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Sports Medicine and Arthroscopy Review Sep 2018The shoulder is a complex joint, with a wide range of motion and functional demands. An understanding of the intricate network of bony, ligamentous, muscular, and... (Review)
Review
The shoulder is a complex joint, with a wide range of motion and functional demands. An understanding of the intricate network of bony, ligamentous, muscular, and neurovascular anatomy is required in order to properly identify and diagnose shoulder pathology. There exist many articulations, unique structural features, and anatomic relationships that play a role in shoulder function, and therefore, dysfunction and injury. Evaluation of a patient with shoulder complaints is largely reliant upon physical exam. As with any exam, the basic tenets of inspection, palpation, range of motion, strength, and neurovascular integrity must be followed. However, with the degree of complexity associated with shoulder anatomy, specific exam maneuvers must be utilized to isolate and help differentiate pathologies. Evaluation of rotator cuff injury, shoulder instability, or impingement via exam guides clinical decision-making and informs treatment options.
Topics: Humans; Joint Instability; Ligaments; Muscle, Skeletal; Physical Examination; Range of Motion, Articular; Rotator Cuff Injuries; Shoulder
PubMed: 30059442
DOI: 10.1097/JSA.0000000000000202 -
Annals of Physical and Rehabilitation... Jan 2021Several studies reported the importance of glenohumeral and scapular muscle activity and scapular kinematics in multidirectional shoulder instability (MDI), yet a... (Review)
Review
BACKGROUND
Several studies reported the importance of glenohumeral and scapular muscle activity and scapular kinematics in multidirectional shoulder instability (MDI), yet a systematic overview is currently lacking.
OBJECTIVE
This systematic review evaluates and summarizes the evidence regarding muscle activity and shoulder kinematics in individuals with MDI compared to healthy controls.
METHOD
The electronic databases PubMed and Web of Science were searched in September 2020 with key words regarding MDI (population), muscle activity, and glenohumeral and scapular movement patterns (outcomes). All studies that compared muscle activity or scapular kinematics between shoulders with MDI and healthy shoulders were eligible for this review, except for case reports and case series. All articles were screened on the title and abstract, and remaining eligible articles were screened on full text. The risk of bias of included articles was assessed by a checklist for case-control data, as advised by the Cochrane collaboration.
RESULTS
After full text screening, 12 articles remained for inclusion and one study was obtained by hand search. According to the guidelines of the Dutch Institute for Healthcare Improvement, most studies were of moderate methodological quality. We found moderate evidence that MDI individuals show increased or prolonged activity of several rotator cuff muscles that control and centre the humeral head. Furthermore, we found evidence of decreased and/or shortened activity of muscles that move or accelerate the arm and shoulder girdle as well as increased and/or lengthened activity of muscles that decelerate the arm and shoulder girdle. The most consistent kinematic finding was that MDI individuals show significantly less upward rotation and more internal rotation of the scapula during elevation of the arm in the scapular plane as compared with controls. Finally, several studies also suggest that the humeral head demonstrates increased translations relative to the glenoid surface.
CONCLUSION
There is moderate evidence for altered muscle activity and altered humeral and scapular kinematics in MDI individuals as compared with controls.
Topics: Biomechanical Phenomena; Humans; Joint Instability; Muscle, Skeletal; Range of Motion, Articular; Scapula; Shoulder; Shoulder Joint
PubMed: 33221471
DOI: 10.1016/j.rehab.2020.10.008 -
The Journal of the American Academy of... Jan 2018The shoulder achieves a wide spectrum of motion, and in a subset of patients, including those who use manual wheelchairs and upper extremity walking aids, the shoulder... (Review)
Review
The shoulder achieves a wide spectrum of motion, and in a subset of patients, including those who use manual wheelchairs and upper extremity walking aids, the shoulder also serves as the primary weight-bearing joint. Because the weight-bearing shoulder is subject to considerable joint reaction forces and overuse, a broad spectrum of pathology can affect the joint. The combination of muscle imbalance and repetitive trauma presents most commonly as subacromial impingement syndrome but can progress to other pathology. Patients with high-level spinal cord injury, leading to quadriplegia and motor deficits, have an increased incidence of shoulder pain. Understanding the needs of patients who use manual wheelchairs or walking aids can help the physician to better comprehend the pathology of and better manage the weight-bearing shoulder.
Topics: Activities of Daily Living; Biomechanical Phenomena; Canes; Humans; Postoperative Care; Shoulder; Shoulder Impingement Syndrome; Shoulder Injuries; Shoulder Pain; Weight-Bearing; Wheelchairs
PubMed: 29176492
DOI: 10.5435/JAAOS-D-15-00598 -
Annals of Physical and Rehabilitation... Jan 2018The global range of motion of the arm is the result of a coordinated motion of the shoulder complex including glenohumeral (GH), scapulothoracic, sternoclavicular and... (Review)
Review
BACKGROUND
The global range of motion of the arm is the result of a coordinated motion of the shoulder complex including glenohumeral (GH), scapulothoracic, sternoclavicular and acromioclavicular joints.
METHODS
This study is a non-systematic review of kinematic patterns in degenerated shoulders. It is a based on our own research on the kinematics of the shoulder complex and clinical experience.
RESULTS
For patients with subacromial impingement syndrome without rotator-cuff tears, most kinematic studies showed a small superior humeral translation relative to the glenoid and decreased scapular lateral rotation and posterior tilt. These scapular kinematic modifications could decrease the subacromial space and favor rotator-cuff tendon injury. For patients with shoulder pain and restricted mobility, the studies showed a significant increase in scapular lateral rotation generally seen as a compensation mechanism of GH decreased range of motion. For patients with multidirectional GH instability, the studies found an antero-inferior decentering of the humeral head, decreased scapular lateral rotation and increased scapular internal rotation.
CONCLUSION
The clinical or instrumented assessment of the shoulder complex with a degenerative pathology must include the analysis of scapula-clavicle and trunk movements complementing the GH assessment. Depending on the individual clinical case, scapular dyskinesis could be the cause or the consequence of the shoulder degenerative pathology. For most degenerative shoulder pathologies, the rehabilitation program should take into account the whole shoulder complex and include first a scapular and trunk postural-correcting strategy, then scapulothoracic muscle rehabilitation (especially serratus anterior and trapezius inferior and medium parts) and finally neuromotor techniques to recover appropriate upper-limb kinematic schemas for daily and/or sports activities.
Topics: Biomechanical Phenomena; Humans; Range of Motion, Articular; Rotation; Scapula; Shoulder; Shoulder Impingement Syndrome; Shoulder Pain
PubMed: 28987866
DOI: 10.1016/j.rehab.2017.09.002 -
AORN Journal Oct 2021
Topics: Shoulder
PubMed: 34586669
DOI: 10.1002/aorn.13526 -
Physical Medicine and Rehabilitation... Aug 2010The shoulder is the most common region to be evaluated with musculoskeletal ultrasound. The shoulder's complex anatomy enables an exceptional range of mobility at the... (Review)
Review
The shoulder is the most common region to be evaluated with musculoskeletal ultrasound. The shoulder's complex anatomy enables an exceptional range of mobility at the expense of static stability. Consequently, the shoulder is susceptible to a multitude of traumatic and atraumatic injuries. This article presents an overview of shoulder anatomy, recommends a standardized approach to the sonographic shoulder evaluation, and discusses common sonographically apparent pathology of the shoulder.
Topics: Humans; Reproducibility of Results; Shoulder; Shoulder Joint; Ultrasonography
PubMed: 20797546
DOI: 10.1016/j.pmr.2010.04.001 -
Nederlands Tijdschrift Voor Geneeskunde 2011Examination of the active and passive range of motion of the shoulder joint is of major importance when diagnosing shoulder disorders. Abduction and external exorotation... (Review)
Review
Examination of the active and passive range of motion of the shoulder joint is of major importance when diagnosing shoulder disorders. Abduction and external exorotation movements of the shoulder joint can be judged reliably. Limitations in the range of abduction indicate subacromial pathology and limitations in the range of external exorotation indicate glenohumeral pathology. Other shoulder joint movement tests have only low inter-rater reliability. Palpation of the shoulder serves no useful purpose if inspection of the joint and examination of the active range of motion reveal no abnormal signs. The value of physical examination tests that identify impingement or stability of the shoulder joint has not been reliably demonstrated.
Topics: Humans; Physical Examination; Range of Motion, Articular; Shoulder; Shoulder Impingement Syndrome; Shoulder Injuries; Shoulder Joint; Shoulder Pain
PubMed: 21447205
DOI: No ID Found -
Clinics in Sports Medicine Jan 1986The shoulder is the joint most subjected to repetitive microtrauma in swimming. This results in clinical manifestations of subacromial encroachment. The anatomy,... (Review)
Review
The shoulder is the joint most subjected to repetitive microtrauma in swimming. This results in clinical manifestations of subacromial encroachment. The anatomy, radiographic changes, clinical findings, and histopathology of this disease process are discussed. The role of conservative exercises used in prevention as well as the role of surgical decompression of the subacromial space is explained.
Topics: Athletic Injuries; Diagnosis, Differential; Exercise Therapy; Humans; Ligaments, Articular; Pain; Radiography; Shoulder; Shoulder Injuries; Swimming
PubMed: 3512100
DOI: No ID Found -
Sports Biomechanics Jun 2017In volleyball, the dominant shoulder of the athlete undergoes biomechanical and morphological adaptations; however, definitive conclusions about their exact nature,... (Review)
Review
In volleyball, the dominant shoulder of the athlete undergoes biomechanical and morphological adaptations; however, definitive conclusions about their exact nature, aetiology, purpose and associations with shoulder injury have not been reached. We present a systematic review of the existing literature describing biomechanical adaptations in the dominant shoulders of volleyball players and factors that may predispose to shoulder pain/injury. A thorough literature search via Medline, EMBASE and SCOPUS was conducted for original studies of volleyball players and 15 eligible articles were identified. Assessment of study quality was performed using the STROBE statement. The reviewed literature supports the existence of a glenohumeral internal rotation deficit (GIRD) and a possible (and less pronounced) external rotation gain in the dominant vs. the non-dominant shoulder of volleyball athletes. Unlike other overhead sports, the GIRD in volleyball athletes appears to be anatomical as a response to the repetitive overhead movements and not to be associated with shoulder pain/injury. Additionally, the dominant shoulder exhibits muscular imbalance, which appears to be a significant risk factor for shoulder pain. Strengthening of the external rotators should be used alongside shoulder stretching and joint mobilisations, core strengthening and optimisation of spike technique as part of injury management and prevention programmes.
Topics: Adaptation, Physiological; Biomechanical Phenomena; Humans; Muscle Strength; Muscle, Skeletal; Range of Motion, Articular; Risk Factors; Rotation; Shoulder; Shoulder Injuries; Shoulder Pain; Volleyball
PubMed: 27659068
DOI: 10.1080/14763141.2016.1222629 -
The Journal of the American Academy of... Apr 2016Surgical repair, reduction, fixation, and reconstruction for glenohumeral trauma, instability, and degenerative joint disease often require an open surgical exposure.... (Review)
Review
Surgical repair, reduction, fixation, and reconstruction for glenohumeral trauma, instability, and degenerative joint disease often require an open surgical exposure. Open shoulder surgery is challenging because the deltoid and rotator cuff musculature envelop the joint, and in most approaches, exposure is limited by the proximity and importance of the axillary nerve. An understanding of the importance of the deltoid and the rotator cuff for glenohumeral function has led to a progression of innovative, advanced, and less invasive approaches to the shoulder. Various advantages, disadvantages, and risks are encountered when performing deltopectoral, deltoid-splitting, and posterior approaches to the glenohumeral joint, with variations of each approach and techniques to extend them and maximize exposure. The ability to perform each of these exposures provides the surgeon with the flexibility to best address the widest variety of pathology.
Topics: Humans; Joint Instability; Shoulder; Shoulder Joint
PubMed: 26918414
DOI: 10.5435/JAAOS-D-14-00342