Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Skeletal Radiology
Published in: Skeletal Radiology 10/2013

01-10-2013 | Review Article

The deltoid, a forgotten muscle of the shoulder

Authors: Thomas Moser, Junie Lecours, Johan Michaud, Nathalie J. Bureau, Raphaël Guillin, Étienne Cardinal

Published in: Skeletal Radiology | Issue 10/2013

Login to get access

Abstract

The deltoid is a fascinating muscle with a significant role in shoulder function. It is comprised of three distinct portions (anterior or clavicular, middle or acromial, and posterior or spinal) and acts mainly as an abductor of the shoulder and stabilizer of the humeral head. Deltoid tears are not infrequently associated with large or massive rotator cuff tears and may further jeopardize shoulder function. A variety of other pathologies may affect the deltoid muscle including enthesitis, calcific tendinitis, myositis, infection, tumors, and chronic avulsion injury. Contracture of the deltoid following repeated intramuscular injections could present with progressive abduction deformity and winging of the scapula. The deltoid muscle and its innervating axillary nerve may be injured during shoulder surgery, which may have disastrous functional consequences. Axillary neuropathies leading to deltoid muscle dysfunction include traumatic injuries, quadrilateral space and Parsonage–Turner syndromes, and cause denervation of the deltoid muscle. Finally, abnormalities of the deltoid may originate from nearby pathologies of subdeltoid bursa, acromion, and distal clavicle.
Literature
1.
Le Double AF. Traité des variations musculaires de l’homme et de leur signification au point de vue de l’anthropologie zoologique. Paris: Schleicher frères; 1897.
2.
Billuart F, Devun L, Skalli W, Mitton D, Gagey O. Role of deltoid and passives elements in stabilization during abduction motion (0 degrees–40 degrees): an ex vivo study. Surg Radiol Anat. 2008;30(7):563–8.PubMedCrossRef
3.
Lorne E, Gagey O, Quillard J, Hue E, Gagey N. The fibrous frame of the deltoid muscle. Its functional and surgical relevance. Clin Orthop Relat Res. 2001;386:222–5.PubMedCrossRef
4.
Leijnse JN, Han SH, Kwon YH. Morphology of deltoid origin and end tendons—a generic model. J Anat. 2008;213(6):733–42.PubMedCrossRef
5.
Kumar VP, Satku K, Liu J, Shen Y. The anatomy of the anterior origin of the deltoid. J Bone Joint Surg Br. 1997;79(4):680–3.PubMedCrossRef
6.
Edelson JG, Luchs J. Aspects of coracoacromial ligament anatomy of interest to the arthroscopic surgeon. Arthroscopy. 1995;11(6):715–9.PubMedCrossRef
7.
Morgan SJ, Furry K, Parekh AA, Agudelo JF, Smith WR. The deltoid muscle: an anatomic description of the deltoid insertion to the proximal humerus. J Orthop Trauma. 2006;20(1):19–21.PubMedCrossRef
8.
Klepps S, Auerbach J, Calhon O, Lin J, Cleeman E, Flatow E. A cadaveric study on the anatomy of the deltoid insertion and its relationship to the deltopectoral approach to the proximal humerus. J Shoulder Elbow Surg. 2004;13(3):322–7.PubMedCrossRef
9.
Kulkarni RR, Nandedkar AN, Mysorekar VR. Position of the axillary nerve in the deltoid muscle. Anat Rec. 1992;232(2):316–7.PubMedCrossRef
10.
Groh GI, Simoni M, Rolla P, Rockwood CA. Loss of the deltoid after shoulder operations: an operative disaster. J Should Elb Surg. 1994;3(4):243–53.CrossRef
11.
Hue E, Gagey O, Mestdagh H, Fontaine C, Drizenko A, Maynou C. The blood supply of the deltoid muscle. Application to the deltoid flap technique. Surg Radiol Anat. 1998;20(3):161–5.PubMed
12.
Torpey BM, Ikeda K, Weng M, van der Heeden D, Chao EY, McFarland EG. The deltoid muscle origin. Histologic characteristics and effects of subacromial decompression. Am J Sports Med. 1998;26(3):379–83.PubMed
13.
Neer 2nd CS. Anterior acromioplasty for the chronic impingement syndrome in the shoulder: a preliminary report. J Bone Joint Surg Am. 1972;54(1):41–50.PubMed
14.
Rockwood CA, Lyons FR. Shoulder impingement syndrome: diagnosis, radiographic evaluation, and treatment with a modified Neer acromioplasty. J Bone Joint Surg Am. 1993;75(3):409–24.PubMed
15.
Ellman H. Arthroscopic subacromial decompression: analysis of one- to three-year results. Arthroscopy. 1987;3(3):173–81.PubMedCrossRef
16.
Gartsman GM. Arthroscopic acromioplasty for lesions of the rotator cuff. J Bone Joint Surg Am. 1990;72(2):169–80.PubMed
17.
Gumina S, Di Giorgio G, Perugia D, Postacchini F. Deltoid detachment consequent to open surgical repair of massive rotator cuff tears. Int Orthop. 2008;32(1):81–4.PubMedCrossRef
18.
Samuel J, Levernieux J, de Seze S. A propos d’un cas de rupture du deltoïde. Rev Rhum Mal Osteoartic. 1975;42(12):769–71.PubMed
19.
Pointud P, Clerc D, Manigand G, Deparis M. Rupture spontanée du deltoïde. Nouv Presse Med. 1976;5(35):2315–6.PubMed
20.
Morisawa K, Yamashita K, Asami A, Nishikawa H, Watanabe H. Spontaneous rupture of the deltoid muscle associated with massive tearing of the rotator cuff. J Shoulder Elbow Surg. 1997;6(6):556–8.PubMedCrossRef
21.
Blazar PE, Williams GR, Iannotti JP. Spontaneous detachment of the deltoid muscle origin. J Shoulder Elbow Surg. 1998;7(4):389–92.PubMedCrossRef
22.
Bianchi S, Martinoli C, Abdelwahab IF. Imaging findings of spontaneous detachment of the deltoid muscle as a complication of massive rotator cuff tear. Skeletal Radiol. 2006;35(6):410–5.PubMedCrossRef
23.
Ilaslan H, Iannotti JP, Recht MP. Deltoid muscle and tendon tears in patients with chronic rotator cuff tears. Skeletal Radiol. 2007;36(6):503–7.PubMedCrossRef
24.
Lecours J, Moser T, Cardinal E. Incidence of proximal deltoid tears with MR imaging in shoulder pain patients. Chicago: Radiological Society of North America; 2010.
25.
Craig EV. The acromioclavicular joint cyst. An unusual presentation of a rotator cuff tear. Clin Orthop Relat Res. 1986;202:189–92.PubMed
26.
Dennis D, Ferlic D, Clayton M. Acromial stress fractures associated with cuff-tear arthropathy. A report of three cases. J Bone Joint Surg Am. 1986;68(6):937–40.PubMed
27.
Sanders TG, Tirman PF, Feller JF, Genant HK. Association of intramuscular cysts of the rotator cuff with tears of the rotator cuff: magnetic resonance imaging findings and clinical significance. Arthroscopy. 2000;16(3):230–5.PubMedCrossRef
28.
Billuart F, Gagey O, Skalli W, Mitton D. Biomechanics of the deltoideus. Surg Radiol Anat. 2006;28(1):76–81.PubMedCrossRef
29.
Boileau P, Watkinson DJ, Hatzidakis AM, Balg F. Grammont reverse prosthesis: design, rationale, and biomechanics. J Shoulder Elbow Surg. 2005;14(1 Suppl S):147S–61.PubMedCrossRef
30.
Roberts CC, Ekelund AL, Renfree KJ, Liu PT, Chew FS. Radiologic assessment of reverse shoulder arthroplasty. RadioGraphics. 2007;27(1):223–35.PubMedCrossRef
31.
Lin JT, Nagler W. Partial tear of the posterior deltoid muscle in an elderly woman. Clin J Sport Med. 2003;13(2):120–1.PubMedCrossRef
32.
Allen AA, Drakos MC. Partial detachment of the deltoid muscle. A case report. Am J Sports Med. 2002;30(1):133–4.PubMed
33.
Chiba D, Sano H, Nakajo S, Fujii F. Traumatic deltoid rupture caused by seatbelt during a traffic accident: a case report. J Orthop Surg (Hong Kong). 2008;16(1):127–9.
34.
Banerji D, De C, Pal AK, Das SK, Ghosh S, Dharmadevan S. Deltoid contracture: a study of nineteen cases. Indian J Orthop. 2008;42(2):188–91.PubMedCrossRef
35.
Groves RJ, Goldner JL. Contracture of the deltoid muscle in the adult after intramuscular injections. J Bone Joint Surg Am. 1974;56(4):817–20.PubMed
36.
Chen CK, Yeh L, Chen CT, Pan HB, Yang CF, Resnick D. Contracture of the deltoid muscle: imaging findings in 17 patients. AJR Am J Roentgenol. 1998;170(2):449–53.PubMedCrossRef
37.
Huang CC, Ko SF, Ko JY, Huang HY, Ng SH, Wan YL, et al. Contracture of the deltoid muscle: sonographic evaluation with MRI correlation. AJR Am J Roentgenol. 2005;185(2):364–70.PubMedCrossRef
38.
Steinmann SP, Moran EA. Axillary nerve injury: diagnosis and treatment. J Am Acad Orthop Surg. 2001;9(5):328–35.PubMed
39.
May DA, Disler DG, Jones EA, Balkissoon AA, Manaster BJ. Abnormal signal intensity in skeletal muscle at MR imaging: patterns, pearls, and pitfalls. Radiographics. 2000;20 Spec No:S295–315.
40.
Tuckman GA, Devlin TC. Axillary nerve injury after anterior glenohumeral dislocation: MR findings in three patients. AJR Am J Roentgenol. 1996;167(3):695–7.PubMedCrossRef
41.
Linda DD, Harish S, Stewart BG, Finlay K, Parasu N, Rebello RP. Multimodality imaging of peripheral neuropathies of the upper limb and brachial plexus. RadioGraphics. 2010;30(5):1373–400.PubMedCrossRef
42.
Gaskin CM, Helms CA. Parsonage-Turner syndrome: MR imaging findings and clinical information of 27 patients. Radiology. 2006;240(2):501–7.PubMedCrossRef
43.
Scalf RE, Wenger DE, Frick MA, Mandrekar JN, Adkins MC. MRI findings of 26 patients with Parsonage–Turner syndrome. AJR Am J Roentgenol. 2007;189(1):W39–44.PubMedCrossRef
44.
45.
McAdams TR, Dillingham MF. Surgical decompression of the quadrilateral space in overhead athletes. Am J Sports Med. 2008;36(3):528–32.PubMedCrossRef
46.
Robinson P, White LM, Lax M, Salonen D, Bell RS. Quadrilateral space syndrome caused by glenoid labral cyst. AJR Am J Roentgenol. 2000;175(4):1103–5.PubMedCrossRef
47.
Sanders TG, Tirman PF. Paralabral cyst: an unusual cause of quadrilateral space syndrome. Arthroscopy. 1999;15(6):632–7.PubMedCrossRef
48.
Cormier PJ, Matalon TA, Wolin PM. Quadrilateral space syndrome: a rare cause of shoulder pain. Radiology. 1988;167(3):797–8.PubMed
49.
Linker CS, Helms CA, Fritz RC. Quadrilateral space syndrome: findings at MR imaging. Radiology. 1993;188(3):675–6.PubMed
50.
Cothran Jr RL, Helms C. Quadrilateral space syndrome: incidence of imaging findings in a population referred for MRI of the shoulder. AJR Am J Roentgenol. 2005;184(3):989–92.PubMedCrossRef
51.
Lambert RG, Dhillon SS, Jhangri GS, Sacks J, Sacks H, Wong B, et al. High prevalence of symptomatic enthesopathy of the shoulder in ankylosing spondylitis: deltoid origin involvement constitutes a hallmark of disease. Arthritis Rheum. 2004;51(5):681–90.PubMedCrossRef
52.
Falsetti P, Frediani B, Filippou G, Acciai C, Baldi F, Storri L, et al. Enthesitis of proximal insertion of the deltoid in the course of seronegative spondyloarthritis. An atypical enthesitis that can mime impingement syndrome. Scand J Rheumatol. 2002;31(3):158–62.PubMed
53.
Morgan H, Damron T, Cohen H, Allen M. Pseudotumor deltoideus: a previously undescribed anatomic variant at the deltoid insertion site. Skeletal Radiol. 2001;30(9):512–8.PubMedCrossRef
54.
Donnelly LF, Helms CA, Bisset 3rd GS. Chronic avulsive injury of the deltoid insertion in adolescents: imaging findings in three cases. Radiology. 1999;211(1):233–6.PubMed
Metadata
Title
The deltoid, a forgotten muscle of the shoulder
Authors
Thomas Moser
Junie Lecours
Johan Michaud
Nathalie J. Bureau
Raphaël Guillin
Étienne Cardinal
Publication date
01-10-2013
Publisher
Springer Berlin Heidelberg
Published in
Skeletal Radiology / Issue 10/2013
Print ISSN: 0364-2348
Electronic ISSN: 1432-2161
DOI
https://doi.org/10.1007/s00256-013-1667-7

Other articles of this Issue 10/2013

Skeletal Radiology 10/2013 Go to the issue

Case Report

Intramuscular myxoma of the buttock mimicking low-grade fibromyxoid sarcoma: diagnostic usefulness of MUC4 expression

Case Report

Recurrent skeletal extra-axial chordoma confirmed with brachyury: Imaging features and review of the literature

Test Yourself: Question

Multicentric reticulohistiocytosis

Scientific Article

Lumbar nerve root injections: a prospective cohort outcomes study comparing age- and gender-matched patients who returned an outcomes-based postal questionnaire with patients who did not return the postal questionnaire

Scientific Article

Association of trochlear dysplasia with degenerative abnormalities in the knee: data from the Osteoarthritis Initiative

Case Report

Lipoma arborescens of the biceps tendon sheath