Ligamentous restraints to external rotation of the humerus in the late-cocking phase of throwing - A cadaveric biomechanical investigation

The late-cocking phase of throwing is characterized by extreme external rotation of the abducted arm; repeated stress in this position is a potential source of glenohumeral joint laxity. To determine the ligamentous restraints for external rotation in this position, 20 cadaver shoulders (mean age, 65 +/- 16 years) were dissected, leaving the rotator cuff tendons, coracoacromial ligament, glenohumeral capsule and ligaments, and coracohumeral ligament intact. The combined superior and middle glenohumeral ligaments, anterior band of the inferior glenohumeral ligament, and the entire inferior glenohumeral ligament were marked with sutures during arthroscopy. Specimens were mounted in a testing apparatus to simulate the late-cocking position. Forces of 22 N were applied to each of the rotator cuff tendons. An external rotation torque (0.06 N.m/sec to a peak of 3.4 N.m) was applied to the humerus of each specimen with the capsule intact and again after a single randomly chosen ligament was cut (N = 5 in each group). Cutting the entire inferior glenohumeral ligament resulted in the greatest increase in external rotation (10.2 degrees +/- 4.9 degrees). This was not significantly different from sectioning the coracohumeral ligament (8.6 degrees +/- 7.3 degrees). The anterior band of the inferior glenohumeral ligament (2.7 degrees +/- 1.5 degrees) and the superior and middle glenohumeral ligaments (0.7 degrees +/- 0.3 degrees) were significantly less important in limiting external rotation.