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Transcript of Shoulder
The human shoulder is made up of three bones: the
, the latter providing the
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
are located around the capsule to aid mobility by reducing friction: the
What is it ?
The glenohumeral joint is a ball and socket joint between 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
is a group of muscles and their tendons that act to stabilize the shoulder. The four muscles are the
, the t
, and the
The articulations between the bones of the shoulder make up the shoulder joints: the
is a connective tissue envelope that encircles the glenohumeral joint and connects the scapula to the humerus. It has two parts: an outer
inner synovial membrane
. On the inside of the capsule, articular
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:
It acts as a stabilizer for the joint
Humeral head is free from the socket
A wrong muscolar movement
A violent contact with something or another person
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 :
may be obtained to make sure about the position of the shoulder.
may also be obtained to evaluate the labrum, shoulder joint and rotator cuff tendons.
Rotator cuff strengthening
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.
Retrain ‘position sense’
Return to sport or activity
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
Teres minor muscle
1.Stabilize the shoulder
From physiology to pathology
Rotator cuff tear
Rotator cuff tear
of the tendons
inability to move or
lift the arm sufficiently
Achieve range of motion
what is it?
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
Intense pain in the outer shoulder area
Pain in the upper arm.
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)
The condition usually gets better on its own
Improvement can take two to three years
Over 90% of patients improve with non-surgical treatments:
Intra-articular corticosteroid injections
Primary glenohumeral osteoarthritis
Rotator cuff tear arthropathy
Post-traumatic glenohumeral arthritis
Loss of function
Grinding on shoulder motion.
Non-steroidal antiinflammatory and analgesic medications
Range of motion and strengthening exercises
Various surgical options
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
Crossover arm stretch
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