Macroscopic and microscopic anatomy of the rotator cable in the shoulder

Abstract

Background: The rotator cable, a semicircular fiber bundle in the lateral portion of the rotator cuff, has been believed to transmit forces among cuff tendons. This study was performed to clarify the functional anatomy of the rotator cable through histoanatomical methods.

Methods: Twenty-two cuff-intact shoulders of fixed cadavers were dissected. The cable was investigated from the cuff surface and articular/bursal sides of the capsule. The width of the cable and distances from the capsule attachment to both of the lateral and medial borders of the cable were measured, and their correlations to the humeral head diameter were calculated. The location of the cable on the humeral head was observed and recorded. In additional five shoulders the cuff/capsule complex and greater tubercle were harvested en block and histologically investigated.

Results: The rotator cable was evident in the capsule of 14 shoulders. One specimen demonstrated the cable of double curves. The capsule thickness alteration corresponding to the medial border of the cable with a single curve existed approximately on the so-called 'flexion point' where the humerus started to form a spherical curve from the greater tubercle to the joint surface. The 'flexion point' macroscopically corresponded to the medial boundary of the contact area between the cuff and head. The distance between the cable and capsule attachment showed marked negative correlation to the head diameter. Histologically the cable demonstrated cartilaginous metaplasia and vertical fiber orientation to the supraspinatus.

Conclusions: The rotator cable does not always exist in all the shoulders and its appearances are varied. The location and cartilaginous metaplasia of the cable suggested compression force between the cuff and humeral head, and the force would help cable creation in capsule layer. The vertical fiber orientation of the cable to the supraspinatus would be unlikely to explain force transmission among the cuff tendons.