Étude anatomique de la vascularisation des tendons des muscles de la coiffe des rotateurs de l'épaule

Abstract

The aim of this study was a better understanding of the role of the vascular supply as a pathogenic factor in rotator cuff disease. Twenty-five shoulders from unembalmed cadavers were studied after injection of the upper limb aa. with barium sulfate. The predominant arteries were the vessels of the subscapularis m. These branches originated from the axillary a. the anterior circumflex humeral a., and the posterior circumflex humeral a. The supraspinatus m. was supplied by the suprascapular a. but the acromial branch of the thoracoacromial a. supplied the tendon of the supraspinatus. The infraspinatus and teres minor tendons were vascularised by the ascending branches of the posterior circumflex humeral a. The tendon of the long head of the biceps brachii m. was supplied by a branch termed the "arcuate artery" and by a branch we describe derived from the brachial a. at the level of the latissimus dorsi tendon and travelling in a true mesotendon. There is a very real critical zone, with a lesser blood-flow, 1.5 cm from greater tubercle, situated mainly at the supraspinatus tendon. This is a convergence zone of the anterior and posterior circumflex humeral aa., the suprahumeral a. and the thoracoacromial a. The histologic studies confirmed the poor vascularity of this critical zone.

Arterial Supply to the Rotator Cuff Muscles

“…This classic description has been reported by many authors (Maral et al, 1993;Determe et al, 1996;Abrassart et al, 2006;Standring et al). Determe et al, observed that the suprascapular artery supplied the supraspinatus muscle.…”

The Histological Analysis of the Glenohumeral "Critical Zone"

“…Intrinsic system situated at the musculo-tendinous junction, intrinsic system located at the osteo-tendinous junction and the extrinsic system via the paratenon or synovial sheath. As the principal arterial source of the supraspinatus muscle-tendon complex, the suprascapular artery ramifies within the muscular belly to convey an anastomotic network across the musculotendinous junction to supply the distal portions of the supraspinatus tendon (Moseley & Goldie, 1963;Ling et al;Determe et al;Standring et al;Naidoo et al, 2014). …”

“…Subsequently, authors have described it as being hypovascular (Codman;Macnab, 1973;Lohr & Uhthoff, 1990;Brooks et al, 1992;Determe et al, 1996;Kane et al, 2006;Adler et al, 2008;Levy et al, 2008), avascular (Rathburn & Macnab;Herberts et al, 1981;Ling et al, 1990;Chansky & Iannotti) or hypervascular (Seitz et al) (Table I). Barr (2004) postulated avascularity to arise from the compression and attrition of the supraspinatus tendon in a narrowed subacromial space.…”

Midterm outcome after rotator cuff reconstruction

“…A funkcionális kapillárissűrűség csökken a sérült izomrész közelében [11]. Cadavervizsgálatban egy relatív hypovascularizált részt (critical zone) találtak a supraspinatus izom tapadásától 8 mm-re, amely megfelel a szakadások leggyakoribb predilekciós helyének [12].…”