The Lateral Deltoid Originates From the Entire Lateral Wall of the Acromion: MRI and Histologic Cadaveric Analysis Regarding Vertical Lateral Acromioplasty
Purpose: The aim of this study was to assess the nature of the middle deltoid muscle insertion onto the lateral acromion by macroscopic, MRI and histologic examination and to, therefore, assess the potential impact of a vertical lateral acromioplasty on the deltoid origin. Methods: We assessed the a...
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doaj-1dca2918e37746e3a8f5c05094afc7562021-06-07T06:53:23ZengElsevierArthroscopy, Sports Medicine, and Rehabilitation2666-061X2020-10-0125e547e552The Lateral Deltoid Originates From the Entire Lateral Wall of the Acromion: MRI and Histologic Cadaveric Analysis Regarding Vertical Lateral AcromioplastyGeoffrey C.S. Smith, M.B.B.Ch., F.R.A.C.S.0Victor K. Liu, B.Sci. (Med)1S. Fiona Bonar, M.B.B.Ch., F.R.C.Path2Patrick Hong Lam, M.D. Ph.D.3University of New South Wales, Sydney, New South Wales, Australia; St George Orthopaedic Department, Sydney, New South Wales, Australia; Address correspondence to Geoffrey C.S. Smith, M.B.B.Ch., F.R.A.C.S., Suite 5, Level 2, 19 Kensington Street, Kogarah, New South Wales 2217, Australia.University of New South Wales, Sydney, New South Wales, AustraliaDouglass Hanly Moir Pathology, Sydney, New South Wales, AustraliaUniversity of New South Wales, Sydney, New South Wales, Australia; Orthopaedic Research Institute, Sydney, New South Wales, AustraliaPurpose: The aim of this study was to assess the nature of the middle deltoid muscle insertion onto the lateral acromion by macroscopic, MRI and histologic examination and to, therefore, assess the potential impact of a vertical lateral acromioplasty on the deltoid origin. Methods: We assessed the acromial origin of the deltoid in 6 cadaver shoulders by macroscopic, MRI and histologic examination. The cadavers were scanned with T1 and proton density-weighted sequences. H&E- and Masson trichrome-stained histologic sections through the acromion were taken and visualized under polarized microscopy. Results: The enthesis of the deltoid muscle consisted of dense birefringent bundles of collagen that blended with the bony endplate of the acromion at all points on its lateral wall. A prominent band of collagen was seen on both MRI and histologic slices, traversing the superior surface of the acromion. It was continuous with the deltoid origin and blended with the superficial fascia of the deltoid laterally. Conclusions: The middle deltoid muscle occupies the entire lateral acromion. Clinical Relevance: A high critical shoulder angle is associated with rotator cuff tears. A lateral acromioplasty resects the lateral acromion and aims to normalize the critical shoulder angle. However, a vertical lateral acromioplasty may release the middle deltoid origin from the lateral acromion. The superior band of collagen may anchor the middle deltoid to the superior acromion and prevent retraction.http://www.sciencedirect.com/science/article/pii/S2666061X20300791 |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Geoffrey C.S. Smith, M.B.B.Ch., F.R.A.C.S. Victor K. Liu, B.Sci. (Med) S. Fiona Bonar, M.B.B.Ch., F.R.C.Path Patrick Hong Lam, M.D. Ph.D. |
spellingShingle |
Geoffrey C.S. Smith, M.B.B.Ch., F.R.A.C.S. Victor K. Liu, B.Sci. (Med) S. Fiona Bonar, M.B.B.Ch., F.R.C.Path Patrick Hong Lam, M.D. Ph.D. The Lateral Deltoid Originates From the Entire Lateral Wall of the Acromion: MRI and Histologic Cadaveric Analysis Regarding Vertical Lateral Acromioplasty Arthroscopy, Sports Medicine, and Rehabilitation |
author_facet |
Geoffrey C.S. Smith, M.B.B.Ch., F.R.A.C.S. Victor K. Liu, B.Sci. (Med) S. Fiona Bonar, M.B.B.Ch., F.R.C.Path Patrick Hong Lam, M.D. Ph.D. |
author_sort |
Geoffrey C.S. Smith, M.B.B.Ch., F.R.A.C.S. |
title |
The Lateral Deltoid Originates From the Entire Lateral Wall of the Acromion: MRI and Histologic Cadaveric Analysis Regarding Vertical Lateral Acromioplasty |
title_short |
The Lateral Deltoid Originates From the Entire Lateral Wall of the Acromion: MRI and Histologic Cadaveric Analysis Regarding Vertical Lateral Acromioplasty |
title_full |
The Lateral Deltoid Originates From the Entire Lateral Wall of the Acromion: MRI and Histologic Cadaveric Analysis Regarding Vertical Lateral Acromioplasty |
title_fullStr |
The Lateral Deltoid Originates From the Entire Lateral Wall of the Acromion: MRI and Histologic Cadaveric Analysis Regarding Vertical Lateral Acromioplasty |
title_full_unstemmed |
The Lateral Deltoid Originates From the Entire Lateral Wall of the Acromion: MRI and Histologic Cadaveric Analysis Regarding Vertical Lateral Acromioplasty |
title_sort |
lateral deltoid originates from the entire lateral wall of the acromion: mri and histologic cadaveric analysis regarding vertical lateral acromioplasty |
publisher |
Elsevier |
series |
Arthroscopy, Sports Medicine, and Rehabilitation |
issn |
2666-061X |
publishDate |
2020-10-01 |
description |
Purpose: The aim of this study was to assess the nature of the middle deltoid muscle insertion onto the lateral acromion by macroscopic, MRI and histologic examination and to, therefore, assess the potential impact of a vertical lateral acromioplasty on the deltoid origin. Methods: We assessed the acromial origin of the deltoid in 6 cadaver shoulders by macroscopic, MRI and histologic examination. The cadavers were scanned with T1 and proton density-weighted sequences. H&E- and Masson trichrome-stained histologic sections through the acromion were taken and visualized under polarized microscopy. Results: The enthesis of the deltoid muscle consisted of dense birefringent bundles of collagen that blended with the bony endplate of the acromion at all points on its lateral wall. A prominent band of collagen was seen on both MRI and histologic slices, traversing the superior surface of the acromion. It was continuous with the deltoid origin and blended with the superficial fascia of the deltoid laterally. Conclusions: The middle deltoid muscle occupies the entire lateral acromion. Clinical Relevance: A high critical shoulder angle is associated with rotator cuff tears. A lateral acromioplasty resects the lateral acromion and aims to normalize the critical shoulder angle. However, a vertical lateral acromioplasty may release the middle deltoid origin from the lateral acromion. The superior band of collagen may anchor the middle deltoid to the superior acromion and prevent retraction. |
url |
http://www.sciencedirect.com/science/article/pii/S2666061X20300791 |
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