shoulder anatomy and biomechanics

Shoulder function: the perfect compromise between mobility and stability. Ogul H, Tuncer K, Kose M, Pirimoglu B, Kantarci M. Br J Radiol. Anatomy and Biomechanics of the Unstable Shoulder This knowledge allows the surgeon to evaluate the possible causes of instability, to assess which are the structures that must be reconstructed and to decide which surgical technique must be performed. NLM The inferior glenohumeral ligament, better-called the inferior glenohumeral ligament complex (IGHLC), is formed by 3 parts: two thicker bands on the anterior and posterior and an axillary thinner recess, assuming a sling-like structure. Loss of intracapsular negative pressure manifests itself as augmented anterior translation; this factor could be marginal when muscles are contracted and capsuloligamentous structures are in tension, especially in athletes [36]. Anatomy and Biomechanics of the Sporting Shoulder. The clinical relevance of normal shoulder anatomy, biomechanics, and pathomechanics related to this surgery is emphasized to provide the reader with an understanding of the rationale for treatment. The effect of internal and external rotation on the IGHLC (courtesy of Lennard Funk, ​www.​shoulderdoc.​co.​uk). Shoulder Anatomy & Biomechanics SKU: 206 By Jeffrey K. McCamman, BS, MPT Reviews anatomy and biomechanics of the human shoulder.  |   |  (2010). An excessive retroversion of the glenoid could be a rare cause of posterior instability, but more frequently it is only a contributory factor. The structures successfully evaluated by ultrasound include: •The rotator cuff tendons •The long head of biceps tendon •Bursaearound the shoulder •Impingement of the above structures on the coraco-acromial arch •The bony structures of the shoulder •The A … shoulderdoc. Radiologe. Epub 2008 Jun 3. 2018 Nov 18;9(11):245-254. doi: 10.5312/wjo.v9.i11.245. Describe the basic biomechanics of the human shoulder with the motions of flexion, extension, abduction, adduction, horizontal abduction, horizontal adduction, internal rotation and external rotation. 2007;40(10):2119-29. doi: 10.1016/j.jbiomech.2006.10.016. Biomechanics of the Shoulder DENNIS L. HART, MPA, PT,* STEPHEN W. CARMICHAEL, PhDt The terminology of engineering has made bio- mechanics unnecessarily confusing and intimidat- ing to many clinicians. Epub 2018 Apr 4. Considering bony stabilisers, it’s important to underline the glenoid track concept, defined as a contact area between glenoid and humeral head, created by shifting of the glenoid from the inferomedial to the posterolateral portion of the posterior articular surface of the humeral head when the arm moves in maximum external rotation, extension and abduction. Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), on Anatomy and Biomechanics of the Sporting Shoulder. The glenoid track influences the risk of engagement of a Hill–Sachs lesion: if the bony loss in the humeral head remains within the glenoid track there is no possibility that the Hill–Sachs lesion overrides the glenoid rim. En: Warren RF, Craig EV, Altchek DW. Acromioclavicular (AC) joint 3. Shoulder Anatomy & Biomechanics 20 Questions | By Drgeej | Last updated: Sep 29, 2020 | Total Attempts: 1053 Questions All questions 5 questions 6 questions 7 questions 8 questions 9 questions 10 questions 11 questions 12 questions 13 questions 14 questions 15 questions 16 questions 17 questions 18 questions 19 questions 20 questions Moreover, SLAP lesions are common in contact athletes: Funk and Snow [30] reported a 35% incidence of SLAP tears, arthroscopically diagnosed, in 51 rugby players’ shoulders. Green and Christensen [23] classified Bankart lesions in 5 arthroscopic types: type 1 refers to an entire labrum; type 2 is a simple detachment of labrum with no other significant lesions; type 3 is an intraparenchymal tear of labrum; type 4 and 5 are complex tears with a significant or complete degeneration of the inferior glenohumeral ligament, respectively. The rotator interval is a triangular space, with medial base and lateral apex, limits of which are the coracoid medially, the long head of biceps and its groove laterally, the superior fibres of subscapularis inferiorly and the anterior fibres of supraspinatus superiorly. The most common injury to the labrum, found in more than 90% of traumatic anterior instability [21], is a Bankart lesion. Furthermore, synovial fluid generates the adhesion-cohesion mechanism: when two articular cartilage wet surfaces, such as the humeral head and glenoid, come into contact with each other this creates an adhesion-cohesion bond that provides stability to the glenohumeral articulation [37]. J Orthop Sports Phys Ther. Usually, it is larger in males than in females and becomes smaller with internal rotation. HHS During abduction, external rotation and extension the IGHLC moves anteriorly, forming a restraint to anterior translation of the humeral head (Fig. 1999; 51-76.]. Philadelphia. COVID-19 is an emerging, rapidly evolving situation. Shoulder & Elbow⎜Glenohumeral Joint Anatomy, Stabilizer, and Biomechanics (ft. Dr. Anthony Romeo) Team Orthobullets (J) Shoulder & Elbow On the other hand, during adduction, flexion and internal rotation, the IGHLC moves posteriorly, forming a restraint to posterior translation. Anatomy and biomechanics of the shoulder in throwing, swimming, gymnastics, and tennis | Read by QxMD. Braz J Phys Ther. It is an important inferior stabiliser and its insufficiency could be clinically appreciated with sulcus sign examination. An understanding of the anatomy and biomechanics of the shoulder is essential for clinicians who treat spinal disorders, as well as for other orthopedic practitioners. Glenohumeral (GH) joint, 2. 2004 Jun;44(6):556-61. doi: 10.1007/s00117-004-1046-4. Negative intracapsular pressure plays a role in shoulder stability. It could be damaged more frequently at the glenoid insertion (anteroinferior glenoid rim), but also in the middle part or at the humeral insertion [33]. Soft tissue static stabilisers include glenoid labrum, glenohumeral capsule, glenohumeral ligaments, rotator interval, negative intracapsular pressure and the adhesion-cohesion mechanism. Doukas WC(1), Speer KP. Described for the first time by Snyder et al. The constitutional trait of laxity facilitates extensive motion in multiple planes and may be essential to athletic performance. Course Length: 3.0 contact hours Instructional Level: Beginner Course Goals and Objectives: Goal: To instruct the student, through self-paced study, of the anatomy and basic biomechanics of the human shoulder. Hill-Sachs lesion of the posterior humeral head (courtesy of Lennard Funk, ​www.​shoulderdoc.​co.​uk). 2018 Mar;232(3):422-430. doi: 10.1111/joa.12753. A rotator interval defect could be a little foramen or could reach larger size, influencing significantly inferior stability [35]. Phys Med Rehabil Clin N Am 15 (2004) 313–349 Shoulder anatomy and biomechanics Barry Goldstein, MD, PhD VA Puget Sound Health Care System, 1660 South … [29], SLAP lesions occur during the ending deceleration phase of throwing, because of a traction force wielded by the long head of biceps on the glenoid labrum. The ball-shaped humeral head rotates and glides on a shallow scapular cup. Epub 2017 Nov 28. As the most mobile joint in the body, the shoulder is structurally insecure. The dynamic-stabilizing structures include the rotator cuff muscles and the other muscular structures surrounding the shoulder joint. The shoulder comprises three synovial joints and two movement interfaces. 1993 Jul;18(1):342-50. doi: 10.2519/jospt.1993.18.1.342. 2018 Sep-Oct;22(5):370-375. doi: 10.1016/j.bjpt.2018.03.007. co. uk) The glenoid is a shallow socket that holds humeral head; its mean depth is 2.5 mm on anteroposterior direction and 9 mm in superior inferior direction. When looking at the biomechanics of the shoulder, the motion comes from 2 joints: the scapulothoracic (ST) joint, and the glenohumeral (GH) joint. T he joints of the shoulder com plex have to rely on adjacent ligam ents and m uscles to provide stability. The mechanism of injury could trace back to a direct blow to the anterior and lateral aspect of the shoulder, while the arm is adducted; a rare mechanism of injury is a posterior blow to the arm, while holding a tackle shield [28]. The PICO method, suggested by Baudi et al. Athletes who use the arm for a propelling force strain the extremes of … The glenoid is a shallow socket that holds humeral head; its mean depth is 2.5 mm on anteroposterior direction and 9 mm in superior inferior direction. The following principles are important to establish an accurate anatomic diagnosis and to develop a treatment plan: (1) perform a careful history and physical examination; (2) determine whether or not … The posterior capsular also can be damaged, seeing that recurrent posterior subluxations or luxations produce capsular redundancy and increase joint volume, resulting in posterior instability. The evaluation of shoulder disorders is challenging because of anatomic and biomechanical complexities. Lippincott Raven eds. It is the synergism of these joints and the muscles acting on them that produce smooth and full movement while we perform pressing and pulling exercises in … Join Karen Clippinger in her workshop that brings scientific information about anatomy and shoulder biomechanics and makes it practical and usable when you are teaching. Please enable it to take advantage of the complete set of features! The acromioclavicular system (ACS) is formed by a complex of ligaments (conoid, trapezoid and acromioclavicular capsular ligaments) that stabilize the acromioclavicular joint (Fig. Its structural limitations indicate that the primary source of joint stability must be balanced muscle control. NIH Clipboard, Search History, and several other advanced features are temporarily unavailable. The shoulder ligamentous anatomy is clearly different from the knee ligaments, as there are no shoulder ligaments that maintain tension throughout the complete movement arch of the shoulder. Effect of flexibility deficit on scapular asymmetry in individuals with and without shoulder pain. 2018 Jun 19;6(2):68. doi: 10.3390/healthcare6020068. 2008 Oct;68(1):16-24. doi: 10.1016/j.ejrad.2008.02.051. Anatomy and Biomechanics of the Unstable Shoulder Ricardo Cuéllar 1 , Miguel Angel Ruiz-Ibán 2 , Adrián Cuéllar 3 , * 1 Deparment of Traumatology and Orthopaedic Surgery of Universitary Donostia Hospital San Sebastián, Spain Instability in the athlete presents a unique challenge to the orthopaedic surgeon. Fig. Superior and middle glenohumeral ligaments, together with the coracohumeral ligament, long head of the biceps and a thin layer of capsule, help to form rotator interval and they will be discussed in detail later. Bony geometry of the scapula and glenoid (courtesy of Lennard Funk, ​www.​shoulderdoc.​co.​uk). USA.gov. Development of the human shoulder joint during the embryonic and early fetal stages: anatomical considerations for clinical practice. Shoulder ligaments only act in the extreme positions of the range of motion (ROM), and remain lax if the shoulder is at rest or during non-extreme ROM . A Hill–Sachs lesion is an impact fracture occurring after one or more traumatic anterior shoulder dislocations and involves the posterior-lateral articular surface of the humeral head (Fig. Learn vocabulary, terms, and more with flashcards, games, and other study tools. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. Intracapsular pressure is about −42 mmHg H2O and it acts especially when rotator cuff muscles are not contracted and glenohumeral ligaments and capsular structure are not in tension. Reverse Bankart lesions are quite frequent in athletes, in particular contact athletes such as rugby players, being reported with a 20% incidence in a study of 142 elite rugby player shoulder arthroscopies [27]. Another lesion that involves anteroinferior aspect of the labrum is the anterior labro-ligamentous periosteal sleeve avulsion (ALPSA) lesion: the anterior labro-ligamentous complex rolls up in a sleeve-like fashion and becomes displaced medially and inferiorly on the glenoid neck [24]. Try using search on phones and tablets. 49.1 (A and B) The shoulder is composed of four joints: the glenohumeral (GH), the acromioclavicular (AC), the sternoclavicular (SC), and the scapulothoracic (ST). ALPSA lesions probably have a higher risk of redislocation than undisplaced Bankart tears, as the normal bumper and capsule that stabilise the front of the shoulder are displaced and the anterior glenoid is deficient of a capsule and labrum. Scapulothoracic (ST) joint - known as a "functional joint". Specular lesions can be described for the posterior aspect of the labrum: a reverse Bankart lesion involves the posterior labrum and the posterior band of inferior glenohumeral ligament [25]; a POLPSA is a posterior labroligamentous sleeve avulsion, that if chronic could become a Bennett lesion (an extraarticular calcification along the posteroinferior glenoid neck close to the posterior band of the glenohumeral ligament) [26]. Anatomy, biomechanics and pathophysiology of glenohumeral instability. The ST joint involves the gliding movement of the scapula along the rib cage during upper extremity movements and does not include a physical bone-to-bone attachment. There is a fine balance between the mobility to perform athletic activities and stability required to power and stabilise the arm. C onse- … This area’s width is 84% of the glenoid width, therefore, any glenoid articular surface loss (as in bony Bankart lesions) greatly influences the width of the glenoid track. The shoulder complex involves 3 physiological joints and one floating joint: 1. The rotator interval is composed of the coracohumeral ligament (CHL) and superior and middle glenohumeral ligaments deeper, even if the middle glenohumeral ligament contribution is relatively variable (different studies has reported its absence, from 10 to 40% of cases). Morphologic and biomechanical changes in pathologic conditions briefly are described. 29 pages. It is defined as a detachment of the anteroinferior aspect of the labrum and its attached portion of the inferior glenohumeral ligament. SC joint connects the … Bibliography – Anatomy and Biomechanics ontempo, N., & Mazzocca, A. Get the latest public health information from CDC: https://www.coronavirus.gov, Get the latest research information from NIH: https://www.nih.gov/coronavirus, Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. 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