Purpose of the study: Compression of the suprascapular nerve in the superior or inferior scapular incisures is a well-known syndrome compression syndrome triggered in the narrow osteofibrous tunnel. This study was undertaken after observing several cases of nerve compression in the supraspinatus fossa after neruolysis procedures. We wanted to better understand the relations with the supraspinatus fascia.

Material and methods: Thirty human cadaver shoulders were dissected. After exposing the supra and infraspina-tus fossae and section of the scapular spine, the supra and infraspintus tendons were sectioned and folded back medially to expose the suprascapular pedicle in the superior scapular incisure, the supraspinatus fossa, and the inferior scapular incisure. The presence of a fascia sheathing the nerve, of subfascial tissue, and of a transversal inferior (spinoglenoid) ligament was noted together with the histology of the observed structures.

Results: A supraspinatus fascia sheathing the nerve was observed in 29 dissections. This fascia was inserted on the superior border of the scapula and the superior scapular ligament and the floor of the supraspinatus fossa. Diffuse adipose deposits under the fascia was observed in 55.5% of the dissections, or located around the vasculonervous bundle in 44.5%. There was a fibrous buttonhole facing the lateral border of the spine in 28 shoulders with a thickened zone which constituted histologically the equivalent of an inferior transvers ligament in 26 shoulders. One subfascial lipoma was discovered.

Discussion: Sheathing with a supraspinatus fascia could explain suprascapular nerve compression in the supra-spinatus fossa where the nerve is exposed to compression against the bony base on which it runs between the superior and inferior incisures. These anatomic data suggest that suprascapular neurolysis should release the nerve over its entire length and not just at the superior or inferior scapular incisure.

Conclusion: The succession of the superior transverse ligament, the supraspinatus fascia, and the inferior transverse ligament constitutes an osteofibrous tunnel which should be considered as a potential source of a suprascapular tunnel syndrome at three levels.

Purpose: During surgery for repair of rotator cuff tears, some authors always associate tenotomy-tenodesis of the long head of the brachial biceps. Others decide as a function of the gross aspect of the tendon and its position in relation to the bicipital groove. It is a classical notion the preservation of the long head of the brachial biceps is a cuase of persistent pain in operated shoulders. This study was conducted to search for a histological validation of the decision to perform tenotomy.

Material and methods: Fifty tendons of the long head of the brachial biceps presented a thick and inflammatory aspect with or without subluxation during 68 procedures to repair recent rotator cuff tears (23 men, 27 women, mean age 53.5 years). Tenodesis of the long head of the brachial biceps was associated with proximal tenotomy. The histological examination concerned the most proximal centimeter of the tendon. Four parameters were studied: two concerned the tendon (organisation of the collagen network and aspect of the interstitial connective tissue), two concerned the synovial border (sub-synoviocytic layer and synovial mesothelium). Sixteen tendons which appeared perfectly healthy were harvested from cadaver shoulders to determine the normal aspect of histological parameters (parallel and cohesive orientation of the collagen network, absence of hypertrophic interstitial connective tissue, thin subsynovio-cytic layer and pluristratified synovial mesothelium).

Results: The tendon. The collagen bundles were oriented in 32 cases but thick in 40 and dissociated in 47. Microscopic signs of fissuration or intratendinous tears were present in 17 cases. The tendinous connective tissue was oedematous in 49 cases, presenting fibroblastic hyper-cellularity in 37 and hypervascularity in 43. Scar-like fibrosis was observed in 28 cases. The synovial layer was regular in 11 tendons and clearly thickened in 26 with a mixed irregular aspect in the others. The subsynoviocytic layer was thick in 33 tendons with signs of hypervascularity or hypercellularity in 12. The synovial mesothelium was paucistratifed in 23 cases, thick in 12, and regular in 15. Lesions had an inflammatory aspect and were intense in 26 cases. Degenerative lesions were observed in 21 tendons. These four histological parameters demonstrated that the lesions were advanced and associated with degenerative sclerosis with reactional synovitis in 30 cases, moderate combined lesions in 13, tendon and synovial inflammation alone in four, and advanced degenerative lesions of the tendon and the synovial in six.

Discussion: Histological lesions of the long head of the brachial biceps tendon are generally degenerative and irreversible while most synovial lesions are reversible inflammatory reactions. The zones of intratendinous fibrosis, vascularity and weak or absent cellularity constitute the anatomic conditions before tendon tears in chronic tendinopathy. This histological study confirmed the validity of the intra-operative decision for tenodesistenotomy of the long head of the brachial biceps in 46 (92%) of the cases. The oedematous and fissu-rated aspect of the tendon appeared to be a reliable criteria while inflammatory synovitis, which surrounds the tendon, does not constitute in itself a formal argument in favour of tendon sacrifice.

Purpose: A fibrous element between the radial capitulum and the fovea is classically described; it is often called a synovial fringe. The term “meniscus” has been proposed to designate a truly rigid peripheral structure partially inter-postioned between the joint surfaces and susceptible of producing joint disease by internal disregulation of repeated pronation supination movements. This led us to study the anatomic and histological properties of this intra-articular structure.

Material and methods: Fifty adult cadaver shoulders were dissected. The en bloc resection included the capsule of the humeroradial joint and the entire annular ligament. We searched for a fibrous structure, noting its soft or rigid aspect, its position relative to the five-part segmentation of the capsuloligament resection, and its size and thickness. Vertical sections were made for the histology study to determine the organized connective tissue or synovial nature of the structure.

Results: An intra-articular element was visible in 43 cases, two structures were observed in two cases, on the deep aspect of the junction between the capsule and the annular ligament. The main positions observed were: circular (n=3), lateral and posterior (n = 11), posterior (n = 10). The anterior (n = 4), or lateral (n = 5) positions were rare. Mean length was 21.4 mm (9–51), mean width between the capsular attachment and the free edge was 2.9 mm (1–10), maxiam mean thickness was 1.7 mm (1–4 mm). The histology report showed two types of structures: a rigid structure with an oriented fibrous armature that had a triangular peripheral base continuous with the superior border of the annular ligament and covered with synovial on both sides of the free edge; a soft flexible structure formed uniquely by two layers of synovial and a more or less villous free edge. Fibrochondroid structures of the meniscal type were not observed. Small nerve fibers were demonstrated in some cases.

Discussion: Certain lateral epiconylalgias of the elbow would suggest involvement of the humeroradial joint, possibly related to injury of the humeoradial “mensiscus”. This study points out the frequency of this synovial or fiborsynovial fringe of variable dimensionts interpose between the radial capitulum and fovea. The structure has a more or less marked connective armature, basically in the lateral and posterior portion, and correctly cannot be termed a “meniscus”. This structure might be involved in inflammatory and painful syndromes observed in epicondylalgias of the humeroradial joint.