shoulder anatomy and biomechanics

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Furthermore, external rotation of the shoulder is altered with rotator interval pathology. 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. It is an important inferior stabiliser and its insufficiency could be clinically appreciated with sulcus sign examination. This classification has a prognostic value: type 4 and 5 has a good chance (87%) of recurrent instability after arthroscopic Bankart procedure. Described for the first time by Snyder et al. USA.gov. The dynamic-stabilizing structures include the rotator cuff muscles and the other muscular structures surrounding the shoulder joint. The acromioclavicular system (ACS) is formed by a complex of ligaments (conoid, trapezoid and acromioclavicular capsular ligaments) that stabilize the acromioclavicular joint (Fig. The shoulder comprises three synovial joints and two movement interfaces. [4] reported that its bending radius is larger than humeral head radius in 93% of examined joints; the remainder have glenoid and humeral head with the same bending radius. 2 Outline Anatomy Biomechanics [10], could be used to calculate bone deficiency produced by a bony Bankart lesion: it needs Computed Tomography Multiplanar Reconstruction of both shoulder and defects and is calculated as a ratio between the surface of the damaged glenoid and the surface of not damaged glenoid. T he joints of the shoulder com plex have to rely on adjacent ligam ents and m uscles to provide stability. The contact sports most commonly associated with shoulder instability include rugby, football, wrestling and hockey. Hill-Sachs lesion of the posterior humeral head (courtesy of Lennard Funk, ​www.​shoulderdoc.​co.​uk). The rotator interval contains multiple static stabilizers of the shoulder, and its integrity is important for anterior and inferior stability of the shoulder, especially when the shoulder is adducted. Capsuloligamentous structures include the joint capsule, whose mean thickness is 5 mm, and glenohumeral ligaments (superior, middle and inferior), described as located at the thickening of the capsule (Fig.  |  Capsular redundancy, both anterior and inferior and posterior, is a very common find in atraumatic multidirectional instability. The shoulder comprises three synovial joints and two movement interfaces. Eur J Radiol. NIH The SC joint is the only bony attachment site of the upper extremity to the axial skeleton. Functional anatomy of the shoulder complex. Anatomy and Biomechanics of the Sporting Shoulder. 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. 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 … 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 unstable shoulder. As the most mobile joint in the body, the shoulder is structurally insecure. Epub 2008 Jun 3. 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]. Clipboard, Search History, and several other advanced features are temporarily unavailable. MR arthrographic characterization of posterior capsular folds in shoulder joints. Lennard Funk The shoulder is potentially one of the most unstable joints of the body, with very little bony stability or containment and has been likened to a golf ball on a golf tee. Affiliation 1 Orthopedic Biomechanics Laboratory, Mayo Clinic Rochester, The Mayo Foundation, Rochester, MN 55901, USA. Learn vocabulary, terms, and more with flashcards, games, and other study tools. 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]. Anatomy and biomechanics of the shoulder Orthop Clin North Am. Frankel and Burnstein's4 classic text on orthopedic biomechanics was so difficult to understand that it was not fully appre- ciated. 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 … 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. eCollection 2018 Nov 18. Bony Bankart lesions become significant when they involve more than 20% of the length of the glenoid and are predisposed to recurrence despite correct soft tissues repair; if the bony Bankart lesion involves more than 50% of the length of the glenoid, shoulder stability is reduced by more than 30% [7]. 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. It is retroverted on average 1.2° (range 9.5° of anteversion to 10.5° of retroversion) and inclined superiorly on average 5° (range 7° of inferior inclination to 15.8° of superior inclination) [3]. Shoulder Anatomy and Biomechanics The shoulder can really be considered a complex ( Fig. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. Epub 2017 Nov 28. The GH joint is of particular inter… Bony geometry of the scapula and glenoid (courtesy of Lennard Funk, www. J Biomech. Braz J Phys Ther. The IGHLC suffers an initial plastic deformation during initial dislocation, but the damage becomes more critical after several episodes [32]. 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. Bibliography – Anatomy and Biomechanics ontempo, N., & Mazzocca, A. There are different kinds of labrum lesions and it’s very important not to confuse tears with anatomical variants that don’t require surgical repair, like sublabral foramen associated with cord-like middle glenohumeral ligament or meniscoid labrum [. 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]. Start studying Shoulder Anatomy and Biomechanics. (2010). Epub 2018 Nov 28. 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 Thus, the labral avulsion injury is often associated with excessive capsular laxity that promotes a pathological redundancy (Fig. A rotator interval defect could be a little foramen or could reach larger size, influencing significantly inferior stability [35]. The ball-shaped humeral head rotates and glides on a shallow scapular cup. Describe the role of the accessory structures of the human shoulder during the shoulder’s biomechanics. 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. 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. Glenohumeral ligaments act at maximum degrees of range of motion, when they appear in tension; at middle degrees of motion, when they are slack, stability depends on rotator cuff and long head biceps activities, those compress the humeral head inside the glenoid concavity. 2007;40(10):2119-29. doi: 10.1016/j.jbiomech.2006.10.016. World J Orthop. [Anatomy of the shoulder-clinical aspects for imaging and anatomical varieties]. 42-1 ), consisting of four joints or articulations (all with important stabilizing ligaments), two spaces, and more than 30 muscles and their respective tendons. It’s different according to different planes: 0.75 in the sagittal plane and 0.6 in the coronal plane [6]. 2018 Sep-Oct;22(5):370-375. doi: 10.1016/j.bjpt.2018.03.007. Despite its frequency, it cannot be considered a cause of instability in isolation, seeing that a concomitant plastic deformation needs to produce certain instability [22]. Lippincott Raven eds. Shoulder Anatomy & Biomechanics SKU: 206 By Jeffrey K. McCamman, BS, MPT Reviews anatomy and biomechanics of the human shoulder. 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. Thoracic Outlet Syndrome: Biomechanical and Exercise Considerations. 2018 Mar;232(3):422-430. doi: 10.1111/joa.12753. Usually capsular stretching is noted along with a Bankart lesion and it’s present in up to 28% of patients with recurrent anterior instability [31]. Scapulothoracic (ST) joint - known as a "functional joint". 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). During abduction, external rotation and extension the IGHLC moves anteriorly, forming a restraint to anterior translation of the humeral head (Fig. 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/. 1993 Jul;18(1):342-50. doi: 10.2519/jospt.1993.18.1.342. 1999; 51-76.]. Anatomy, pathophysiology, and biomechanics of shoulder instability. [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. 2019 Feb;92(1094):20180527. doi: 10.1259/bjr.20180527. The most common injury to the labrum, found in more than 90% of traumatic anterior instability [21], is a Bankart lesion. Its structural limitations indicate that the primary source of joint stability must be balanced muscle control. 2). Healthcare (Basel). Authors A M Halder 1 , E Itoi, K N An. Shoulder function: the perfect compromise between mobility and stability. 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. SC joint connects the … Try using search on phones and tablets. 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. The PICO method, suggested by Baudi et al. The evaluation of shoulder disorders is challenging because of anatomic and biomechanical complexities. HHS If a bone fragment is present it will be reabsorbed within a year [9]. The suction effect of the glenoid labrum, the negative intracapsular pressure and the adhesion-cohesion mechanism are the three mechanisms providing the vacuum effect. She teaches how you can be more effective in the execution of the exercises as well as teaching clients with injuries and injury prevention. The glenohumeral ratio shows a dimensional relationship between humeral head and glenoid: it’s the result of the division between the maximum diameter of the glenoid and the maximum diameter of the humeral head. The evaluation of shoulder disorders is challenging because of anatomic and biomechanical complexities. Development of the human shoulder joint during the embryonic and early fetal stages: anatomical considerations for clinical practice. 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). In this episode of eOrthopodTV, orthopaedic surgeon Randale C. Sechrest, MD narrates an animated tutorial on the basic anatomy of the shoulder. 29 pages. Although much is known regarding both the structure and the biomechanics of the shoulder, there are factual gaps in our overall understanding, and supposition abounds. 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]. 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. This site needs JavaScript to work properly. Shoulder Biomechanics Lecture originally developed by Bryan Morrison, Ph.D. candidate Arizona State University Fall 2000. Its jobs are to make the glenoid socket deeper, to increase contacting area and congruity, to generate a suction effect, to function as an insertion area for capsular-ligamentous structures and to help muscles to compress the humeral head within the glenoid. Overview of shoulder anatomy, biomechanics, and pathomechanical principles Epub 2018 Apr 4. Bony geometry of the scapula and glenoid (courtesy of Lennard Funk, ​www.​shoulderdoc.​co.​uk). Bony Bankart lesion (courtesy of Lennard Funk, ​www.​shoulderdoc.​co.​uk). Bony Bankart lesions are classified as described by Bigliani et al. Usually, it is larger in males than in females and becomes smaller with internal rotation. Introduction The shoulder is composed of 3 Synovial Joints : 1) The Glenohumeral joint (GH) 2) The Acromioclavicular joint (AC) 3) The Sternoclavicular joint ( SC) The scapulothoracic joint also functions as joints in the shoulder complex. iomechanics and treatment of acromioclavicular and sternoclavicular joint injuries. Ogul H, Tuncer K, Kose M, Pirimoglu B, Kantarci M. Br J Radiol. The fol­lowing description is based on sound anatomic knowledge along with integration of the pertinent literature. On the other hand, during adduction, flexion and internal rotation, the IGHLC moves posteriorly, forming a restraint to posterior translation. Glenohumeral (GH) joint, 2. Snyder has classified SLAP tear in 4 different types: type II and IV are the most significant in determining instability because they involve both labrum and long head of the biceps, so resulting in an increased total range of motion, particularly in antero posterior and superior inferior translation.

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