The superior glenohumeral recess is the synovial extension of the glenohumeral joint into the rotator interval space between the anterior supraspinatus and the superior subscapularis. It communicates with the bicipital groove through the subscapular recess and is adjacent to the biceps pulley formed by the superior glenohumeral ligament, coracohumeral ligament, and subscapularis superior tendon fibres.
The superior recess and the rotator interval are involved in adhesive capsulitis, where fibroproliferative changes thicken the coracohumeral ligament and obliterate the superior recess. On MRI this appears as thickening and increased signal of the rotator interval capsule. Arthroscopic rotator interval closure, performed for multidirectional instability, selectively tightens this recess to restore inferior and posterior stability. The superior recess communicates with the subscapular recess and the bicipital sheath in most individuals, explaining how pathology in the biceps tendon sheath can coexist with glenohumeral synovitis.
Fibrosis of the superior recess and coracohumeral ligament in the rotator interval produces loss of external rotation in adduction, the characteristic early finding in adhesive capsulitis, treated by arthroscopic rotator interval release when conservative measures and hydrodilatation fail.
Disruption of the biceps pulley structures at the superior glenohumeral recess allows medial subluxation of the long head of biceps tendon out of the bicipital groove, producing a palpable click and anterior shoulder pain reproduced by Speed test, managed by biceps tenodesis or tenotomy.
