The Transverse Humeral Ligament: An Anatomical Narrative Review

Shoulder pain often involves the tendon of the long head of the biceps brachii (LHBT) and the transverse humeral ligament (THL). Traditionally, the THL is considered a ligament that prevents the LHBT from dislocating, but recent studies suggest that it may be part of the subscapularis tendon. This review evaluates the nature of the THL and its overlying structures. We reviewed the literature from PubMed and Scopus through April 2024 and selected seven studies. Four described the THL as a ligament, and three did not. THL measurements ranged from 14 to 21 mm in length and 14 to 17 mm in width. Histology was inconsistent, with some studies suggesting it is more tendon-like. Clinically, LHBT injuries are associated with rotator cuff injuries. Biomechanical studies, such as those by Kwon et al. (2009), associate the LHBT with subscapularis tendon tears. Accurate diagnosis and treatment of shoulder pain should consider these anatomical variations. The structure covering LHBT in the intertubercular sulcus is most likely the subscapularis tendon, rather than a ligament. Understanding these variations is critical to improving the management of shoulder pain.