Purpose: This study aimed to morphologically and histologically investigate the relationship between deep subregions of the rotator cuff muscle and shoulder joint capsule as well as the relationship between the rotator cuff tendon or capsule and bony insertion.
Methods: We examined 13 shoulders of embalmed cadavers and measured the capsular attachments and footprints macroscopically. We also histologically examined the fibres in three shoulders.
Results: Loose attachment, which was less tight with spaced connective tissue, and firm attachment, which was tight with dense connective tissue, were found under the surface of the supraspinatus and infraspinatus. The anterior-deep and posterior-deep subregions of the supraspinatus and the middle partition and inferior partition of the infraspinatus formed firm attachments to the capsule. The mean areas of firm attachment for the anterior-deep subregion, posterior-deep subregion and middle partition were 118.8 mm2, 267.8 mm2 and 399.3 mm2, respectively, while the area of the inferior partition was small. The transverse fibres were located just lateral to the medial edge of the firm attachment area. The thick capsule had a substantial footprint. Both tendon fibres and the capsule inserted into the superior and middle facets through the attachment fibrocartilage.
Conclusions: The posterior-deep subregion of the supraspinatus and middle partition of the infraspinatus evenly occupied the capsular attachment area. The transverse fibres were located just lateral to the medial edge of the firm attachment area, and the thick capsule had a substantial footprint. Both tendon fibres and the capsule inserted into the superior and middle facets through the attachment fibrocartilage.
Keywords: Capsular attachment; Infraspinatus; Rotator cuff; Subregion; Supraspinatus.