0:00

Now there are a number of Glen ligaments,

0:03

and I'm listing here the four major ones.

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You've heard of three of the four.

0:08

You may not have heard of the Fosus, ocus

0:11

or spiral ligament.

0:13

Now tomorrow we'll talk more about the spiral ligament

0:15

and about the inferior glen ligament complex.

0:19

Today we'll talk a bit about the superior glen mal ligament

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and middle glen mal ligament.

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You can see their general orientation.

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The superior glen mal ligament SGHL

0:30

is transversely oriented.

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The middle gonu mal ligament is obliquely oriented

0:34

as extends from a higher position on the scapula

0:38

to a lower position on the proximal humerus.

0:44

To give you an overall idea of

0:47

what these ligaments look like, I show you here a drawing,

0:50

a sagittal section, an MR arthrogram in the sagittal plane,

0:55

and I put arrows.

0:57

Yellow arrow is the super, then al li ligament.

1:00

The green arrow is the middle venue mal ligament.

1:03

And the blue arrows are in fact the inferior venue

1:06

mal ligament complex.

1:07

Again, we'll cover that tomorrow.

1:10

You can see that the sugen mal ligament is mainly

1:13

transversely oriented.

1:14

So sometimes you see it on a single axial image.

1:18

The middle glen mal ligament is obliquely oriented.

1:21

And as it descends in the joint,

1:23

you can see it becomes intimate

1:25

with the subscapularis muscle and tendon.

1:30

Now, some people would say,

1:31

why are you talking about ligaments?

1:33

These are not capsular ligaments. They're capsular folds.

1:37

And the evidence for that is indeed that when you go ahead

1:40

and look at the ligaments, they tend

1:42

to be prominent in internal rotation of the, uh,

1:47

proximal humerus and they disappear in external rotation.

1:52

I don't know if this proves that their capsular folds,

1:56

but I will tell you they are capsular structures,

1:59

whether they be folds or ligaments.

2:01

They're not extracapsular, they are intracapsular.

2:05

Now let's look at, uh, the superior and middle al ligaments.

2:10

The superior glen ligament, uh, is one

2:14

of the important stabilizers of the intraarticular portion

2:18

of the biceps tendon as it extends over to its pulley.

2:21

And I'm showing you with yellow arrow its course here,

2:25

located along the undersurface of the biceps tendon.

2:29

Most anatomic, uh, anatomic, uh,

2:32

description say there are two groups of fibers, direct

2:36

and o like and many attachments, many attachments

2:40

of this particular structure.

2:42

Now I'm going to show you, rather than go over all

2:44

of these attachments, some of the Mr appearances that the

2:49

Len mal ligament can assume

2:53

rarely it arises

2:55

or seems to arise at least in part from the biceps tendon.

2:59

So here with Mr. Arthrography, I show you the longhead

3:02

of the biceps LHB

3:05

and the slen mal ligament extending from it,

3:09

heading toward the cricoid process.

3:11

This is a rare appearance of the slen mal ligament.

3:17

More commonly it looks like this, it arises from

3:20

the anterosuperior labrum,

3:23

and if you're lucky, you'll see it on an MR gram in the

3:26

transverse plane owing to contrast material

3:30

located both medially and laterally.

3:32

Sometimes there is no contrast but fat here

3:36

and so on a fat suppressed image,

3:38

this will just look like a very thick ligament.

3:41

But you're lucky when you see it this way.

3:43

The rises from the anterior labrum, it swings over

3:47

paralleling the outer margin of the corticoid,

3:50

and in this region it joins the cortical humeral ligament

3:53

extending laterally

3:55

and then becoming important stabilizers of the biceps tendon

3:59

as it approaches the pulley and the bici group.

4:04

Now recently, there are some other names

4:05

that have been applied to ligaments like this,

4:07

including the corco glenoid ligament,

4:10

but most people do notte, uh, accept that nomenclature.

4:16

The other appearance is when the superior glen mal ligament

4:21

and the middle glen mal ligament arise in common.

4:25

So you'll see a transversely oriented superior glen mal

4:28

ligament and a vertically oriented middle glen mal ligament

4:32

extending downward posterior to the subscapularis.

4:38

Let's turn our attention now

4:39

to the middle glen mal ligament.

4:42

And this extends from a higher region on the glenoid side

4:46

to a lower region.

4:47

As you can see on the humeral side,

4:50

here is the superior glen mal ligament.

4:53

Here is the cortical humal ligament,

4:55

and you can appreciate this extending downward here.

4:58

Okay, and you can appreciate also this other ligament

5:02

that we're gonna be talking about tomorrow,

5:04

the Fascicular Orcus.

5:06

When we turn to Mr.

5:08

Arthrography, this is the way the middle bunum mal ligament

5:12

looks in this particular image.

5:14

It's arising from the anterior labrum

5:17

less often from the tip of the labrum,

5:19

and more often from the base of the labrum

5:22

and extends obliquely outward and downward.

5:25

And you can see it's intimate with the subscapularis.

5:28

The second and less common way it may appear it arises from

5:32

the scapular neck.

5:34

This produces some diagnostic problems

5:36

because it can look like the anterior capsule

5:40

has been stripped, which it has not.

5:42

I'll talk about the stripping of the capsule, uh,

5:46

tomorrow in a couple of the, uh, uh, lectures.

5:49

So this is the middle glen ligament.

5:53

Now, of the three glen ligaments, the one that is most

5:57

Variable, both in caliber

5:59

and also sometimes in number, is the middle mal ligament.

6:04

It may be absent, it may be thin and leaf like thick

6:08

and leaf like multis stranded,

6:10

and I'll call your attention to this.

6:12

It may be cord light.

6:15

So be aware

6:16

that a cord like middle lineal mal ligament shown here,

6:20

labeled MGHL doesn't mean you're dealing

6:24

with a Buford complex.

6:26

There's another finding we see

6:28

with a Buford complex more about

6:30

that in a couple of minutes.

6:32

So this is variability in the size

6:36

or thickness of the middle al ligament.