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Surgery of the Shoulder
Published in Timothy W R Briggs, Jonathan Miles, William Aston, Heledd Havard, Daud TS Chou, Operative Orthopaedics, 2020
Nick Aresti, Omar Haddo, Mark Falworth
Blunt soft tissue release is carried out around the cuff. The coracohumeral ligament is released at its coracoid origin. This improves the external rotation. With the arm in external rotation, a bone retractor is inserted on the medial side of the humeral neck, marking the inferior border of the subscapularis muscle. This is detached laterally from its insertion to the lesser tuberosity together with the capsule. Stay sutures are inserted.
A to Z Entries
Published in Clare E. Milner, Functional Anatomy for Sport and Exercise, 2019
The synovial joints of the shoulder complex are the glenohumeral and acromioclavicular joints. The scapulothoracic articulation is not a traditional joint and does not have ligaments associated with it. The glenohumeral joint is the primary joint of the shoulder, between the trunk and upper extremity. This joint is a shallow ball and socket joint which relies on its soft tissue structures for stability and support (Figure 20). The ligaments of the glenohumeral joint are thickenings of the joint capsule. They are the glenohumeral ligament and the coracohumeral ligament. The glenohumeral ligament is an anterior thickening of the joint capsule. It consists of superior, middle and inferior parts. It is not particularly strong and is vulnerable to damage during traumatic injuries, such as glenohumeral joint dislocation (see shoulder complex – joints). The coracohumeral ligament runs from the coracoid process of the scapula to the greater and lesser tubercles of the humerus. It is a superior thickening of the joint capsule. This strong ligament helps to support the weight of the upper limb which hangs from the glenoid fossa. Due to its lack of bony support and limited contribution from the glenohumeral ligament, the glenohumeral joint relies heavily on the muscles of the shoulder joint for support.
Biomechanics and Joint Replacement of the Shoulder and Elbow
Published in Manoj Ramachandran, Tom Nunn, Basic Orthopaedic Sciences, 2018
Mark Falworth, Prakash Jayakumar, Simon Lambert
The rotator cuff maintains the centre of rotation of the humeral head and provides significant stability to the shoulder. Rotator cuff contraction causes a compressive force driving and stabilizing the humeral head within the glenoid fossa (Figure 22.3). This action maximally contributes to joint stability at the mid-range of shoulder motion whilst the glenohumeral and coracohumeral ligaments are most effective at the limits of motion.
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).
Comprehensive review of the physical exam for glenohumeral instability
Published in The Physician and Sportsmedicine, 2020
Brandon T. Goldenberg, Lucca Lacheta, Samuel I. Rosenberg, W. Jeffrey Grantham, Mitchell I. Kennedy, Peter J. Millett
Stabilization of the shoulder joint occurs by means of both static and dynamic stabilizers. The bony concavity of the glenoid balances the humeral head. The labrum, a dense, fibrous structure surrounding the glenoid rim increases the depth of the glenoid and acts as an anti-shear bumper [1–3]. The capsuloligamentous complex, consisting of the coracohumeral ligament, the middle glenohumeral ligament, the superior glenohumeral ligament, and the inferior glenohumeral ligament, is variably taught throughout shoulder motion and helps to prevent abnormal humeral head translation and optimize articular cartilage contact mechanics [4]. Additional static constraints include the negative intraarticular pressure created by less than 1 mL of joint fluid sealed in the capsule [5], and the coracoacromial arch, which is thought to prevent anterosuperior translation of the humeral head [4].
Effectiveness of translational manipulation under interscalene block for the treatment of adhesive capsulitis of the shoulder: A nonrandomized clinical trial
Published in Physiotherapy Theory and Practice, 2019
Daniel G. Rendeiro, Gail D. Deyle, Norman W. Gill, Guy R. Majkowski, Ian E. Lee, Dale A. Jensen, Robert S. Wainner
Interventions for AC have ranged from supervised neglect (Diercks and Stevens, 2004) to open surgery (Murnaghan, 1990). Between these extremes, practitioners have utilized: capsular distension (Fouquet et al, 2006; Vad, Sakalkale, and Warren, 2003); arthroscopic sectioning of the coracohumeral ligament (Pollock, Dyralde, Flatlow, and Bigliani, 1994) or other structures (Warner, Allen, Marks, and Wong, 1996); corticosteroid injection (Bal et al, 2008); oral corticosteroids (Buchbinder, Green, Youd, and Johnston, 2006); acupuncture (Sun, Chan, Lo, and Fong, 2001); trigger point dry needling (Clewely, Flynn, and Koppenhaver, 2014); joint manipulation under anesthesia (MUA) (Kivimaki and Pohjolainen, 2001; Roubal, Dobritt, and Placzek, 1996; Wang et al, 2010); and exercise and stretching (Carette et al, 2003; Diercks and Stevens, 2004; Guler-Uysal and Kozanoglu, 2004). Although evidence is stronger for the benefit of glenohumeral joint corticosteroid injection over other treatments in a 4- to 6-week time frame (Kelley, McClure, and Leggin, 2009), no form of treatment has been shown to be of greater benefit than any other on a long-term basis.