g-functional anatomy review of the shoulder...
TRANSCRIPT
Functional Anatomy Review of the Shoulder Complex
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Objectives
• Review specific functional anatomy of the shoulder complex.
• Understand the biomechanics of the shoulder complex.
• Identify sources of pain• Not all anatomical illustrations are
completely accurate
General Principles of the Shoulder
• Shoulder is complex• Cuff insertion is anterior• Cuff is always activated• Tendon of cuff is less
vascular• Small muscle for long
lever arm = mechanical disadvantage
• Many other structures can affect the shoulder (ie neck and scapula)
Roof and Floor
RoofFloor
Functional Anatomy of the Shoulder Complex
• 25%-30% of the humerus contacts the glenoid.
• Glenoid is shallow • Why is there an
unstable bony configuration?
• Muscular activity is very important
Superficial MusclesHow often do you see a tear of
these?
Bony Shoulder Anatomy
Bony Posterior Shoulder Anatomy
Anterior Orientation
Muscles - Dynamic Stabilizers
Capsular Tissue
Cuff/Capsule
Capsule
Capsule
Biceps Tendon
• Can be both intra-articular and extra-articular
• Long head depresses humerus
• Long head tears more
Biceps-Labrum
A-C Joint
Tender A-C jointHorizontal adduction painfulPain and swellingDegenerates quicklyCuff path. vs. A-C jt. degen.Spurs can sever the cuff.
A-C Joint
Spur
Vascularity
Angle of Inclination
Rotator Cuff Position
Posterior Capsule
• Thin• Close assoc. with cuff.• Contract cuff=
tightening of capsule• Tight posterior cuff
can cause impingement at the subacromial space
• Demo.
Coracohumeral Ligament
Suspends humerus.Little function.Thoracic kyphosis increase laxity = cuff works harder
R-C Function (cont.)
Compresses the G-H joint.ElevatesIR & ERAccelerates and decelerates the arm
Hammock Effect
Inverted Hammock
Humeral Head Depression
Massive Rotator Cuff Tear
Neuromuscular Inhibition
Pain Swelling
Instability
Functional Stability of the Shoulder
Shoulder Knee
Dynamic Stability Static
Stability
omuscular Component