This cadaveric anatomic study measured the humeral attachment of the superior shoulder capsule on the greater tuberosity. It maps how the capsule relates to the supraspinatus and infraspinatus footprints. The goal was to determine whether prior studies confused capsule with actual tendon insertion.
The classic teaching that the supraspinatus inserts on the highest impression and dominates the cuff footprint is anatomically wrong. This study shows the infraspinatus occupies much of the lateroposterior footprint, and the deepest cuff layer is actually the articular capsule, which attaches broadly to the greater tuberosity.
The practical pearl: the thinnest capsule point sits at the tapered posterior supraspinatus, about 11 mm behind the anterior greater tuberosity margin. This aligns with Kim et al's finding that degenerative tears begin 13-17 mm posterior to the biceps tendon. Think of this zone as the mechanical weak link where age-related cuff failure starts.
Understanding that the capsule complements the tendon insertion also reframes rotator cuff repair. When you assess footprint coverage, you are not just anchoring tendon but a capsule-tendon complex.
This cadaveric anatomic study measured the humeral attachment of the superior shoulder capsule on the greater tuberosity. It maps how the capsule relates to the supraspinatus and infraspinatus footprints. The goal was to determine whether prior studies confused capsule with actual tendon insertion.
The classic teaching that the supraspinatus inserts on the highest impression and dominates the cuff footprint is anatomically wrong. This study shows the infraspinatus occupies much of the lateroposterior footprint, and the deepest cuff layer is actually the articular capsule, which attaches broadly to the greater tuberosity.
The practical pearl: the thinnest capsule point sits at the tapered posterior supraspinatus, about 11 mm behind the anterior greater tuberosity margin. This aligns with Kim et al's finding that degenerative tears begin 13-17 mm posterior to the biceps tendon. Think of this zone as the mechanical weak link where age-related cuff failure starts.
Understanding that the capsule complements the tendon insertion also reframes rotator cuff repair. When you assess footprint coverage, you are not just anchoring tendon but a capsule-tendon complex.