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8/2/2019 Anatomy of Shoulder Sport
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Anatomy of sports related
shoulder problems
Prof P Bala
National University of Singapore
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Common sports relatedproblems of shoulder
Rotator cuff tendinitis
Impingement
Rotator cuff tears mechanical Frozen shoulder non-mechanical
Instability, dislocation
Nerve injuries Non-sports related problems
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Shoulder Problems: clinicalcomplaint
Pain: local or referred
Stiffness , painful arc
Instability Weakness
Drop arm syndrome
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Shoulder : clinical presentation
To understand the pathology, clinicalfeatures, diagnostic imaging and treatment
A knowledge of shoulder anatomy isnecessary.
Otherwise we will be treating images
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The shoulder
A region that connects neck, trunk andupper limb to place hand in space
Enjoys greater freedom of motion
Relies on muscles and ligaments forstability
To achieve its function, shoulder built upon 3 bones and 4 joints
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Use of shoulder in sports
Power ,speed and drive for
Throwing, pitching, tennis stroke, spiking,gymnastics , weight lifting, swimming etc.
Shoulder acceleration and decelerationare demanding actions in overhead throw
Overuse and excessive load
rotatorcuff failure, proximal head migrationand instability
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Shoulder anatomy
Is a 5 jointed system consisting of
Scapulothoracic joint
Acromiothoracic joint Sternoclavicular joint
Coracoclavicular joint syndesmosis
Glenohumeral joint
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Shoulder muscles
Motorised by 3 groups of muscles
Axio-scapulartrapezius, lev scapulae,rhomboids, serratus anterior
Axio-humeral---pec major&minor,lat dorsi
Glenohumeralsubscapularis,supraspinatus, infraspinatus, teres minor
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Scapular muscles and movement
2 functionsprovide stability of scapulawhen shoulder complex is loaded.
-movement of scapulapointing itself
under the humeral head to maintain properlever length and functional length of musls.
Provides the fulcrum to elevate the arm in
all planes Scapular motion by a force couple on a
moving platformthe glenoid
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Scapulo-humeral rhythm
During the first 30 deg of abd scapularmovement is only 1/5 of GH movement
Beyond 30 deg: 1 deg for every 2 deg ofmovement of humerus.
The synchrony of GH and SC-Thmotion produces mobility without loss ofstability
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Scapulo-humeral muscles
In 2 sleeves
Outer sleeve: deltoid & teres major
Inner sleeve : subscapularis
supraspinatus rotator cuff
infraspinatus
teres minor
The 2 sleeves glide on each other
Subacromial bursa gliding mechanism
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Role of rotator cuff and capsularligaments
GH joint lacks bony stability as in hip
Flat glenoid, no stability for a large head
Only little contact, yet great stability
Due to 2 factors-ability of scapula to rotateand support humeral head
Efficiency of soft tissues enveloping head.
Contraction of this group maintains the Hhead in constant contact with glenoid.
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Stability of GH joint
Atmospheric pressure
Glenoid fossa and labrumchock effect
Glenohumeral ligaments and long head ofbiceps attached to labrum
Inferior GH ligament complex like ahammock supporting head in abd and ext.
rotation Middle GH ligament acts like a check rein
to prevent posterior translation
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Stability of GH joint ctd
Superior GH ligament restricts inferiortranslation
Collectively the capsular ligaments and
labrum are static stabilizers Dynamic stability by rotator cuff and long
head of biceps
A thrower relies on dynamic effect ofrotator cuff for joint compression to avoidcapsule stretching
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Glenoid labrum and tears
Common in throwers
Large compression and shearingforces drive the head anteriorly andposteriorly
Creating traumatic cartilage injury andlabral tear
Three types of surface motion at GH joint
Rotation, rolling and translation (gliding)
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Subacromial space and bursa
Subacromial space is inferior to acromion,A-C joint, and coracoacromial ligament
Subacromial bursa lies in the sub acrom.space, between the acromion process andthe coracoacromial ligament above andthe GH joint below
The bursa cushions the rotator cuff
from the overlying acromion
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Subacromial space
Acromion type- 3 has downward pointingspur
Basis for anterior acromioplasty
Sourcil sign: sclerosis on theundersurface of acromion( eyebrow) dueto chronic rotator disease
GH joint and sub acromial space maycommunicate in ch rotator cuff disease
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Long tendon of biceps
Attached to the supraglenoid tubercle
Intrasynovial
Biciptal tendinitis SLAP tear type 2,3 & 4 involve the biceps
tendon
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Nerves , shoulder and sports
Thoracic outlet syndrome
Scapular neuropathy in volleyball players
Denervation of infraspinatus, repeatedstretching during serving
Referred pain from neck ,heart,gallbaldder
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Coracoclavicular ligament/ joint
Is a syndesmosis
Strong conoid and trapezoid ligaments
This joint permits little movement Ligament torn in grade 3 dislocation of
acromioclavicular joint
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Summary
Shoulder is a complex joint system.
In the pursuit of speed and power
Its soft tissues mainly are injured Precise location of the source difficult.
A thorough knowledge of its anatomy
necessary to diagnose and treat them
Recommended