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Musculoskeletal system
Published in David A Lisle, Imaging for Students, 2012
Dislocation of the glenohumeral (shoulder) joint is a common occurrence and in most cases recovery is swift and uncomplicated. In a small percentage of cases, tearing of stabilizing structures, such as the labrum and glenohumeral ligaments, may cause glenohumeral instability and recurrent dislocation. MRI is the investigation of choice for assessment of glenohumeral instability. The accuracy of MRI may be enhanced by the intra-articular injection of a dilute solution of gadolinium (MR arthrogram); this is done under fluoroscopic or US guidance (Fig. 8.55).
Intra-articiilar kinematics of the normal glenohumeral joint in the late preparatory phase of throwing: Kaltenborn's rule revisited
Published in Thomas Reilly, Julie Greeves, Advances in Sport, Leisure and Ergonomics, 2003
J.-P. Baeyens, P. Van Roy, Jan Pieter Clarys
Following the convex–concave rule, the roll and glide of a convex humeral head on a concave glenoid should be in opposite directions. With respect to glenohumeral external rotation, Matsen et al. (1998) demonstrated a posterior translation of the humeral head on the glenoid evolving out of specific capsuloligamentous tightening (i.e. in 90° abduction the anterior band of the inferior glenohumeral ligament and at lower angles the middle glenohumeral band, the anterior band of the inferior glenohumeral ligament and the subscapularis tendon). Consequently, the clinician must reconsider Kaltenborn’s traditional concepts regarding intra-articular glenohumeral motion behaviour as well as restating its clinical impact. In the case of limited motion, mobilization of glenohumeral external rotation at 90° shoulder abduction with combined anterior gliding will stretch the tightening IGHLC. The effect is to enhance a pathokinematic behaviour as seen in anterior instability, which is characterized at the end of the apprehension test pose by a diminished posterior translation of the geometrical centre of the humeral head on the glenoid (Howell et al. 1988, Paletta et al. 1997). Then, glenohumeral mobilization should assess the roll behaviour characteristic of the late cocking motion. However, roll and glide are 2D arthrokinematic terms related to the plane of motion. From an individual point of view it is difficult to define therapeutically the plane of motion as well as the articular surface and thus the magnitude and direction of glide. Consequently, from a practical point of view it seems better to redefine manual therapeutic techniques for the glenohumeral joint in terms of rotation of the humerus and translation of the geometrical centre of the humeral head.
Imaging of the upper limb
Published in Sarah McWilliams, Practical Radiological Anatomy, 2011
o The normal glenohumeral joint has a prominent axillary pouch. The fibrous capsule of the shoulder is thickened anteriorly, forming the glenohumeral ligaments. The shoulder capsule extends inferiorly on to the surgical neck of the humerus (Fig. 8.10).
Influence of glenohumeral joint muscle insertion on moment arms using a finite element model
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2020
M. Hoffmann, M. Begon, Y. Lafon, S. Duprey
Deformable volume models such as 3D finite element models seem to be a promising method to accurately represent muscle geometry. It allows the representation of structure interactions and complex representation of fibre trajectories (Blemker and Delp 2005). Webb et al. (2014) developed a finite element model limited to the rotator cuff muscles and deltoid which was only evaluated for simple motions, like axial rotation. Moreover, it requires a high computational time. The recent model of Zheng et al. (2019) includes the major structure of the shoulder complex: bones (clavicle, humerus and scapula); humeral and glenoid cartilage; rotator cuff muscles; ligaments (coracohumeral ligament, superior glenohumeral ligament, middle glenohumeral ligament and inferior glenohumeral ligament) but the authors did not a complete validation. In most cases, the model evaluation is performed by comparing moment arms to literature data. Some efforts must be done to have rigorous in vivo experimental data for evaluation of the finite element results as underlined by Zheng et al. (2017).
The throwing shoulder in youth elite handball: adaptions of inferior but not anterior capsule thickness differ between the two sexes
Published in Research in Sports Medicine, 2023
Moritz T. Winkelmann, Leonard Achenbach, Florian Zeman, Lior Laver, Sven S. Walter
Throwing is the transmission of force through the progression of segmental movements occurring in proximal-to-distal order. The momentum transfer starts at the pelvis or lower limb and proceeds to the trunk and the throwing arm, thereby enabling high velocities (Van den Tillaar & Ettema, 2009; Wagner et al., 2014). Acting as a link between the trunk and the arm, the repetitive overhead throwing motion places extraordinary stress on the anterior part of the throwing shoulder. In the late cocking phase of throwing, the glenohumeral ligaments seem to exert their restraining effect mainly at these extremes of motion despite their ability to also restrict translation in other positions (Ovesen & Nielsen, 1985a, 1985b; Rb et al., 1992; Urayama et al., 2001). The antero-inferior capsule, particularly the anterior band of the inferior glenohumeral ligament complex (IGHL), is hereby the primary static restraint to anterior translation when the arm is in abduction and the external rotation (ABER) position (Kuhn et al., 2000; O’Brien et al., 1995; Turkel et al., 1981). Anatomically, the inferior glenohumeral ligament complex forms the shape of a hammock that cradles the humeral head (O’Brien et al., 1995; Turkel et al., 1981). Its superior border originates at 2–4 o’clock position on the glenoid rim, whereas the posterior border originates on the glenoid at 7–9 o’clock (Pouliart & Gagey, 2005, 2005). Both borders run down diagonally to the humeral insertion. Capsule thickness in the throwing shoulder has become of increasing interest due to the hypothesis that the process of internal postero-superior shoulder impingement is related to subtle anterior shoulder instability or “microinstability” (Kvitne & Jobe, 1993). This concept is on anterior microinstability because of reduced thickness of the anterior capsule due to the process of “stretching”, thus attenuation, tensile failure and nonrecoverable strain of the anteroinferior glenohumeral capsule under anterior subluxation the ABER throwing position (Kvitne & Jobe, 1993; Soslowsky et al., 1997; Turkel et al., 1981).