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Shoulder

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by

Thomas Maccaccaro

on 20 March 2016

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Transcript of Shoulder

The Shoulder Joint
Shoulder
The human shoulder is made up of three bones: the
clavicle
, the
humerus
and the
scapula
, the latter providing the
glenoid cavity
, the
acromion
and the
coracoid process
.

The joint capsule is very loose and is therefore
strenghten by ligaments:
superior, middle and inferior glenohumeral ligaments and coracohumeral ligament.

A number of small fluid-filled sacs known as
synovial bursae
are located around the capsule to aid mobility by reducing friction: the
subdeltoid bursa
, the
subacromial bursa
, the
subcoracoid bursa
, the
coracobrachial bursa
and the
subscapular bursa
.

What is it ?
SHOULDER INSTABILITY
Testosterone
The glenohumeral joint is a ball and socket joint between the
glenoid cavity
of the
scapula
and the
head of the humerus
. The glenoid cavity is made deeper by a fibrocartilaginous ring attached to the circumference of the cavity:
the glenoid labrum
.

The
rotator cuff
is a group of muscles and their tendons that act to stabilize the shoulder. The four muscles are the
supraspinatus
, the
infraspinatus
, the t
eres minor
, and the
subscapularis
.

The articulations between the bones of the shoulder make up the shoulder joints: the
glenohumeral joint
, the
acromioclavicular joint
and the
sternoclavicular joint
.

The
capsule
is a connective tissue envelope that encircles the glenohumeral joint and connects the scapula to the humerus. It has two parts: an outer
fibrous membrane
and an
inner synovial membrane
. On the inside of the capsule, articular
hyaline cartilage
covers the bones' articulating surfaces.

The shoulder joint is a ball and socket joint, with the humeral head as the ball and the glenoid as the socket.

When the humeral head doesn’t move normally on the glenoid we have the so called “shoulder instability”.

The function of the labrum:
Normal labrum
It acts as a stabilizer for the joint
Damaged labrum
Humeral head is free from the socket
Possible causes
Atraumatic instability
Genetic presisposition
Repetitiving movements
A wrong muscolar movement
Traumatic
instability
A violent contact with something or another person
Symptomps
A sense of pain( anterior, posterior or lateral)
A sense of «dead arm» , the patient becomes apprehensive of moving his arm in certain positions
Instrumental exams :
X-rays
may be obtained to make sure about the position of the shoulder.
An
MRI
may also be obtained to evaluate the labrum, shoulder joint and rotator cuff tendons.

Joint tests
Diagnosis
Treatments
Non-sugical treatment
Rotator cuff strengthening
Shoulder bracing
Anti-inflammatory medications
Surgical treatment
Surgery stabilizes defects in the labrum, capsule and surrounding ligaments. Stabilization occurs with placement of a small anchor into the glenoid. A suture is attached to the anchor and used to secure the labrum, capsule and ligaments to the glenoid.
Physiotherapy treatments
Retrain movement
Strengthen muscles
Retrain ‘position sense’
Return to sport or activity
Rotator
cuff
Rotator cuff tear
A “rotator cuff tear” is a tear of one or more of the tendons of the four rotator cuff muscles of the shoulder
Is among the most common conditions affecting the shoulder
The supraspinatus is most
frequently affected, as it
passes below the acromion
What is rotator cuff?
The rotator cuff is a group of muscles and their tendons
Sovraspinatus muscle
Infraspinatus muscle
Subscapularis muscle
Teres minor muscle
1.Stabilize the shoulder
2.Rotate humerus
3.Abduce humerus
From physiology to pathology
Health shoulder
Rotator cuff tear
Trauma
Sports injuries
Overuse
Age-relate degeneration
Classification
Rotator cuff tear
Partial-thickness
tears
Full-thickness
tears
full thickness
with complete
detachment
of the tendons
from bone.
Diagnosis
Symptoms
Treatment
Physical assessment
Clinical history
Symptoms
MRI
Severe pain
Limited r.o.m.
inability to move or
lift the arm sufficiently
Surgery
Physical therapy
Physical therapy
instrumental therapy
Achieve range of motion
Strength training
Adhesive capsulitis
what is it?
Causes
Shoulder immobilized for a certain period of time
Diabets,Parkinson’s disease, Hyperthyroidism or Hypothyroidism
People between 40 and 60 years old
More common in women
Symptoms
Intense pain in the outer shoulder area
Pain in the upper arm.
Stiffness
Restricted motion
Diagnosis
Doctor’s examination: The diagnosis is established with a doctor’s examination and based on the symptoms the patient is having.
Magnetic resonance imaging (MRI)
X-rays
Treatments
Various treatments
The condition usually gets better on its own
Improvement can take two to three years
Over 90% of patients improve with non-surgical treatments:
Heat
Anti-inflammatory medications
Intra-articular corticosteroid injections
Physical therapy
Glenohumeral Arthritis
Etiology
Primary glenohumeral osteoarthritis
Rotator cuff tear arthropathy
Post-traumatic glenohumeral arthritis
Rheumatoid arthritis
Pain
Stiffness
Loss of function
Grinding on shoulder motion.
Symptoms
Patient Evaluation
Treatment
Non-steroidal antiinflammatory and analgesic medications
Range of motion and strengthening exercises
Corticosteroid injections
Activity modifications
Various surgical options
Arthroscopy
Hemiarthroplasty
Anatomic Total Shoulder Replacement
Reverse Total Shoulder Replacement
Post-operative Course and Rehabilitation
1 or 2 days hospital recovery
immediately after surgery: passive range of motion exercises
4-6 weeks: patients wear a sling
first 6 weeks: strengthening is avoided; limited physical therapy
after 6 weeks: active use and range of motion
after 3 months: usual daily activities
rehabilitation exercises are continued for at least 6 months
External rotation
Forward flexion
Crossover arm stretch
Ultrasound
Eletric stimulation
Specific exercises will help restore motion
Under the supervision of a physical therapist or through home program
Therapy includes stretching or range of motion exercises for the shoulder
Full transcript