shoulder anatomy and biomechanics

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On the other hand, during adduction, flexion and internal rotation, the IGHLC moves posteriorly, forming a restraint to posterior translation. The most common injury to the labrum, found in more than 90% of traumatic anterior instability [21], is a Bankart lesion. Thoracic Outlet Syndrome: Biomechanical and Exercise Considerations. Braz J Phys Ther. Shoulder & Elbow⎜Glenohumeral Joint Anatomy, Stabilizer, and Biomechanics (ft. Dr. Anthony Romeo) Team Orthobullets (J) Shoulder & Elbow Anatomy and biomechanics of the shoulder in throwing, swimming, gymnastics, and tennis. Clipboard, Search History, and several other advanced features are temporarily unavailable. The constitutional trait of laxity facilitates extensive motion in multiple planes and may be essential to athletic performance. The fol­lowing description is based on sound anatomic knowledge along with integration of the pertinent literature. Bäcker HC, Galle SE, Maniglio M, Rosenwasser MP. 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 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]. NIH 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). Anatomy, pathophysiology, and biomechanics of shoulder instability. 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 incidence of humeral avulsion of the glenohumeral ligament (HAGL) has been reported as high as 10%, but they are often unrecognised [34]. 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 J Orthop Sports Phys Ther. Usually, it is larger in males than in females and becomes smaller with internal rotation. 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. Shoulder Anatomy & Biomechanics SKU: 206 By Jeffrey K. McCamman, BS, MPT Reviews anatomy and biomechanics of the human shoulder. 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]. 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. Navigation best viewed on larger screens. 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. Furthermore, external rotation of the shoulder is altered with rotator interval pathology. 2018 Mar;232(3):422-430. doi: 10.1111/joa.12753. 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. 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 shoulder comprises three synovial joints and two movement interfaces. 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]. COVID-19 is an emerging, rapidly evolving situation. 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. 6. If a bone fragment is present it will be reabsorbed within a year [9]. Hill-Sachs lesion of the posterior humeral head (courtesy of Lennard Funk, ​www.​shoulderdoc.​co.​uk). World J Orthop. Fig. On the contrary, if a Hill–Sachs lesion extends over the medial margin of the glenoid track, risk of engagement rises according to the lesion’s position [17, 18]. 2018 Nov 18;9(11):245-254. doi: 10.5312/wjo.v9.i11.245. Philadelphia. Doukas WC(1), Speer KP. It is defined as a detachment of the anteroinferior aspect of the labrum and its attached portion of the inferior glenohumeral ligament. Epub 2008 Jun 3. Friedman et al. 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. Bony geometry of the scapula and glenoid (courtesy of Lennard Funk, ​www.​shoulderdoc.​co.​uk). This chapter analyses the clinical functional anatomy and biomechanics of shoulder structures, with some insight regarding their pathologic changes associated with shoulder instability in the athlete. 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. 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. 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. Bony geometry of the scapula and glenoid (courtesy of Lennard Funk, www. iomechanics and treatment of acromioclavicular and sternoclavicular joint injuries. 5. Shoulder function: the perfect compromise between mobility and stability. The SC joint is the only bony attachment site of the upper extremity to the axial skeleton. 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]. As far as the superior labrum is concerned, a very common lesion in throwing overhead athletes is the SLAP (superior labrum anterior and posterior) tear. Anatomy, biomechanics and pathophysiology of glenohumeral instability. 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. 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. As the most mobile joint in the body, the shoulder is structurally insecure. Soft tissue static stabilisers include glenoid labrum, glenohumeral capsule, glenohumeral ligaments, rotator interval, negative intracapsular pressure and the adhesion-cohesion mechanism. T he joints of the shoulder com plex have to rely on adjacent ligam ents and m uscles to provide stability. The evaluation of shoulder disorders is challenging because of anatomic and biomechanical complexities. 42-1 ), consisting of four joints or articulations (all with important stabilizing ligaments), two spaces, and more than 30 muscles and their respective tendons. [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. It is an important inferior stabiliser and its insufficiency could be clinically appreciated with sulcus sign examination. On the other hand, capsular stretching is noted along with a Bankart lesion and it’s present in up to 28% of patients with recurrent anterior instability [31]. Bibliography – Anatomy and Biomechanics ontempo, N., & Mazzocca, A. 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]. 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. 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. Thus, the labral avulsion injury is often associated with excessive capsular laxity that promotes a pathological redundancy (Fig. 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. Only a maximum of 30% of the humeral articular surface articulates with glenoid articular surface at any time [5]; bearing in mind the importance of soft tissue static and dynamic restrains in shoulder stability. 2 Outline Anatomy Biomechanics Healthcare (Basel). As the most mobile joint in the body, the shoulder is structurally insecure. Development of the human shoulder joint during the embryonic and early fetal stages: anatomical considerations for clinical practice. 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. Bony Bankart lesions are classified as described by Bigliani et al. [Anatomy of the shoulder-clinical aspects for imaging and anatomical varieties]. Shoulder Anatomy and Biomechanics The shoulder can really be considered a complex ( Fig.  |  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 . The anterior glenohumeral joint ligaments: Superior (SGHL), Middle (MGHL) and anterior band of the Inferior (IGHL) (courtesy of Lennard Funk, ​www.​shoulderdoc.​co.​uk). Instability in the athlete presents a unique challenge to the orthopaedic surgeon. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. The evaluation of shoulder disorders is challenging because of anatomic and biomechanical complexities. Acromioclavicular (AC) joint 3. 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). Hita-Contreras F, Sánchez-Montesinos I, Martínez-Amat A, Cruz-Díaz D, Barranco RJ, Roda O. J Anat. 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. Described for the first time by Snyder et al. [8]: type I, a displaced avulsion fracture with attached capsule; type II, a medially displaced fragment malunited to the glenoid rim; type III, an erosion of the glenoid rim lower than 25% (III A) and more than 25% (III B). ritish Journal of … The ball-shaped humeral head rotates and glides on a shallow scapular cup. This classification has a prognostic value: type 4 and 5 has a good chance (87%) of recurrent instability after arthroscopic Bankart procedure. 1993 Jul;18(1):342-50. doi: 10.2519/jospt.1993.18.1.342. Epub 2007 Jan 12. Athletes who use the arm for a propelling force strain the extremes of … Ogul H, Tuncer K, Kose M, Pirimoglu B, Kantarci M. Br J Radiol. This site needs JavaScript to work properly. Please enable it to take advantage of the complete set of features! 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]. When looking at the biomechanics of the shoulder, the motion comes from 2 joints: the scapulothoracic (ST) joint, and the glenohumeral (GH) joint. Start studying Shoulder Anatomy and Biomechanics. 1999; 51-76.]. Radiologe. 2018 Jun 19;6(2):68. doi: 10.3390/healthcare6020068. 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. During abduction, external rotation and extension the IGHLC moves anteriorly, forming a restraint to anterior translation of the humeral head (Fig. Anatomy and biomechanics of the shoulder in throwing, swimming, gymnastics, and tennis | Read by QxMD. 2019 Feb;92(1094):20180527. doi: 10.1259/bjr.20180527. The GH joint is of particular inter… 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. Affiliation 1 Orthopedic Biomechanics Laboratory, Mayo Clinic Rochester, The Mayo Foundation, Rochester, MN 55901, USA. 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 [. Bony Bankart lesion (courtesy of Lennard Funk, ​www.​shoulderdoc.​co.​uk). Its structural limitations indicate that the primary source of joint stability must be balanced muscle control. Epub 2018 Nov 28. Describe the role of the accessory structures of the human shoulder during the shoulder’s biomechanics. The glenoid labrum is a triangular section ring around the glenoid rim to which it’s connected by fibrocartilage and fibrous bone. Try using search on phones and tablets. The PICO method, suggested by Baudi et al. 2018 Sep-Oct;22(5):370-375. doi: 10.1016/j.bjpt.2018.03.007. Learn vocabulary, terms, and more with flashcards, games, and other study tools. SC joint connects the … [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. 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. shoulderdoc. There is a fine balance between the mobility to perform athletic activities and stability required to power and stabilise the arm. Epub 2017 Nov 28. Glenohumeral (GH) joint, 2. The shoulder comprises three synovial joints and two movement interfaces. Scapulothoracic (ST) joint - known as a "functional joint". 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 … A little foramen or shoulder anatomy and biomechanics reach larger size, influencing significantly inferior [... Head ( courtesy of Lennard Funk, www all the bony characteristics stability. 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