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the shoulder

the shoulder. The shoulder. Passive elements Active elements. Bony shoulder. Bony shoulder. Bony shoulder. Bony shoulder. ACROMION TYPES. Glenohumeral joint. Ball and socket Ball:1/3 of a sphere Bony glenoid:covers only 1/3 of the head Glenoid depth: Vertical:9mm

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the shoulder

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  1. the shoulder

  2. The shoulder Passive elements Active elements

  3. Bony shoulder

  4. Bony shoulder

  5. Bony shoulder

  6. Bony shoulder ACROMION TYPES

  7. Glenohumeral joint • Ball and socket • Ball:1/3 of a sphere • Bony glenoid:covers only 1/3 of the head • Glenoid depth: Vertical:9mm Horizontal:5mm

  8. Glenohumeral joint AVERAGE GLENOID DEPTH DOUBLED VERTICAL >HORIZONTAL DEPTH

  9. LABRUM • dense fibrous tissue • superior portion: resembles a meniscus loosely attached to the glenoid rim (12o'clock) inserts into the biceps tendon in The interval is a small (5 mm) recess • the lower portion: round, dense

  10. Glenohumeral joint

  11. Slap lesion

  12. Slap lesion

  13. Glenohumeral capsule • inserts primarily into the anatomic neck of humerus but inferiorly in to the surgical neck • Preservation of glenohumeral stability by an intraarticular vacuum • A cadaver study:with an intact capsule found no subluxation even with sectioning of all the supporting muscles

  14. Glenohumeral Ligaments

  15. Glenohumeral Ligaments

  16. Glenohumeral Ligaments • arm dependent (abduction zero):all three ligaments are visibly slack; primary stabilizer is SGHL • + external rotation:tension in the MGHL and the superior band of the IGHL • >45° of abduction:tightens the superior band of the IGHL

  17. ROTATOR INTERVAL

  18. Coracoacromial Ligament passively restrains humeral subluxation in the shoulder with a deficient rotator cuff

  19. Coracohumeral Ligament forms part of the roof of the bicipital tendon sheath COVERS ROTATOR INTERVAL

  20. ACROMIOCLAVICULAR JOINT

  21. Sternoclavicular joint

  22. MOTIONS OF THE SHOULDER JOINTS ROM:160˚─180˚

  23. SHOULDER ROM Elevation: humerus→2/3 scapula→1/3 minimum in the first and the last 30˚ Rotation: max with the arm adjacent to the trunk(160˚) decrease to 120˚in 90˚ABD/FLEX min in full ABD/FLEX

  24. Scapular motion

  25. SCAPULOTHORACIC MOBILITY ROTATION upward(60˚) downward(extension) ELEVATION DEPRESSION PROTRACTION(away from the spine) RETRACTION(toward the spine)

  26. CLAVICULAR JOINTS • sternoclavicular: only 30° during the first 90° . . of arm elevation. . . Clavicularprotraction and rotation Clavicular rotation of 50˚ • acromioclavicular: 15° during the first and last . 40° of arm elevation

  27. SHOULDER MUSCLES • deltoid (anterior, middle, posterior) • rotator cuff muscles (supraspinatus, subscapularis, infraspinatus, teres minor) plus the biceps • axiohumeral muscles (pectoralis major and latissimusdorsi) plus the teresmajor • Scapular muscle (serratus anterior, trapezius, rhomboid, and levator scapulae)

  28. elevation • Deltoid: primary elevator • posterior part has minor role . except during abduction • Rotator cuff:sup.spinatus→ABD/Compression . inf.spinatus→ext.rot/depressor subscapularis→int.rot/depressor teresminor→ext.rot • Pec.major and lat.dorsi→depressor

  29. The end

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