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]. NIH Instability in the athlete presents a unique challenge to the orthopaedic surgeon. [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). The glenoid labrum acts on the humeral head like a plunger: loss of the glenoid labrum reduces depth of the glenoid socket more than 50%, reducing stability [19]. As the most mobile joint in the body, the shoulder is structurally insecure. Fig. J Biomech. 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]. Shoulder function: the perfect compromise between mobility and stability. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. Friedman et al. 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. 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. There is a fine balance between the mobility to perform athletic activities and stability required to power and stabilise the arm. shoulderdoc. Bony Bankart lesions are classified as described by Bigliani et al. The fol­lowing description is based on sound anatomic knowledge along with integration of the pertinent literature. Shoulder Instability Biomechanics. The anatomies of bones, joints, ligaments, and muscles are described in detail, and current biomechanical concepts concerning motion, stability, and force are presented. 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. The ball-shaped humeral head rotates and glides on a shallow scapular cup. The effect of internal and external rotation on the IGHLC (courtesy of Lennard Funk, ​www.​shoulderdoc.​co.​uk). Frankel and Burnstein's4 classic text on orthopedic biomechanics was so difficult to understand that it was not fully appre- ciated. Scapulothoracic (ST) joint - known as a "functional joint". SC joint connects the … 2018 Nov 18;9(11):245-254. doi: 10.5312/wjo.v9.i11.245. The GH joint is of particular inter… The suction effect of the glenoid labrum, the negative intracapsular pressure and the adhesion-cohesion mechanism are the three mechanisms providing the vacuum effect. O n one hand, this m obility is because of little bony congruity of its artic- ulating surfaces. The dynamic-stabilizing structures include the rotator cuff muscles and the other muscular structures surrounding the shoulder joint. 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. Athletes who use the arm for a propelling force strain the extremes of … All the bony characteristics influence stability, therefore changes in bony anatomy could result in shoulder instability. Anatomy and Biomechanics of the Sporting Shoulder. The constitutional trait of laxity facilitates extensive motion in multiple planes and may be essential to athletic performance. [Anatomy of the shoulder-clinical aspects for imaging and anatomical varieties]. 2018 Jun 19;6(2):68. doi: 10.3390/healthcare6020068. USA.gov. Clipboard, Search History, and several other advanced features are temporarily unavailable. World J Orthop. 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. Navigation best viewed on larger screens. Describe the role of the accessory structures of the human shoulder during the shoulder’s biomechanics. Glenohumeral (GH) joint, 2. 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). 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. The most common injury to the labrum, found in more than 90% of traumatic anterior instability [21], is a Bankart lesion. Learn vocabulary, terms, and more with flashcards, games, and other study tools. 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). 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 . Capsular redundancy, both anterior and inferior and posterior, is a very common find in atraumatic multidirectional instability. 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]. On the other hand, during adduction, flexion and internal rotation, the IGHLC moves posteriorly, forming a restraint to posterior translation. HHS 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. Anatomy and biomechanics of the shoulder Orthop Clin North Am. 2000 Apr;31(2):159-76. doi: 10.1016/s0030-5898(05)70138-3. 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]. Effect of flexibility deficit on scapular asymmetry in individuals with and without shoulder pain. 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. It is an important inferior stabiliser and its insufficiency could be clinically appreciated with sulcus sign examination. C onse- … eCollection 2018 Nov 18. [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. Please enable it to take advantage of the complete set of features! Doukas WC(1), Speer KP. ritish Journal of … 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 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. 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]. 2). The evaluation of shoulder disorders is challenging because of anatomic and biomechanical complexities. Shoulder biomechanics Roberto Lugo, ... the bony anatomy, negative intra-articular pressure, the glenoid labrum, and the glenohumeral ligaments along with the joint capsule. Acromioclavicular (AC) joint 3. 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. 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]. 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]. Anatomy, pathophysiology, and biomechanics of shoulder instability. The unstable shoulder. Bäcker HC, Galle SE, Maniglio M, Rosenwasser MP. MR arthrographic characterization of posterior capsular folds in shoulder joints. The glenoid labrum is a triangular section ring around the glenoid rim to which it’s connected by fibrocartilage and fibrous bone. 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. The shoulder comprises three synovial joints and two movement interfaces. 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 … 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. Hita-Contreras F, Sánchez-Montesinos I, Martínez-Amat A, Cruz-Díaz D, Barranco RJ, Roda O. J Anat. Epub 2007 Jan 12. 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 the most mobile joint in the body, the shoulder is structurally insecure. 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]. 2018 Sep-Oct;22(5):370-375. doi: 10.1016/j.bjpt.2018.03.007. Epub 2008 Jun 3. The acromioclavicular system (ACS) is formed by a complex of ligaments (conoid, trapezoid and acromioclavicular capsular ligaments) that stabilize the acromioclavicular joint (Fig. An excessive retroversion of the glenoid could be a rare cause of posterior instability, but more frequently it is only a contributory factor. 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. Bibliography – Anatomy and Biomechanics ontempo, N., & Mazzocca, A. 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]. 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. 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 … 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 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]. Its superior border blends with the origin of the long head of the biceps. Epub 2018 Nov 28. (2010). In this episode of eOrthopodTV, orthopaedic surgeon Randale C. Sechrest, MD narrates an animated tutorial on the basic anatomy of the shoulder. Biomechanics of posterior shoulder instability - current knowledge and literature review. 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.  |  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. NLM Ogul H, Tuncer K, Kose M, Pirimoglu B, Kantarci M. Br J Radiol. En: Warren RF, Craig EV, Altchek DW. 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. 2004 Jun;44(6):556-61. doi: 10.1007/s00117-004-1046-4. 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]. It is defined as a detachment of the anteroinferior aspect of the labrum and its attached portion of the inferior glenohumeral ligament. If a bone fragment is present it will be reabsorbed within a year [9]. Anatomy and biomechanics of the shoulder in throwing, swimming, gymnastics, and tennis | Read by QxMD. The PICO method, suggested by Baudi et al. The evaluation of shoulder disorders is challenging because of anatomic and biomechanical complexities. 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. Shoulder Biomechanics Lecture originally developed by Bryan Morrison, Ph.D. candidate Arizona State University Fall 2000. 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 shoulder comprises three synovial joints and two movement interfaces. Author information: (1)Sports Medicine and Shoulder Section, Division of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, USA. A rotator interval defect could be a little foramen or could reach larger size, influencing significantly inferior stability [35]. This classification has a prognostic value: type 4 and 5 has a good chance (87%) of recurrent instability after arthroscopic Bankart procedure. Bony geometry of the scapula and glenoid (courtesy of Lennard Funk, www. The anterior glenohumeral joint ligaments: Superior (SGHL), Middle (MGHL) and anterior band of the Inferior (IGHL) (courtesy of Lennard Funk, ​www.​shoulderdoc.​co.​uk). The contact sports most commonly associated with shoulder instability include rugby, football, wrestling and hockey. 2018 Mar;232(3):422-430. doi: 10.1111/joa.12753. 2008 Oct;68(1):16-24. doi: 10.1016/j.ejrad.2008.02.051. 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. 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. 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 1993 Jul;18(1):342-50. doi: 10.2519/jospt.1993.18.1.342. 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. Authors A M Halder 1 , E Itoi, K N An. Anatomy and biomechanics of the shoulder in throwing, swimming, gymnastics, and tennis. 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 Start studying Shoulder Anatomy and Biomechanics. Lippincott Raven eds. [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. Hill-Sachs lesion of the posterior humeral head (courtesy of Lennard Funk, ​www.​shoulderdoc.​co.​uk). Negative intracapsular pressure plays a role in shoulder stability. Shoulder Anatomy and Biomechanics The shoulder can really be considered a complex ( Fig. 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. Thoracic Outlet Syndrome: Biomechanical and Exercise Considerations. 2019 Feb;92(1094):20180527. doi: 10.1259/bjr.20180527. Anatomy, biomechanics and pathophysiology of glenohumeral instability. 5. 2007;40(10):2119-29. doi: 10.1016/j.jbiomech.2006.10.016. Functional anatomy of the shoulder complex. 42-1 ), consisting of four joints or articulations (all with important stabilizing ligaments), two spaces, and more than 30 muscles and their respective tendons. She teaches how you can be more effective in the execution of the exercises as well as teaching clients with injuries and injury prevention. T he shoulder com plex has the greatest m o- bility of all joints. 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. 1999; 51-76.]. COVID-19 is an emerging, rapidly evolving situation. J Orthop Sports Phys Ther. 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. This site needs JavaScript to work properly. Described for the first time by Snyder et al. Furthermore, external rotation of the shoulder is altered with rotator interval pathology. It’s different according to different planes: 0.75 in the sagittal plane and 0.6 in the coronal plane [6]. 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 … Overview of shoulder anatomy, biomechanics, and pathomechanical principles 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. 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 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. 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. 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. 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. Usually, it is larger in males than in females and becomes smaller with internal rotation. 2 Outline Anatomy Biomechanics Radiologe.  |  Healthcare (Basel). 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]. Authors a M Halder 1, E Itoi, K N an RF, EV., Martínez-Amat a, Cruz-Díaz D, Barranco RJ, Roda O. Anat... Redundancy, both anterior and inferior and posterior, is a fine between! Laxity that promotes a pathological redundancy ( Fig exercises as well as teaching clients with injuries injury. 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