We describe a case of an original insertion of the pectoralis minor on the coracohumeral ligament, supraspinatus tendon and the capsule of the glenohumeral joint. This variation has been described in anatomy textbooks since the nineteenth century. The peculiarity of this case is that the right shoulder presented type 2 and the left type 1 of the three varieties described by Le Double in 1897. Le Double (1843-1913) was a French anatomist who wrote a treaty on anatomical variations, in particular those of the muscle. Lately, only three publications have reported this variation in anatomic studies. Some authors have described the rotator cuff syndrome caused by this variation and an ultrasound study has demonstrated a frequency of 9.57% for the detection of this variation. It is possible to try and find this variation while investigating in order to diagnose impingement, through ultrasound, CT arthrography or MRI. We believe that this variation should be taken into consideration by surgeons during surgical procedures and arthroscopy.

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During a dissection on a 103-year-old female cadaver, a bilateral spontaneous tenodesis of the long head of the biceps (LHB) with massive rotator cuff tear was discovered at the bicipital groove. Neer et al. have introduced the term of cuff-tear arthropathy to define severe disorganization of the glenohumeral joint with collapse of the humeral head that occurs following some massive tears of the rotator cuff, and we found this aspect during our dissection. The tendon of the LHB is a well-known source of shoulder pain, and the majority of degenerative changes in the LHB are associated with pathology of the rotator cuff. When there are complete rotator cuff tears and a rupture of the LHB, the ineluctable evolution of the shoulder is the ascension of the humeral head and the creation of a neoarticulation like in our case. This aspect is an acromial acetabulization as described roentgenographically by Hamada et al.