[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 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. Its superior border blends with the origin of the long head of the biceps. The IGHLC suffers an initial plastic deformation during initial dislocation, but the damage becomes more critical after several episodes [32]. Athletes who use the arm for a propelling force strain the extremes of … USA.gov. C onse- … In this episode of eOrthopodTV, orthopaedic surgeon Randale C. Sechrest, MD narrates an animated tutorial on the basic anatomy of the shoulder. 2018 Nov 18;9(11):245-254. doi: 10.5312/wjo.v9.i11.245. Epub 2017 Nov 28. 5. NIH This classification has a prognostic value: type 4 and 5 has a good chance (87%) of recurrent instability after arthroscopic Bankart procedure. 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. Frankel and Burnstein's4 classic text on orthopedic biomechanics was so difficult to understand that it was not fully appre- ciated. MR arthrographic characterization of posterior capsular folds in shoulder joints. The acromioclavicular system (ACS) is formed by a complex of ligaments (conoid, trapezoid and acromioclavicular capsular ligaments) that stabilize the acromioclavicular joint (Fig. World J Orthop. The GH joint is of particular inter… The shoulder complex involves 3 physiological joints and one floating joint: 1. En: Warren RF, Craig EV, Altchek DW. 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. The PICO method, suggested by Baudi et al. 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. 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 [. It’s different according to different planes: 0.75 in the sagittal plane and 0.6 in the coronal plane [6]. [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. 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/. 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. Glenohumeral (GH) joint, 2. 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. The following description is based on sound anatomic knowledge along with integration of the pertinent literature. 42-1 ), consisting of four joints or articulations (all with important stabilizing ligaments), two spaces, and more than 30 muscles and their respective tendons. Fig. 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. Negative intracapsular pressure plays a role in shoulder stability. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. Doukas WC(1), Speer KP. 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]. Thoracic Outlet Syndrome: Biomechanical and Exercise Considerations. It is defined as a detachment of the anteroinferior aspect of the labrum and its attached portion of the inferior glenohumeral ligament. Anatomy, pathophysiology, and biomechanics of shoulder instability. 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. 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]. 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. This site needs JavaScript to work properly. The shoulder comprises three synovial joints and two movement interfaces. The anatomies and biomechanics of the glenohumeral joint and the scapulothoracic articulation are the subjects of this article. 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. 2 Outline Anatomy Biomechanics Soft tissue static stabilisers include glenoid labrum, glenohumeral capsule, glenohumeral ligaments, rotator interval, negative intracapsular pressure and the adhesion-cohesion mechanism. The evaluation of shoulder disorders is challenging because of anatomic and biomechanical complexities. Bony geometry of the scapula and glenoid (courtesy of Lennard Funk, www. 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. J Orthop Sports Phys Ther. 2019 Feb;92(1094):20180527. doi: 10.1259/bjr.20180527. The constitutional trait of laxity facilitates extensive motion in multiple planes and may be essential to athletic performance. The most common injury to the labrum, found in more than 90% of traumatic anterior instability [21], is a Bankart lesion. 2000 Apr;31(2):159-76. doi: 10.1016/s0030-5898(05)70138-3. 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. 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. Functional anatomy of the shoulder complex. eCollection 2018 Nov 18. 1993 Jul;18(1):342-50. doi: 10.2519/jospt.1993.18.1.342. 2007;40(10):2119-29. doi: 10.1016/j.jbiomech.2006.10.016. Biomechanics of posterior shoulder instability - current knowledge and literature review. T he shoulder com plex has the greatest m o- bility of all joints. Hita-Contreras F, Sánchez-Montesinos I, Martínez-Amat A, Cruz-Díaz D, Barranco RJ, Roda O. J Anat. 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. Described for the first time by Snyder et al. Labral tears occur in the antero-inferior labrum, posterior labrum and superior labrum (SLAP) (courtesy of Lennard Funk, www.shoulderdoc.co.uk). 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. Epub 2008 Jun 3. As the most mobile joint in the body, the shoulder is structurally insecure. O n one hand, this m obility is because of little bony congruity of its artic- ulating surfaces. The SC joint is the only bony attachment site of the upper extremity to the axial skeleton. The anterior glenohumeral joint ligaments: Superior (SGHL), Middle (MGHL) and anterior band of the Inferior (IGHL) (courtesy of Lennard Funk, www.shoulderdoc.co.uk). Ogul H, Tuncer K, Kose M, Pirimoglu B, Kantarci M. Br J Radiol. Anatomy and biomechanics of the shoulder in throwing, swimming, gymnastics, and tennis. Bony geometry of the scapula and glenoid (courtesy of Lennard Funk, www.shoulderdoc.co.uk). Shoulder Biomechanics Lecture originally developed by Bryan Morrison, Ph.D. candidate Arizona State University Fall 2000. iomechanics and treatment of acromioclavicular and sternoclavicular joint injuries. 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 and biomechanics of the shoulder in throwing, swimming, gymnastics, and tennis | Read by QxMD. Start studying Shoulder Anatomy and Biomechanics. Healthcare (Basel). Authors A M Halder 1 , E Itoi, K N An. 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. When looking at the biomechanics of the shoulder, the motion comes from 2 joints: the scapulothoracic (ST) joint, and the glenohumeral (GH) joint. 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. 29 pages. During abduction, external rotation and extension the IGHLC moves anteriorly, forming a restraint to anterior translation of the humeral head (Fig. 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]. The unstable shoulder. Development of the human shoulder joint during the embryonic and early fetal stages: anatomical considerations for clinical practice. Shoulder & Elbow⎜Glenohumeral Joint Anatomy, Stabilizer, and Biomechanics (ft. Dr. Anthony Romeo) Team Orthobullets (J) Shoulder & Elbow Friedman et al. 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 glenoid labrum is a triangular section ring around the glenoid rim to which it’s connected by fibrocartilage and fibrous bone. 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. 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]. | HHS 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. 1999; 51-76.]. 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. 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 … Stability [ 35 ] Jun 19 ; 6 ( 2 ):68. doi: 10.1111/joa.12753 providing... 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