the shoulder a balance of mobility and stability
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The Shoulder A Balance Of Mobility and Stability. Glenohumeral Joint Stability Static stabilizing structures: Bony geometry Glenoid labrum Capsulo-ligamentous complex Intra- articular pressure Dynamic stabilizing structures: Musculo-tendinous influences. Static Stabilizing Structures - PowerPoint PPT PresentationTRANSCRIPT
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The ShoulderA Balance Of Mobility and
Stability
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Glenohumeral Joint Stability Static stabilizing structures:
Bony geometry Glenoid labrum Capsulo-ligamentous complex Intra-articular pressure
Dynamic stabilizing structures: Musculo-tendinous influences
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Static Stabilizing Structures Bony Geometry
Sacrifices joint stability for great mobility“Golf ball sitting on a tee”
2 mechanisms for providing stabilityGlenoid fossa/Humeral head contact area
25-30% of humeral head contacts glenoidArticular surface congruency
Glenoid fossa orientationHumeral head orientation
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Static Stabilizing Structures Glenoid Labrum
Most effective in mid-ROM Fibrous rim that deepens the glenoid fossa
depth ~50% or 2.5-5.0 mm total surface contact areaintra-articular pressure
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Capsulo-Ligamentous Joint capsule
Predominantly type I collagen Less than 5 mm thick Primary role – maintaining negative intra-articular
pressure
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Capsulo-Ligamentous Coracohumeral ligament
Tight during shld ER & elevation (0-60°) Prevents inferior translation in shld ADD
Superior Glenohumeral ligament Prevents inferior translation in shld ADD
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Capsulo-Ligamentous Middle Glenohumeral Ligament
Prevents anterior translation Limits shld ER between 0-90° of arm elevation
Inferior Glenohumeral Ligament Complex
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Inferior Glenohumeral Ligament Anterior band and axillary pouch – anterior
stability in upper ranges of elevation Posterior band – inferior stability during arm
elevation In shld elevation:
Anterior band becomes taut w/ shld ER Posterior band becomes taut w/ shld IR
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Capsulo-Ligamentous Structures
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Dynamic Stabilizing StructuresPrimary Stabilizers Secondary
StabilizersSupraspinatus Teres
MajorInfraspinatus
Latissimus DorsiTeres Minor
Pectoralis MajorSubscapularis
Long Head of Biceps
Deltoid*
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Primary Stabilizers Concavity-compression mechanism Dynamic ligament tension – helps reinforce
the joint capsule Initiation of movement, forces for acceleration
and deceleration Neutralize the superior pull of the deltoid
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Primary Stabilizers External rotation controlled by infra and teres
minor – reduces strain on anteroinferior capsuloligamentous structures
Subscapularis – anterior stability w/ arm in abd and neutral rotation
Posterior cuff muscles – anterior stability w/ arm in abd and ER
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Primary Stabilizers Supraspinatus – compression, abd, & generates a
small ER torque, peaks at 30°-60°, generates most force in scapular plane
Infraspinatus/Teres Minor – compression, generates inferoposterior force, provides great ER torque, generates most force at 0° abd
Subscapularis – compression, ant stability, generates IR torque, generates most force at 0° abd, primary IR at 90° abd
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Secondary Stabilizers Long Head of Biceps – dynamic restrain to ER
in the abducted shld; large role in dynamic stability when capsuloligamentous structures are compromised
Deltoid – dynamic stability w/ arm in scapular plane; decreases the stability of the shld w/ arm in coronal plane