Int J Anat Res 2015, 3(2):1084-86. ISSN 2321-4287 1084
Case Report
OSSIFIED BRODIE’S LIGAM ENT
R. Siva Chidambaram *
1, Neelee Jayasree
2, Soorya Sridhar
3.
ABSTRACT
Address for Correspondence: Dr. R.Siva Chidambaram,Post graduate, Depart ment of Anat omy, Narayana M edical College, Nellore, Andhra Pradesh, India. M obile no. +919994473699
E-M ail: drsivavinns@gmail.com
* 1,3 Post Graduat e, 2 Professor and Head.
Depart ment of Anat omy, Narayana M edical College, Nellore, Andhra Pradesh, India.
The t ransverse hum eral ligam ent (THL) or Brodie’s ligam ent is a narrow sheet of connect ive t issue fibers t hat runs bet ween t he lesser and t he greater tubercles of t he hum erus. Toget her wit h t he int ertubercular groove of the hum er us, t he ligam ent creat es a canal t hrough w hich t he long head of t he biceps t endon and it s synovial sheat h passes. The ossif icat ion of t ransver se hum eral ligam ent is a rar e int erest ing anat om ical var iat ion, w hich has been ident if ied as one of t he pr edisposing fact or f or biceps t endonit is and t enosynovit is. In t he present st udy of 100 hum er us bones, w e f ound a right side hum erus w it h com plet ely ossif ied t ransverse hum eral ligam ent w hich ext ended fr om t he lat eral m argin of lesser t ubercle t o t he m edial m argin of great er t ubercle of t he hum erus. The Lengt h and breadt h of t he ossified ligam ent w ere 8 m m and 6 m m respect ively. Such an ossif ied ligam ent m ay dam age t he biceps t endon and it s synovial sheat h dur ing biom echanical m ovem ent of t he arm leading t o ant erior shoulder pain. It m ay also com plicat e t he use of bicipit al groove as a landm ark for orient at ion of t he hum eral prost hesis in com plex proxim al hum er al fract ures. Hence, t he anat om ical know ledge of ossif ied t ransver se hum eral ligam ent is im por t ant for t he r adiologist and ort hopedic surgeon in diagnosis and planning t he t reat m ent for pat ient w it h ant erior shoulder pain.
KEY WORDS:Brodie’s ligam ent , Transverse hum eral ligam ent, Ossificat ion, Biceps t endonit is, Hum eral prost hesis.
INTRODUCTION
Int ernat ional Journal of Anatomy and Research, Int J Anat Res 2015, Vol 3(2):1084-86. ISSN 2321- 4287 DOI: ht t p:/ / dx.doi.org/10.16965/ ijar.2015.169
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Received: 30 Apr 2015 Accept ed: 21 M ay 2015 Peer Review : 30 Apr 2015 Published (O):31 M ay 2015 Revised: None Published (P):30 June 2015 Int ernat ional Journal of Anat omy and Research
ISSN 2321-4287 ww w.ijmhr.org/ ijar.htm
DOI: 10.16965/ ijar.2015.169
Bicipit al groove or Int ert ubercular sulcus is present in t he ant erior aspect of proximal part of t he humerus bet w een t he great er and t he lesser t ubercles and ext ends for almost 5-6cm over t he shaft of t he humerus. Superiorly t he t ransverse humeral ligament (THL) or Brodie’s ligament bridges t he groove int o a canal for t he passage of tendon of long head of biceps brachii m uscle, it s synovial sheat h and ascending branch of ant erior circumflex humeral art ery [1]. The t ransverse humeral ligament cont ribut es t o t he st ab il i t y of t he bi cep s t en do n d u r in g biomechanical movement of arm.
Int J Anat Res 2015, 3(2):1084-86. ISSN 2321-4287 1085 R. Siva Chidam baram , Neelee Jayasr ee, Soor ya Sr idhar. OSSIFIED BRODIE’S LIGAM ENT: A CASE REPORT.
CASE REPORT
In t he present case, w e describe a right side humerus w it h com plet ely ossified t ransverse humeral ligament and it s clinical relevance.
Dur ing ost eology t eaching pr ogr am m e f or undergraduat e m edical st udent s of Narayana medical college, Nellore, Andhra Pradesh, India. Out of 100 humerus we found one right humerus, t hat show ed com plet e ossificat ion of THL. It bridged t he bicipit al groove from lat eral margin of lesser t ubercle t o medial margin of great er t ubercle of t he hum erus and convert ing t he groove int o a canal. The lengt h and breadt h of t he ossified ligament w ere 8 mm and 6mm re-spect ively. The vertical and t ransverse diameters of t he bicipit al canal w ere measured at t he su-perior aspect of t he humerus and w as found t o be 2mm and 3mm respect ively (Fig.2). The area of int erest w as phot ographed (Fig.1,2) and t he clinical import ance of t he ossified ligament w as st udied in det ail.
Fig. 1:Ant erior view of proxim al part of t he right sided hum erus show ing ossified t ransverse hum eral ligam ent .
[GT-Great er t ubercle, LT-Lesser t ubercle, OTHL-Ossif ied t ransver se hum eral ligam ent , M P-M et al probe].
Fig. 2:Superior view of proxim al part of t he right sided hum erus show ing narrow ed bicipit al canal.
[BC-Bicipit al canal, OTHL-Ossified t ransverse hum er al ligam ent ].
DISCUSSION
The t ransverse humeral ligament (THL) was first described in 1889 by Charles Gordan Brodie, a Scot tish anatomist and surgeon, as a broad band of t r ap ezoi dal f ibr ous t issue b et w een t he great er and lesser t ubercle of t he humerus.
The Transverse humeral ligament is not a part of capsule of t he shoulder joint , but a separat e ligam ent bet w een t he t w o t uber cles. It lies bet w een t he synovial m embrane and fibrous capsule as these ext end downw ard bet ween the t ubercles over t he long t endon of t he biceps br achii m uscle. The THL act s as a pow erf ul ret inaculum for t he st abilizat ion of long t endon of biceps brachi m uscle. Recent lit erat ures suggest t hat THL act s as a sling formed mainly by t he t endons of subscapularis, supraspinat us and coracohumeral ligament [5, 6].
In t he present st udy, t he right side hum erus show ed com plet e ossificat ion of THL w it h a narrow ed groove. Narrow ing of t he canal may be due t o t he ossificat ion of THL because of eit her calcium metabolism disorder or repetit ive st ress on t he THL r esult ing in m icr ot r aum a follow ed by calcificat ion.
Clinical relevance of ossified THL: Norm ally w hen t h e ar m is sud d enl y ab d u ct ed an d externally rotated, the long head of biceps brachii t endon is forced m edially against t he lesser t uber cle and super iorly against THL of t he hum er us. This ligam ent cont r ibut es t o t he st abilit y of t he biceps t endon and prevent s it s subluxat ion from t he groove [7]. Ossificat ion of THL can t raum at ize t he long head of biceps br ach ii t en don an d it s syno vial sheat h by const ant ly rubbed over t he bony bridge, leading t o t eno sy no v i t i s, t en di n o si s, gr adu al delam inat ion, pr e-r upt ur e and progr essive degenerat ion of t he biceps brachii t endon [8].
Int J Anat Res 2015, 3(2):1084-86. ISSN 2321-4287 1086 R. Siva Chidam baram , Neelee Jayasr ee, Soor ya Sr idhar. OSSIFIED BRODIE’S LIGAM ENT: A CASE REPORT.
CONCLUSION
Conflicts of Interests: None
REFERENCES
The present st udy suggest s t hat t he ossified THL m ay be one of t he predisposing causes f or ant erior shoulder pain in a patient w ith repeated overhead act ion of arm. It also int erferes in rest oring t he humeral head ret roversion w hen t reat ing complex proximal humeral fract ure. In t he presence of ossified THL, the bicipit al groove may not be used as a landmark for orient at ion of t he humeral prost hesis in reconst ruct ing t he p r o xi m al hu m er al f r act u r e. Hence, t h e know ledge of ossif ied THL is essent it ial f or r adiologist and ort hopedic sur geons in t he management of ant erior shoulder pain and for posit ioning t he humeral prost hesis in complex proximal humeral fract ure.
Acknow ledgem ents:
The aut hors sincerely w ish t o t hank M r. Devi K Shankar Assist ant Pr of essor depart m ent of Anat omy of Narayana M edical College, Nellore for t he great help received. The aut hor also w ishes t o acknow ledge t he scholars w hose art icles cit ed and included in references of t his manuscript. Aut hors are grateful to IJAR edit orial board members and IJAR t eam of reviewers who have helped t o bring qualit y t o t his manuscript .
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