimation. [25] (10.1007/s00167-022-07050-y)
• [L3] Consideration must be given to osseous adaptations that occur at the glenohumeral joint when evaluating and treating this population. [26] (10.1177/23259671241260084)
• [L4] There are no significant side-dependent differences in the osseous anatomy of the glenohumeral joint. [27] (10.1016/j.jse.2015.12.024)
• [L4] Acromial morphology is independent of age, and appears to be a primary anatomic characteristic. [28] (10.1016/s1058-2746(96)80350-8)
• [L4] Consequently, implants designed from Western anatomical data may not fit the Japanese scapula and humerus well. [29] (10.1016/j.jseint.2026.101714)
• [Case_report] Orthopedic surgeons must be familiar with the normal anatomy of the growing shoulder, its secondary ossification centers, and growth plates in order to avoid errors when interpreting imaging tests in the pediatric shoulder. [30] (10.5397/cise.2022.01151)
• [L5] The previously described safe zone of 5 cm below the coracoid process may not be reliable to protect the musculocutaneous nerve or its twigs, as 91.7% of specimens had nerve entry points within this distance when twigs were accounted for. [32] (10.1177/2325967120954417)
• [L5] This case highlights the importance of assessing SSSC integrity and suggests that anatomical reconstruction may be a reasonable treatment option in unstable injury patterns. [33] (10.1177/17585732261469144)
• [L4] The majority of these injuries can be successfully treated nonoperatively. [36] (10.1177/2325967120967914)
• [L5] A combination of these two ligament-preserving approaches enables viewing the entirety of the joint surface and may represent an alternative to ligament-releasing approaches. [37] (10.1016/j.jse.2022.01.013)
• [L4] A length of nerve plus its accompanying artery and vein can be transplanted as a free graft, but few sites can spare them. [40] (10.1016/s0020-1383(84)80055-8)
• [Case_report] This case highlights that excellent functional outcomes can be achieved with a conservative approach even after extensive soft tissue damage from minor injury. [42] (10.1186/1471-2474-3-1)
• [Case_report] Surgical treatment of this injury pattern results in excellent clinical outcomes. [45] (10.1016/j.xrrt.2022.11.007)
• [L5] Knowledge of the safe zone for avoiding suprascapular nerve injury is important; gender and specific scapular dimensions should be evaluated as they influence the dimensions of the safe zone. [47] (10.1016/j.jse.2011.01.033)
• [L5] There were two or three branches of the supraclavicular nerve crossing the clavicle 97% of the time and a wide variability of the location of these branches outside the safe zones. [48] (10.1007/s11999-010-1608-x)
• [L5] Cerclage passage medial to lateral from the latissimus dorsi proximally to the area just distal to the inferior pectoralis major insertion distally is a safe zone for cerclage passage. [49] (10.1016/j.jseint.2024.08.187)
• [L4] Recognition of characteristic clinical features and understanding of the anatomical course of the nerve are essential for accurate diagnosis. [50] (10.1016/j.xrrt.2026.100807)
• [L5] It was also found that the blood supply to the inferior portion of the muscle and to the lower part of the nerve comes from the subscapular artery via the inferior angle of the scapula. [51] (10.1016/s1058-2746(09)80083-9)
• [L3] Minimally invasive surgeries can be performed by using these palpable landmarks to reduce torsional deformities without the need for fluoroscopy. [52] (10.1186/s12891-020-3118-7)
• [L5] Allografts are anchored to the glenoid and humeral head in a sling configuration, restoring capsular restraint and stability. [53] (10.1002/atn2.70017)
• [L5] The study provides biomechanical insights on SCJ biomechanics, and suggests a validated methodology for further analyses. [54] (10.1016/j.jse.2026.07.025)
• [L5] The C-H ligament is the main restrain of the external rotation. [55] (10.1016/s1058-2746(95)80336-x)
• [L5] These values can be used when investigating scapulothoracic kinematics during normal and pathologic situations. [56] (10.1016/j.jseint.2022.09.014)
• [L5] In muscle transfer, the neurovascular pedicle vessels are the predictable limiting factor for translation due to their shorter length compared to the nerve. [57] (10.1016/j.jse.2014.07.001)
• [L5] Despite technology innovations, a precise, easy to use and low-cost non-invasive method able to draw and analyze the kinematics of the shoulder complex has not been developed yet. [58] (10.1177/17585732221090226)
• [L4] Human throwing capabilities largely result from several derived anatomical features that enable elastic energy storage and release at the shoulder. [59] (10.1038/nature12267)
• [Paper] Rigid-body theory overestimated the experimental load, which was not surprising given the visible deformations, but provides a framework to highlight the relevant design parameters. [60] (10.1016/s1058-2746(00)90038-7)
• [L5] Rigid-body theory overestimated the experimental load, which was not surprising given the visible deformations, but provides a framework to highlight the relevant design parameters. [61] (10.1067/mse.2000.105139)
• [Case_report] Potential neurovascular compromises, even if seemingly subtle, should be thoroughly investigated. [62] (10.1016/j.xrrt.2023.03.004)
• [Paper] Corpuscular receptors of different morphology were found both in the joint capsule and the coracoacromial ligament (CAL) but in different distributions. [63] (10.1016/s1058-2746(95)80087-5)
• [L5] The coracohumeral ligament is more capsular than ligamentous based on its histologic features. [64] (10.1016/j.jse.2008.07.012)
• [Paper] The spatial location and biomechanical importance of the coracoid process were considered. [65] (10.1016/s1058-2746(98)90057-x)
• [L5] This technique offers comparatively excellent direct visualization of the proximal humerus and all key anatomic landmarks and preserves the main neurovascular supply to the deltoid. [66] (10.1097/bth.0000000000000091)
• [L5] The authors believe the technique has advantages including efficient individualized plication, greater confidence in reduction of capsular laxity, and reduced risk to neurovascular structures due to control of soft tissue penetration depth. [67] (10.1016/j.eats.2025.103794)
• [L4] This technique provides clinically relevant information by calculating in-vivo joint contact patterns during dynamic conditions and overcomes many limitations associated with conventional techniques for quantifying joint mechanics. [68] (10.1155/2010/162136)
• [L5] Nevertheless, further biomechanical and clinical studies are needed to validate its long-term and versatile utility. [71] (10.1016/j.eats.2021.05.009)
• [L5] Corpuscular receptors of different morphology were found both in the joint capsule and the coracoacromial ligament but in different distributions. [72] (10.1016/s1058-2746(96)80451-4)
• [L5] There is insufficient evidence to support changing surgical techniques to preserve soft tissues based on kinematic concerns. [73] (10.1016/j.arthro.2024.05.017)
• [L5] The anterior division of the axillary nerve innervates all three deltoid segments in most instances (85% of the deltoid by weight). [74] (10.1142/s2424835518500546)
• [L5] Repair of both pathologic conditions successfully restored range of motion and increased the force required for dislocation. [75] (10.1016/j.arthro.2013.05.031)
• [L5] The procedure can be performed without altering the anatomy of nearby structures such as the coracoid process, the conjoined tendon, and the axillary and musculocutaneous nerves. [76] (10.1016/j.eats.2021.03.027)
• [Abstract] The trapezius transfer demonstrated biomechanical advantages in restoring compressive forces and kinematics compared to the latissimus dorsi transfer in this cadaveric model. [77] (10.1016/j.jse.2012.12.009)
• [L5] Therefore our findings suggest that alternative surgical approaches leading to normal joint biomechanics may reduce implant wear. [78] (10.1016/j.jseint.2024.08.151)
• [L5] Future research should focus on biomechanical outcomes to show the reliability of this technique. [79] (10.1002/atn2.70233)
• [L5] Clinicians should be aware of the measurement methods used in biomechanical studies when making surgical decisions. [80] (10.1016/j.arthro.2015.02.020)
• [L4] The scope of this article is to present an overview of the fundamentals of conventional surgical treatment options for osteoarthritis of the human skeleton, with emphasis on arthroscopy, preservation, arthrodesis, and replacement. [81] (10.3390/life12070982)
• [L3] While more advanced measurement techniques that take glenoid concavity into account are more accurate in determining the biomechanical relevance of glenoid bone loss, the reliability of manually performed, more complex measurements was moderate. [82] (10.1177/23259671231222938)
• [L5] Small but significant asymmetries exist between the dominant and nondominant shoulders in terms of kinematics. [83] (10.1016/j.jse.2013.08.020)
• [L4] The use of a multitude of different descriptive terminology has led to confusion in the literature concerning acromial architecture; this review aims to show the discrepancy and advise suitable terminology to prevent future confusion. [84] (10.1007/s001670050062)
• [L4] The current study summarizes the characteristics and the usefulness of the most popular upper-limb functional tests. [85] (10.1177/17585732221101880)
• [L4] This review explores the causes of scapula winging, with an overview of the relevant anatomy, proposed aetiology and treatment, with particular focus given to lesions of the long thoracic nerve, which is reported to be the most common aetiological factor. [88] (10.1111/sae.12033)
• [L4] The review outlines current surgical options for proximal humerus reconstruction in oncological patients, highlighting that consensus on the best technique is not established and the choice depends on patient age, clinical picture, functional demands, and potential sacrifice of muscles or nerves. [89] (10.1155/2021/5559377)
• [L5] Understanding the anatomy of the rotator cuff and surrounding structures is essential for treating rotator cuff disease, with recent advances in basic science and surgical technology improving knowledge of this anatomy to guide surgical management. [90] (10.1016/j.arthro.2008.07.023)
• [L5] The first facet of subscapularis tendon area consists of approximately 1/3 of the entire footprint area, and the first two facets consist of 60% of its entire footprint. [91] (10.1016/j.arthro.2013.07.104)
• [L5] An improved understanding of the fascial anatomy and innervation pattern of the teres minor muscle may help clinicians who treat patients with symptomatic isolated teres minor muscle atrophy. [92] (10.1016/j.jse.2011.12.005)
• [L5] The capsulolabral footprint contributes significantly to the glenoid face, inserts directly adjacent to the articular cartilage, and extends medially along the glenoid neck. [93] (10.1016/j.arthro.2018.03.017)
• [L5] The infraspinatus does not need to be released from its humeral footprint but rather can be split in line with its muscle and tendon fibers, which has a high potential for a benign postoperative healing process. [94] (10.1016/j.eats.2024.103288)
• [L4] The DP approach allowed better access to anterior quadrant structures, including improved ability to visualize the myotendinous junction of the subscapularis (100% versus zero) and the medial anatomic neck (100% versus 20%). [95] (10.5435/jaaosglobal-d-18-00017)
• [L5] Prior studies overestimated the rotator cuff footprint width due to a lack of discrimination between the actual cuff insertion and the capsule. [97] (10.1016/j.jse.2011.04.034)
• [L4] Apart from acromial morphology, there could be innate anatomical features of the scapula that predispose people to extrinsic lesions to the supraspinatus tendon (lateral overhang, coracoacromial arch angle) by reducing the subcoracoacromial canal's surface area. [98] (10.1016/j.otsr.2016.08.001)
• [L4] An unconstrained implant approaching normal anatomy permits better function and endurance than an implant with a fixed fulcrum, provided there is meticulous reconstruction and rehabilitation of the rotator-cuff and deltoid muscles. [99] (10.2106/00004623-198264030-00001)
• [L5] Tenodesis performed between the midpoint of the pectoralis major insertion and more distal points involves a significant portion of muscle, which may not be optimal. [100] (10.1016/j.arthro.2015.11.048)
• [L5] The posterior ridge of the greater tuberosity is a suitable landmark to locate the internervous plane between the infraspinatus and teres minor muscles and should not be crossed distally. [101] (10.1016/j.jse.2017.10.034)
• [L3] Shoulder anatomy affects the mechanisms of rotator cuff tear formation, with GTA, CSA, AI, LAA, and footprint dimensions playing a more significant role in L-shaped tears compared to other tear shapes. [102] (10.1186/s12891-024-07829-9)
• [L5] This landmark allows for accurate differentiation of the lower trapezius from the middle trapezius during tendon harvest. [103] (10.1016/j.jseint.2026.101622)

See Also

• Total shoulder arthroplasty
• Rotator Cuff
• Shoulder Instability
• Fractures
• Latarjet Procedure
• Clavicle Fracture

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