Transverse Humeral Ligament

[Sandra St Cyr]

Hi Steve,
Do you feel that the “transverse humeral ligament” is a true structure? From what I have been told, it has not been definitively identified in cadaveric studies. Personally I prefer not to mention it as a structure. What are your thoughts?
Sandy

[Stephen Bird]

Hi Sandy,

I think its is a real structure that runs across the anterior inter tubercular groove with the LHBT beneath it.

It is a thin collagen structure and the important thing to understand is that it is NOT a significant structure in terms of LHBT stabilisation.

When I was a young puppy sonographer everyone lectured about this structure and claimed it held the biceps in place preventing medial migration / subluxation and I took notes to that effect believing them as you do.

But now we know they were MSU (making shit up)

We now understand that the transverse humeral ligament is not important and that other structures hold the LHBT in place.

The heavy lifters holding the LHBT in place are the coracohumeral ligament and the superior glenohumeral ligament. The CHL and SHGL blend together forming a sling called the rotator cuff interval and this tough collagen structure prevents the medial movement of the LHBT.

A tear of the transverse humeral ligament will in no way cause medial migration of the LHBT, however if the CHL / SGHL complex is damaged the LHBT is unstable. This is commonly, but not always associated with a tear in the superior fibres of the subscapularis tendon.

So personally I never mention the transverse humeral ligament at all , but I do carefully examine the upper part of subscap and the rotator cuff interval for damage.

Let me use a metaphor to explain what I think of the transverse humeral ligament.

Imagine a person driving a car alum a freeway with a mattress strapped to the roof racks on the roof of the car. The car is doing 100Km/Hr and the person has the drivers side window down and has their arm out the window holding the mattress. They are being as effective in holding the mattress to the roof as the transverse humeral ligament is at holding the LHBT in the groove.
The canvas ties / octopus straps etc that are holding the mattress place are doing ALL the work like the CHL / SGHL and the arm out the window like the transverse humeral ligament is just for decoration.

It has to be said that the pec major tendon insertion to the humerus may also play a minor role in LHBT stabilisation as well.

Steve.

[Sandra St Cyr]

Steve
That is exactly the answer I was looking for.
thanks as always
Sandy

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