The effect of the conjoined tendon of the short head of the biceps and coracobrachialis on shoulder stability and kinematics during in-vitro simulation.

The kinematics and stability of the shoulder during in-vitro simulation are affected by the muscles chosen for simulation and their loads. Existing simulators have commonly actuated the rotator cuff and deltoids; however, the contribution of secondary muscles, such as those which form the conjoined tendon, are not well understood. The conjoined tendon consists of the origins of the short head of the biceps and coracobrachialis (SH&C), and is thought to produce an anterior stabilizing effect. This study investigated the effect of SH&C tension at four loading levels: 0, 5, 10, 15N. Our primary outcome variable was glenohumeral stiffness for anterior loading but internal/external rotation and extension ranges of motion were also measured. Four joint configurations were tested: adduction and 90° combined abduction, each in neutral and maximal external rotation. Increasing SH&C load resulted in a significant trend of increased glenohumeral stiffness across the average of all joint configurations (p=0.008). In abduction, neutral rotation differences were found between the stiffness at 10 and 15N compared to 0N (p=0.038 and 0.043, respectively); however, no differences were found for the three other joint configurations. There was a tendency for a decrease in the range of shoulder extension with increasing SH&C load, but this did not achieve significance (p=0.065). These findings demonstrate that the SH&C provides a stabilizing barrier effect, but only in configurations when it wraps directly anterior to the humeral head. Thus SH&C loading is likely critical to in-vitro simulation due to its effect on joint stability and kinematics.