Académique Documents
Professionnel Documents
Culture Documents
The 4 Joints
Acromio-Clavicular Sterno-Clavicular Scapular-Thoracic Gleno-Humeral
Acromioclavicular Joint
Clavicular shape Ligaments
AC lig. Trapezoid lig. Coracoacromial lig.
Sternoclavicular Joint
Ball & Socket
Rotation in long axis
ST joint
Passive stabilizer AC joint Dynamic stabilizers
Trapezius Serrantus anterior Rhomboids Levator scapula
6 Dr Youssef masharawi emai: yossefm@post.tau.ac.il
ST joint functions
To orient the glenoid fossa for optimal contact with the humeral head To increase the range of arm elevation To provide a stable base for the RC muscle activity
7 Dr Youssef masharawi emai: yossefm@post.tau.ac.il
Glenohumeral Joint
Passive System
OSSEOUS MORPHOLOGY
Ball & Socket type
Glenoid labrum
10
11
Passive System
Capsuloligamentous mechanism Passive muscle tension Negative intra-articular pressure
12
Dynamic System
Dynamic stability = muscle activity
(Richardson 1992)
13
Dynamic System
They circumduct the humeral head Adjust tension in passive structures Create a compressive vector on the humeral head
14
15
<>
16
Neural System
Facilitates normal interaction between the passive and active system Static stabilizers have to work in synergy with the dynamic stabilizers (Lippit & Matson, 1993, Peat, 1986) Strength alone is not sufficient (Matson et al 1990) A reflex arch from the GH capsule to several muscles crossing the GH joint has been described by Guanche et al (1995) in cats
17 Dr Youssef masharawi emai: yossefm@post.tau.ac.il
18
19
(Johnson et al, 1994, Dvir& Berme, 1978, Bagg & Forrest, 1986, Ludewig et al, 1996).
Middle Phase
SHR ratio 1:1
0 (30
0) 140
AC joint elevation & protraction Scapula ICR is now located at the AC joint After 600 the humeral head glide downward and rotate externally (Donatelli, 1997; Kapandji, 1982)
22 Dr Youssef masharawi emai: yossefm@post.tau.ac.il
The Deltoid and Supras. reached their peak activity around 900 (De Luca & Forrest, 1973; Dvir & Berme, 1978)
23
Muscle function
Different reports of scapular rotators muscle activity in the literature (Bradly & Tibone, 1991; Inman et al., 1944, Ludewig et al., 1996) A change in muscle task from scapula stabilizer to prime mover (Bagg & Forrest, 1986) Ludewig et al., 1996 described 3 possible patterns of upper and lower trapezius activity
Dr Youssef masharawi emai: yossefm@post.tau.ac.il
24
Final Phase
0 (140
0) 180
SHR varies between 3:1 to 7:1 Tightness of the AC joint caused by tightness in the coracoclavicular ligaments The flexibility of the Latiss., Pect.Maj., Subs., Ter.Maj can affect the ROM in Abd. (Donatelli, 1997)
25 Dr Youssef masharawi emai: yossefm@post.tau.ac.il
Serrat.ant activity remain high Decrease activity of the RC, and mid. Delt.
1. Outer range = active insufficiency 2. GHJ at a closed pack position less dynamic stabilisation is needed
(Inman et al., 1944; Kronberg et al., 1990)
26 Dr Youssef masharawi emai: yossefm@post.tau.ac.il
SHR roles
Prevent impingement Optimize length/tension relationship Optimize contact between humeral head and glenoid help to stabilize GH joint
27 Dr Youssef masharawi emai: yossefm@post.tau.ac.il
28
SHR conclusions
SHR is variable between subjects SHR change during arm elevation Scapular ICR is not fixed Average contribution to arm elevation ST about 600, GH about 1000
29 Dr Youssef masharawi emai: yossefm@post.tau.ac.il
30
Secondary Impingement
Minor instability: Static stabilisers, dynamic stabilisers Muscle imbalance: Abnormal function of the RC, Abnormal function of the scapula rotators
31
Primary Impingement
Intrinsic factors: Degenrative changes, Tendinitis Extrinsic factors: Osteophytes, coracoacromial arch Abnormality, capsule tightness
32 Dr Youssef masharawi emai: yossefm@post.tau.ac.il
Shoulder Impingement
Possible Etiology
Shoulder impingement
GH joint hypermobility
33
Muscle imbalance
Dr Youssef masharawi emai: yossefm@post.tau.ac.il
Extrinsic
Intrinsic
34