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shoulder anatomy and biomechanics

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]. A rotator interval defect could be a little foramen or could reach larger size, influencing significantly inferior stability [35]. Negative intracapsular pressure plays a role in shoulder stability. 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. iomechanics and treatment of acromioclavicular and sternoclavicular joint injuries. [Anatomy of the shoulder-clinical aspects for imaging and anatomical varieties]. 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. 29 pages. Start studying Shoulder Anatomy and Biomechanics. 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. 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. The incidence of humeral avulsion of the glenohumeral ligament (HAGL) has been reported as high as 10%, but they are often unrecognised [34]. COVID-19 is an emerging, rapidly evolving situation. Shoulder function: the perfect compromise between mobility and stability. It is defined as a detachment of the anteroinferior aspect of the labrum and its attached portion of the inferior glenohumeral ligament. As the most mobile joint in the body, the shoulder is structurally insecure. The glenoid labrum is a triangular section ring around the glenoid rim to which it’s connected by fibrocartilage and fibrous bone. 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. Epub 2018 Apr 4. Labral tears occur in the antero-inferior labrum, posterior labrum and superior labrum (SLAP) (courtesy of Lennard Funk, ​www.​shoulderdoc.​co.​uk). Anatomy and biomechanics of the shoulder in throwing, swimming, gymnastics, and tennis | Read by QxMD. 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 Try using search on phones and tablets. Shoulder Instability Biomechanics. 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. 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. 1993 Jul;18(1):342-50. doi: 10.2519/jospt.1993.18.1.342. The constitutional trait of laxity facilitates extensive motion in multiple planes and may be essential to athletic performance. 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 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 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. Its structural limitations indicate that the primary source of joint stability must be balanced muscle control. Shoulder Anatomy & Biomechanics SKU: 206 By Jeffrey K. McCamman, BS, MPT Reviews anatomy and biomechanics of the human shoulder. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. Sternoclavicular (SC) joint 4. Epub 2008 Jun 3. The superior half of glenoid labrum is more movable than the inferior half that is tenaciously connected to the glenoid rim. Bony Bankart lesion (courtesy of Lennard Funk, ​www.​shoulderdoc.​co.​uk). This site needs JavaScript to work properly. The suction effect of the glenoid labrum, the negative intracapsular pressure and the adhesion-cohesion mechanism are the three mechanisms providing the vacuum effect. Most important bony lesions that result in instability occur after traumatic events and involve the anterior-inferior glenoid rim and the posterolateral aspect of the humeral head, called a bony Bankart lesion and a Hill–Sachs lesion, respectively (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. shoulderdoc. 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 [. The effect of internal and external rotation on the IGHLC (courtesy of Lennard Funk, ​www.​shoulderdoc.​co.​uk). Capsular redundancy, both anterior and inferior and posterior, is a very common find in atraumatic multidirectional instability. T he joints of the shoulder com plex have to rely on adjacent ligam ents and m uscles to provide stability. 2 Outline Anatomy Biomechanics Bony geometry of the scapula and glenoid (courtesy of Lennard Funk, ​www.​shoulderdoc.​co.​uk). 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. If a bone fragment is present it will be reabsorbed within a year [9]. 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. Hill-Sachs lesion of the posterior humeral head (courtesy of Lennard Funk, ​www.​shoulderdoc.​co.​uk). NLM Described for the first time by Snyder et al. 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. Braz J Phys Ther. 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. Effect of flexibility deficit on scapular asymmetry in individuals with and without shoulder pain. Bäcker HC, Galle SE, Maniglio M, Rosenwasser MP. Thus, the labral avulsion injury is often associated with excessive capsular laxity that promotes a pathological redundancy (Fig. The anatomies of bones, joints, ligaments, and muscles are described in detail, and current biomechanical concepts concerning motion, stability, and force are presented. Anatomy and biomechanics of the shoulder in throwing, swimming, gymnastics, and tennis. The PICO method, suggested by Baudi et al. 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 … Epub 2017 Nov 28. 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. The dynamic-stabilizing structures include the rotator cuff muscles and the other muscular structures surrounding the shoulder joint. 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. 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]. Eur J Radiol. World J Orthop. 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]. 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 … 2018 Nov 18;9(11):245-254. doi: 10.5312/wjo.v9.i11.245. This classification has a prognostic value: type 4 and 5 has a good chance (87%) of recurrent instability after arthroscopic Bankart procedure. 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. During abduction, external rotation and extension the IGHLC moves anteriorly, forming a restraint to anterior translation of the humeral head (Fig. In this episode of eOrthopodTV, orthopaedic surgeon Randale C. Sechrest, MD narrates an animated tutorial on the basic anatomy of the shoulder.  |  Affiliation 1 Orthopedic Biomechanics Laboratory, Mayo Clinic Rochester, The Mayo Foundation, Rochester, MN 55901, USA. Radiologe. 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. 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]. Bony Bankart lesions are classified as described by Bigliani et al. Difficult to understand that it was not fully appre- ciated suffers an initial plastic deformation during initial dislocation but... Laxity that promotes a pathological redundancy ( Fig, Galle SE, Maniglio M, B... 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