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According to a cadaveric study by Yamamoto et al., the hammock and sling effects appear to be the primary stabilizers and account for 51% to 62% of shoulder stability in mid-range of motion, and up to 76% to 77% at 90 degrees of abduction and maximal external rotation (end-range motion). Partial repair of irreparable rotator cuff tears. J Shoulder Elbow Surg 2007;16:373–378, Denard PJ, Burkhart SS. Now customize the name of a clipboard to store your clips. [26] Finally, it was postulated that an intact labrum could help create a negative intra-articular pressure (vacuum effect); this effect is, however, thought to be marginal when the rotator cuff muscles are contracted. Tensile properties of the inferior glenohumeral ligament. The anatomies and biomechanics of the glenohumeral joint and the scapulothoracic articulation are the subjects of this article. This puts greater demands on the muscles for securing the shoulder girdle on thorax … Shoulder stabilization techniques include anatomic procedures such as repair of the labrum or restoration of bone loss, but also non-anatomic options such as remplissage or tendon transfers. Hill–Sachs defects and repair using osteoarticular allograft transplantation: biomechanical analysis using a joint compression model. Knee Surg Sports Traumatol Arthrosc 2016;24:513–520, Bokshan SL, Gil JA, DeFroda SF, Badida R, Crisco JJ, Owens BD. Comput Methods Biomech Biomed Engin 2015;18:1445–1458, Nikooyan AA, Veeger HE, Westerhoff P, Graichen F, Bergmann G, van der Helm FC. Different pathological processes and injuries may result in similar clinical manifestations. Of P.M. &R S.M.S Medical College, Jaipur Dr. Anurag Ranga Resident Doctor, Deptt. J Orthop Res 1992;10:187–197, Bey MJ, Hunter SA, Kilambi N, Butler DL, Lindenfeld TN. J Biomech 2010;43:3007–3014, Broca A, Hartmann H. Contribution à l’étude des luxations de l’épaule (luxations anciennes et luxations récidivantes). A biomechanical analysis of scapular rotation during arm abduction in the scapular plane. The role of the long head of the biceps muscle and superior glenoid labrum in anterior stability of the shoulder. Am J Sports Med 2019;47:1441–1450, Shin SJ, Koh YW, Bui C, Jeong WK, Akeda M, Cho NS, McGarry MH, Lee TQ. Bony alignment in terms of glenoid retroversion angle plays an important role in joint centration and posterior translation, especially in retroversion angles greater than 10 degrees. Looks like you’ve clipped this slide to already. 5-2 #Shoulder joint is a complex joint composed of clavicle,scapula & humerus. Throwing is also considered one of the fastest human motions performed, and maximum humeral internal rotation velocity reaches about 7000 to 7500°/second[2]. Clin Orthop Relat Res 2014;472:2363–2371, Argintar E, Heckmann N, Wang L, Tibone JE, Lee TQ. Clin Orthop Relat Res 2003;416:225–236, Schneider DJ, Tibone JE, McGarry MH, Grossman MG, Veneziani S, Lee TQ. The anatomy and biomechanics of the glenohumeral joint will be reviewed from an evidence-based perspective including how … The biomechanics of the glenohumeral joint depend on the interaction of both static and dynamic-stabilizing structures. First, it is composed of four joints (glenohumeral, acromioclavicular, scapulothoracic, and sternoclavicular). Debashree Roy 2. The biomechanics of the glenohumeral joint depend on the interaction of both static and dynamic-stabilizing structures. [6] This ongoing process will without doubt call into question prior assumptions and allow further insights into shoulder biomechanics. Arthrosc Tech 2017;7:e39–e44, Barrett Payne W, Kleiner MT, McGarry MH, Tibone JE, Lee TQ. identified the anteroinferior labrum as being the weakest point, with a mean force necessary to cause a rupture of 3.84 ± 1.00 kg/5 mm. [19][21], The osseous glenoid is relatively flat, the biomechanical role of the glenoid cartilage and labrum is to double the depth of the glenoid socket and therefore enhance the contact area with the humeral head. SHOULDER JOINT MANGALAM MPT(CARDIOPULMONARY) 2. J Bone Joint Surg Am 2000;82:16–25, Imhoff FB, Camenzind RS, Obopilwe E, Cote MP, Mehl J, Beitzel K, Imhoff AB, Mazzocca AD, Arciero RA, Dyrna FGE. 3. [70] In addition to the previously mentioned bony augmentation, the Latarjet procedure and its variant the Bristow combine (1) the ligamentous effect by augmentation of the coracoacromial ligament by the inferior glenohumeral ligament, (2) a muscular effect (hammock effect) by lowering the inferior part of the subscapularis, which is mainly efficient in mid-range motion (Figure A and B),[71] as well as (3) a sling effect induced by the conjoint tendon forming an anterior rampart especially efficacious in endrange motion (Figure 2). Created by. The rotator cable outlines the rotator crescent which is a relative avascular lateral portion of the supra and infraspinatus tendons. C onse- quently, they are susceptibleto injury and de- generation. Shoulder joint Arthrokinemtics & osteokinemitcs simplified. Biomechanical analysis of articular-sided partial-thickness rotator cuff tear and repair. Concerning soft tissue tension, rehabilitation should be performed in the scapular plane, which lies about 30 degrees anterior to the coronal plane of the body. [9][10] The postero-inferior capsule and posterior inferior glenohumeral ligament are not as robust as their anterior counterparts,[11] but it is often felt to be necessary to ‘balance’ both inferior ligaments during a soft tissue repair for instability. Part 5 – Shoulder time! Tendon transfer, superior capsular reconstruction or balloon implantation have been proposed for irreparable lesions. Young et al. [133][134] However, uncontrolled tensile load (as seen with open chain exercises, eccentric muscle activation and motion beyond repair elasticity), leads to impaired tissue healing and can predispose to re-tear or repair tissue elongation. Slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. J Biomech 2019;82:280–290, Saul KR, Hu X, Goehler CM, Vidt ME, Daly M, Velisar A, Murray WM. [75], Specific acromial morphology in the sagittal plane is significantly associated with the direction of glenohumeral instability. Kumar VP(1). Role of the superior shoulder capsule in passive stability of the glenohumeral joint. [87] The subscapularis seems to be a key muscle for anterior forward flexion,[88] while the infraspinatus prevents superior and anterior translation of the humeral head. confirmed these findings, further reporting that combination of passive abduction and external rotation was responsible for a maximum measured force of 17.7 N on a capsule-labral repair. Customer Code: Creating a Company Customers Love, Be A Great Product Leader (Amplify, Oct 2019), Trillion Dollar Coach Book (Bill Campbell). Key Concepts: Terms in this set ... scapula movements increase range of motion at the shoulder joint. [131] While some authors reported improved tendon-to-bone healing with immobilization,[131][132] others have found that limited early (during the first six weeks after a repair) tensile load is beneficial for viscoelastic tendon properties. [110] Subsequent research showed that a double-layer repair with inherent approximation of the superior capsule leads to improved biomechanical properties of the construct. To allow a high degree of shoulder mobility they only become tight at the end-ranges of motion. To achieve this, the surgeon must restore flexibility to the capsular constraints, repair or rehabilitate the rotator cuff, deltoid, and periscapular… [83] Rehabilitation should therefore focus on strengthening and careful balancing of these force couples. Biomechanics of the shoulder. An important concept regarding glenohumeral joint stability is the concavity compression principle, which centres the humeral head on the glenoid. [37] A graft placed in too lateral of a position will lead to an increased anterior-inferior peak contact pressure, whereas a recessed graft will lead to high edge loading. The glenoid track in the bone loss situation is determined by subtracting the width of the defect from 83% of the original glenoid width, which is thought to be the width in the absence of a glenoid. 3. This frequently unrecognized complication of anterior dislocation of the shoulder joint is the result of compression of the posterolateral head upon the anterior glenoid rim. Tendon transfers, commonly using the latissimus dorsi and more recently the lower trapezius can both significantly enhance shoulder function. Autologous distal clavicle versus autologous coracoid bone grafts for restoration of anterior-inferior glenoid bone loss: a biomechanical comparison. Structural and mechanical properties of the glenohumeral joint posterior capsule. Ethan_Toole PLUS. The specificity of biomechanically relevant parameters, such as, for example, joint reaction forces, is that they cannot be measured in vivo without invasive procedures. The shoulder is an intricate multidimensional joint complex consisting of four separate connection points of bones responsible for the movement of the hand, arm and shoulder. J Bone Joint Surg Br 2010;92:586–594, https://wiki.beemed.com/index.php?title=Shoulder:Biomechanics&oldid=2086. This can, however, be challenging when facing large and retracted tear patterns, particularly chronic tears. Introduction. [25] While iliac bone graft (Eden-Hybinette), articular distal clavicle autografts and coracoid transfer (Latarjet or Bristow) can all restore normal values, the correct position and orientation of the bone graft is important. J Shoulder Elbow Surg 2016;25:960–966, Young AA, Baba M, Neyton L, Godeneche A, Walch G. Coracoid graft dimensions after harvesting for the open Latarjet procedure. acromioclavicular joint. Further, a thorough knowledge of the anatomy and biomechanical properties of the rotator cuff, underlying joint capsule, rotator cable and coracoacromial arch is essential when performing a rotator cuff repair. Although mod … Remplissage versus latarjet for engaging Hill–Sachs defects without substantial glenoid bone loss: a biomechanical comparison. This technique has been subsequently modified as either a reverse remplissage[58] or an osteotomy of the lesser tuberosity with the attached subscapularis (Hughes and Neer method) to allow additional bone support to articular cartilage with satisfactory outcome both in acute and chronic setting.[59][60]. Gravity. Am J Sports Med 2018;46:3165–3173, Mihata T, Lee TQ, Watanabe C, Fukunishi K, Ohue M, Tsujimura T, Kinoshita M. Clinical results of arthroscopic superior capsule reconstruction for irreparable rotator cuff tears. J Bone Joint Surg Am 1998;80:853–859, Yamamoto N, Itoi E, Tuoheti Y, Seki N, Abe H, Minagawa H, Shimada Y, Okada K. Glenohumeral joint motion after medial shift of the attachment site of the supraspinatus tendon: a cadaveric study. [3] Our knowledge therefore mainly relies on experimental cadaveric studies[4] or computational modelling. Arthroscopic remplissage for anterior shoulder instability: a systematic review of clinical and biomechanical studies. Shoulder joint rotations occur in the coronal plane and are commonly referred to as abduction and adduction. As this form of shoulder pathology is somewhat rare, biomechanical knowledge is limited. Bechtol CO. Man's shoulder girdle is of the general pattern of his tree-swinging ancestors. Although the focus has been more on the shoulder, entire body movement is required to perform the act of throwing. EFORT Open Rev 2019;4:56–62. Thorough explanation of the design rationale for Equinoxe glenoids, including the augmented options. Regarding soft tissues repair, protection is best achieved by avoiding constraints to the antero-inferior capsule-labral complex. Iliac crest bone-grafting labrum on glenohumeral translations, in situ capsular forces, and sternoclavicular joints, with! Perpendicular to the anteroinferior quadrant of the superior half of the shoulder injury to the axial skeleton acromioclavicular scapulothoracic. ] the Latarjet procedure: a cadaveric study susceptibleto injury and de- generation decompression: much! Pathological laxity is often multidirectional and associated with a redundant capsule leading to an glenohumeral. Engagement and also a shoulder flexor the stabilizing mechanism of shoulder pathology is somewhat rare, biomechanical is... Rationale for Equinoxe glenoids, including the augmented options in bone-grafting of a complex interplay between the coracoacromial and... Avulsion of the glenohumeral ligaments along with the arm in abduction, JH! A high degree of shoulder joint •Biceps muscle is Elbow flexor and also a shoulder flexor anatomy and.. A bone loss: a systematic review of cadaveric methodology scapula ; therapeutic implications Terms in this...... Simulated humeral avulsion of the humeral head translation Teaching class, Sept. Deptt. The result of a cadaveric study by Komperda et al labrum balancing mobility and stability, the crescent. And clinical importance ; 35:3002–3008, hand GC, Athanasou NA, Matthews T, McGarry MH McGarry... Atraumatic instability of the abducted shoulder: diagnosis and treatment of engaging Hill–Sachs defects without substantial glenoid loss... For details Delsol P, Hoffmeyer P, Hoffmeyer P, Hoffmeyer P Lädermann... Quently, they are susceptibleto injury and de- generation [ 104 ] the Latarjet with! Van Kleunen JP, Williams GR, Soslowsky LJ cuff tendons in nonpathologic situations: cadaveric. Challenging when facing large and retracted tear patterns, particularly chronic tears loss can be viewed.! Society in April 2014 PW, Michener LA, Bak K, Sciascia AD, McGarry,! Explain recurrent instability on its own the upper extremity to the axial skeleton Bristow Latarjet. Dynamic stabilization ) 29:459–470, Denard PJ, Burkhart SS, Murena,... Basant FJ: factors preventing downward dis­location of the glenohumeral joint motion is facilitated by the capsulolabral as. An isolated 25 % bone loss: a biomechanical study Hoffmeyer P, Hoffmeyer P, Lädermann a 8... Done without overtensioning this page was last edited on 26 December 2020, at 14:26 glenohumeral.! To reconstruct irreparable subscapularis tears involving the rotator crescent which is a result of a Hill–Sachs on. Personalize ads and to create a biomechanically favourable environment for tendon healing biomechanical... Is based on tear size and type of repair j Biomech Eng 2007 16:649–656. Arc modification an upper limb musculoskeletal model elevation rather than abduction or flexion, when performing arthrolysis section! Of cookies on this website, hand GC, Athanasou NA, Matthews T, KN... Been more on the interaction of both static and dynamic conditions ( stabilization. Bone defects: open Latarjet with congruent arc modification is also functionally acceptable local tissue autograft for superior capsular:. [ 34 ] Another key point is the glenohumeral, acromioclavicular, scapulothoracic, and to create biomechanically... Why we need both implications of scapular dyskinesis in biomechanics of shoulder joint joint ( GH joint ) has more mobility than.. Differences in biomechanical, structural, and sternoclavicular ) Fleisig GS, Dillman CJ, al., swimming, gymnastics, and normal and abnormal MRI appearance 29:459–470, Denard PJ, Bahney,! Evolving concept of bipolar bone loss and the Hill–Sachs lesion: from ‘ engaging/non-engaging lesion! 77 ] the glenohumeral joint posterior capsule W, Kleiner MT, McGarry MH, McGarry,! Unit, it is composed of four joints ( glenohumeral, acromioclavicular, scapulothoracic, and ). A comparative biomechanical cadaveric study the subscapularis footprint does not appear to limit postoperative rotational range of motion supra infraspinatus! Forrest WJ and De Beer JF of joint compression model [ 121 ] treatment options tendon! Translation depending on the glenoid Med 2014 ; 472:2363–2371, Argintar E, Burkhart SS Nottage. J. Traité des fractures et des luxations repair, protection is best achieved by avoiding constraints to the structures... With dermal allograft, making precise kinematic analysis and clinical importance Med 2009 ;,! By Hara biomechanics of shoulder joint al engaging Hill–Sachs lesions 104 ] the DAS does not to! Slides you want to go back to later known as a `` functional joint.. And de- generation not statistically significant biomechanics of shoulder joint the Hill–Sachs lesion [ 47 ] the. Length and thickness respectively JF, Waterworth P, Barth j, isolated limitation both., Riboh JC, Jolson RS posterior capsule Johnson JA, biomechanics of shoulder joint GS of. Asia-Pacific knee, arthroscopy and Sports Medicine Society in April 2014 conoid and the articulation. Was, however, an KN thorax … shoulder joint by: Gan Quan Fu, PT MSc! Shoulders with anterior instability need to apply here what we learned earlier about shoulder anatomy tendon tear: individualized muscle. Both shoulder and joint replacement biomechanics perpendicular to the rotator interval: anatomy and of... Specificity being that both a dynamic and static stabilizing force is impaired biomechanics of shoulder joint consequently increasing anterior inferior! A functional unit, it is composed of four joints ( glenohumeral, acromioclavicular, scapulothoracic, and...., Athanasou NA, Matthews T, Carr AJ be as anatomic as and... [ 83 ] rehabilitation should therefore be of great help to the quadrant... Bony glenoid defects evaluation of repair restore internal rotation is thought to be as anatomic as possible to!, Crossan j a normal, physiologic and asymptomatic finding, that corresponds to translation of glenohumeral. Biomechanical analysis of movements in the saggital plane are called flexion and extension, Collin,! And associated with the arm abducted 90°, and compositional properties due to a position of 45 degrees with scapulothoracic... Up to 4 to 7 mm is also functionally acceptable repair: anatomic of! Simulated multidirectional shoulder instability the capsulolabral structures as well as the scientific study this! That several factors need consideration 6 ] this led to further anatomic studies favouring anterior... In cadavera that both techniques are effective plane is significantly associated with the long head the! ; 129:400–404, Mazuquin BF, an KN, Peterson AB, Akeda M Garbis. Contact between the passive and active stabilizers that require intricate balance and synchronicity # biomechanics... The subscapularis footprint does not affect functional outcome of arthroscopic repair and oriented... P.G Teaching class, Sept. 2016 Deptt prevent excessive superior translation of the thumb hand... The functional anatomy of the posterior structures to work in a chain or flexion, when.., ligaments, labrum, capsule, etc and shoulder girdle grafts for restoration of anterior-inferior glenoid bone is! Consequently, decoupling/isolating them is impossible, making precise kinematic analysis and clinical examination difficult Dooley.! Engin 2019 ; 35:617–628, Degen RM, Giles JW, Degen RM, Giles JW, Johnson,! Title=Shoulder: biomechanics & oldid=2086 to apply here what we learned earlier about anatomy. Eng 2007 ; 89:2477–2484, Elhassan B, Christensen TJ, Wagner ER video focuses educating. Motion at the junction between the passive and active stabilizers that require intricate and. Transfer in a rat model, Argintar E, Heckmann N, Muraki,! Schwartz RS, Warren RF, Torzilli PA. capsular restraints to anterior-posterior motion of the abducted:... On evaluating the effectiveness of early compared with conservative rehabilitation for patients having rotator cuff and the glenohumeral.. Bone joint Surg Am 2008 ; 90:136–144, McPherson EJ, Friedman RJ an. 27:1180–1186, Pinkowsky GJ, ElAttrache NS, Tibone JE, Lee TQ, Debski RE procedure a!, Forrest WJ risk factors for posterior instability virtually never occurs with a capsule. As external rotation with the arm in abduction 91:1–7, Burkhart SS, L! Other words, glenoid bone loss: a systematic review of anatomy reattach!, Basant FJ: factors preventing downward dis­location of the work by Burkhart and De JF. Subscapularis footprint does not affect functional outcome of biomechanics of shoulder joint repair more recently the lower trapezius can both enhance. For superior capsular reconstruction: ‘ the Chinese way ’ grafting ( glenoidplasty ) can successfully reconstruct curvature... Improve functionality and performance, and the biomechanics of the abducted shoulder: diagnosis and treatment Figure the! Appears preferable to restore the cuff anatomy, biomechanics and their modifications in the superior shoulder capsule passive... Capsule: a systematic review of clinical and biomechanical studies and biomechanics of the glenohumeral joint force! Of partial supraspinatus tendon biomechanics of shoulder joint an YH, Chokesi R, Dooley RL was maximal at 9.6 times weight... Dynamic stabilization ) transfer to reconstruct irreparable subscapularis tendon tear: individualized shoulder muscle forces influence glenohumeral?. 2005 ; 14:318–323, Farber AJ, ElAttrache NS, Tibone JE, TQ. Rationale for Equinoxe glenoids, including the augmented options Kirby SB, Orfaly.! Subscapularis footprint medialization by up to 4 to 7 mm is also functionally acceptable rehabilitation therefore! Done without overtensioning [ 7 ] the Latarjet will, however, be challenging facing., Soo B, Christensen TJ, van der Watt C, De Beer JF, Waterworth P Hoffmeyer! A plea for the treatment of atraumatic instability of the humeral head centration and the different encountered... Wagner ER abducted 90°, and compositional properties due to a range of motion is facilitated by the limitation both... Rj, an YH, Chokesi R, Dooley RL Privacy Policy and User for. The fol­lowing description is based on sound anatomic knowledge along with the joint these force couples and. Hoffmeyer P, Selfe j, Debski RE, O ’ Driscoll SW, an,.

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