PURPOSE: The aim of the present study was to describe the precise anatomy of the so-called "Comma Sign" which has been observed during arthroscopy in retracted subscapularis (SSC) tears. METHODS: Fourteen fresh cadaveric shoulders were prepared to obtain an articular view comparable to arthroscopic posterior portal view. A step-by-step dissection was carried out to verify the presence of any anatomic structure inserting directly on the lateral margin of the SSC tendon. A sequential detachment of the superior gleno-humeral ligament (SGHL), the coraco-humeral ligament (CHL), and the SSC tendon from their bony humeral insertions was performed. Under intra-articular and extra-articular view, the SSC and its connections with the supraspinatus (SS), the SGHL and the CHL were evaluated. RESULTS: The detachment of the CHL and the SGHL from the humerus did not reveal any structure directly inserted on the superior-lateral margin of the SSC tendon. However, when the SSC tendon was excised from the lesser tuberosity and pulled medially, a bundle of fibers, which inserted directly onto its superior-lateral edge, was constantly observed. CONCLUSIONS: We constantly found an effective link between the superior-lateral corner of the SSC tendon and a bundle of fibers coming from SS and CHL. It became visible only after medial traction of the detached SSC. This structure yields the "Comma Sign" in subscapularis tendon tears.
PURPOSE: The aim of the present study was to describe the precise anatomy of the so-called "Comma Sign" which has been observed during arthroscopy in retracted subscapularis (SSC) tears. METHODS: Fourteen fresh cadaveric shoulders were prepared to obtain an articular view comparable to arthroscopic posterior portal view. A step-by-step dissection was carried out to verify the presence of any anatomic structure inserting directly on the lateral margin of the SSC tendon. A sequential detachment of the superior gleno-humeral ligament (SGHL), the coraco-humeral ligament (CHL), and the SSC tendon from their bony humeral insertions was performed. Under intra-articular and extra-articular view, the SSC and its connections with the supraspinatus (SS), the SGHL and the CHL were evaluated. RESULTS: The detachment of the CHL and the SGHL from the humerus did not reveal any structure directly inserted on the superior-lateral margin of the SSC tendon. However, when the SSC tendon was excised from the lesser tuberosity and pulled medially, a bundle of fibers, which inserted directly onto its superior-lateral edge, was constantly observed. CONCLUSIONS: We constantly found an effective link between the superior-lateral corner of the SSC tendon and a bundle of fibers coming from SS and CHL. It became visible only after medial traction of the detached SSC. This structure yields the "Comma Sign" in subscapularis tendon tears.
Authors: Johannes M Boon; Mattys A de Beer; Delene Botha; Nicolaas G J Maritz; Anna A Fouche Journal: J Shoulder Elbow Surg Date: 2004 Mar-Apr Impact factor: 3.019
Authors: Paul D Gleason; Douglas P Beall; Timothy G Sanders; James L Bond; Justin Q Ly; Lorne L Holland; Charles B Pasque Journal: Am J Sports Med Date: 2005-09-16 Impact factor: 6.202
Authors: B Toussaint; J Barth; C Charousset; A Godeneche; T Joudet; Y Lefebvre; L Nove-Josserand; E Petroff; N Solignac; P Hardy; C Scymanski; C Maynou; C-E Thelu; P Boileau; N Graveleau; S Audebert Journal: Orthop Traumatol Surg Res Date: 2012-11-11 Impact factor: 2.256
Authors: Dinesh Dhanaraj; Robert L Parisien; Kevin J McHale; Brian Cable; Antonio Cusano; Brian J Sennett; John D Kelly Journal: Arthrosc Sports Med Rehabil Date: 2021-03-21