Effect of Posterior Capsule Tightness on Glenohumeral Translation in the Late-Cocking Phase of Pitching

2007 ◽  
Vol 16 (1) ◽  
pp. 41-49 ◽  
Author(s):  
Kim M. Clabbers ◽  
John D. Kelly ◽  
Dov Bader ◽  
Matthew Eager ◽  
Carl Imhauser ◽  
...  
Keyword(s):  
Outcome Measures ◽  
Humeral Head ◽  
Glenohumeral Joint ◽  
External Rotation ◽  
Head Position ◽  
Posterior Capsule ◽  
Nonsignificant Trend ◽  
Before And After ◽  
Fresh Frozen ◽  
Head Translation

Context:Throwing injuries.Objective:To study the effects of posterior capsule tightness on humeral head position in late cocking simulation.Design:Eight fresh frozen shoulders were placed in position of “late cocking,” 90 degrees abduction, and 10 degrees adduction and maximal external rotation. 3D measurements of humeral head relationship to the glenoid were taken with an infrared motion sensor, both before and after suture plication of the posterior capsule. Plications of 20% posterior/inferior capsule and 20% entire posterior capsule were performed, followed by plications of 40% of the posterior/inferior capsule and 40% entire posterior capsule.Setting:Cadaver Lab.Intervention:Posterior capsular placation.Main Outcome Measures:Humeral head position.Results:40%, but not 20%, posterior/inferior and posterior plications demonstrated a trend to increased posterior-superior humeral head translation relative to controls.Conclusion:Surgically created posterior capsular tightness of the glenohumeral joint demonstrated a nonsignificant trend to increased posterior/superior humeral head translation in the late cocking position of throwing.

Quantification of Anterior Translation of the Humeral Head in the Throwing Shoulder

2000 ◽  
Vol 28 (2) ◽  
pp. 161-167 ◽  
Author(s):  
Todd S. Ellenbecker ◽  
Angelo J. Mattalino ◽  
Eric Elam ◽  
Roger Caplinger
Keyword(s):  
Clinical Evaluation ◽  
Humeral Head ◽  
Glenohumeral Joint ◽  
External Rotation ◽  
Professional Baseball ◽  
Intrarater Reliability ◽  
Stress Radiography ◽  
Significant Difference ◽  
Baseball Pitchers ◽  
Head Translation

Clinical evaluation of humeral head translation relies mainly on manual tests to measure laxity in the human shoulder. The purposes of this study were to determine whether side-to-side differences exist in anterior humeral head translation in professional baseball pitchers, to compare manual laxity testing with stress radiography for quantifying humeral head translation, and to test intrarater reliability of the manual humeral head translation and stress radiography tests. Twenty professional baseball pitchers underwent bilateral manual anterior humeral head translation and stress radiographic tests. Stress radiography was performed by imparting a 15-daN anterior load to the shoulder in 90° of abduction with both neutral and 60° of external rotation and recording the glenohumeral joint translation at rest and under stress in each position. Eight subjects were retested to assess the reliability of these methods. Results showed no significant difference between the dominant and nondominant extremity in the amount of anterior humeral head translation measured manually and with stress radiography, nor significant correlation between anterior humeral head translation measured manually and by stress radiography. Testretest reliability was moderate-to-poor for the manual humeral head translation test and moderate for stress radiography.

scholarly journals Change in the Distance From the Axillary Nerve to the Glenohumeral Joint With Shoulder External Rotation or Abduction Position

Hand ◽  
2016 ◽  
Vol 12 (4) ◽  
pp. 395-400 ◽  
Author(s):  
Juan Pablo Simone ◽  
Philipp N. Streubel ◽  
Joaquin Sanchez-Sotelo ◽  
Scott P. Steinmann ◽  
Julie E. Adams
Keyword(s):  
Humeral Head ◽  
Glenohumeral Joint ◽  
External Rotation ◽  
Axillary Nerve ◽  
Shoulder Abduction ◽  
Continuous Variables ◽  
Inferior Aspect ◽  
Fresh Frozen ◽  
The Mean ◽  
Inferior Border

Background: This study investigated whether axillary nerve (AN) distance to the inferior border of the humeral head and inferior glenoid would change while placing the glenohumeral joint in different degrees of external rotation and abduction. Methods: A standard deltopectoral approach was performed on 10 fresh-frozen cadaveric specimens. The distance between AN and the inferior border of the humeral head and inferior glenoid while placing the shoulder in 0°, 45°, and 90° of external rotation or abduction was measured. Continuous variables for changes in AN position were compared with paired 2-tailed Student t test. Results: The mean distance between the AN and the humeral head with the shoulder in 0°, 45°, and 90° of external rotation and 0° of abduction was 13.77 mm (SD 4.31), 13.99 mm (SD 4.12), and 16.28 mm (SD 5.40), respectively. The mean distance between the AN and glenoid with the shoulder in 0°, 45°, and 90° of external rotation was 16.33 mm (SD 3.60), 15.60 mm (SD 4.19), and 16.43 (SD 5.35), respectively. The mean distance between the AN and the humeral head with the shoulder in 0°, 45°, and 90° of abduction and 0° of external rotation was 13.76 mm (SD 4.31), 10.68 mm (SD 4.19), and 3.81 mm (SD 3.08), respectively. The mean distance between the AN and glenoid with the shoulder in 0°, 45°, and 90° of abduction was 16.33 mm (SD 3.60), 17.66 mm (SD 5.80), and 12.44 mm (SD 5.57), respectively. Conclusions: The AN position relative to the inferior aspect of the glenohumeral joint does not significantly change despite position of external rotation. Increasing shoulder abduction over 45° decreases the distance from the glenohumeral joint to the AN and should be avoided.

Flexibility, Position, and Strength of the Shoulder Complex in Pediatric and Adult Amateur Tennis Athletes

2021 ◽  
pp. 1-9
Author(s):  
Germanna M. Barbosa ◽  
Larissa P. Ribeiro ◽  
Ana B. Nasser ◽  
Gretchen D. Oliver ◽  
Paula R. Camargo
Keyword(s):  
At Risk ◽  
Outcome Measures ◽  
External Rotation ◽  
Posterior Capsule ◽  
Serratus Anterior ◽  
Cross Sectional ◽  
Shoulder Range Of Motion ◽  
Cutoff Values ◽  
Shoulder Complex ◽  
Dominant Side

Context: Understanding the musculoskeletal adaptations in the shoulder complex of varying ages of tennis athletes may suggest preventive protocols and conditioning and rehabilitation programs to this population. This study aimed to generate a bilateral descriptive profile of shoulder flexibility, scapular and clavicular position, and muscle strength in pediatric and adult amateur tennis athletes. The outcome measures were compared between groups and sides. The number and percentage of athletes “at risk” according to cutoff values for shoulder range of motion (ROM) were also analyzed. Design: Cross-sectional study. Methods: 36 pediatric and 28 adult amateur tennis athletes were tested. Outcome measures were ROM of shoulder flexion, abduction, internal and external rotation, posterior capsule tightness, pectoralis minor index (PMI), scapular upward rotation, clavicular elevation, and strength of the external rotators, serratus anterior, and lower trapezius of the dominant/nondominant sides. Results: Pediatric athletes had greater dominant side external rotation (P = .01) and total ROM (P = .04), increased Low Flexion test (P = .01), and decreased PMI (P = .01) compared with the adults. Bilaterally, the pediatric athletes had greater dominant side external rotation ROM (P < .01) and decreased PMI (P = .002) as compared with their nondominant side, whereas the adults displayed lower values on posterior capsule tightness (P = .01) and decreased PMI (P = .02) on their dominant side compared with their nondominant side. For the remaining outcomes, no interaction effects were observed. The cutoff values for shoulder ROM showed that several athletes were “at risk” of shoulder problems. Conclusion: Upper extremity adaptations at the shoulder are present in both pediatric and adult tennis athletes. These data can assist clinicians in better understanding the biomechanical adaptations in the shoulder of amateur tennis athletes in different age groups.

scholarly journals Anatomy and Biomechanic of the Shoulder

2019 ◽  
Vol 7 (11_suppl6) ◽  
pp. 2325967119S0046
Author(s):  
Troydimas Panjaitan
Keyword(s):  
Rotator Cuff ◽  
Humeral Head ◽  
Glenohumeral Joint ◽  
External Rotation ◽  
Central Component ◽  
Subscapularis Tendon ◽  
Glenoid Fossa ◽  
Greater Tuberosity ◽  
Glenohumeral Ligaments ◽  
Shoulder Complex

The shoulder is one of the most complex joints of the human body. Consequently, they are susceptible to injury and degeneration. Mechanical shoulder pathology typically results when overuse, extremes of motion, or excessive forces overwhelm intrinsic material properties of the shoulder complex resulting in tears of the rotator cuff, capsule, and labrum. The fundamental central component of the shoulder complex is the glenohumeral joint. It has a ball-and-socket configuration with a surface area ratio of the humeral head to glenoid fossa of about 3:1 with an appearance similar to a golf ball on a tee. Overall, there is minimal bony covering and limited contact areas that allow extensive translational and rotational ability in all three planes. The glenohumeral joint has 2 groups of stabilizers, which are static (passive) and dynamic (active) restrains. Static stabilizers include the concavity of the glenoid fossa, glenoid fossa retroversion and superior angulation, glenoid labrum, the joint capsule, and glenohumeral ligaments, and a vacuum effect from negative intra-articular pressure. Dynamic stabilization is merely the coordinated contraction of the rotator cuff muscles that create forces that compress the articular surfaces of the humeral head into the concave surface of the glenoid fossa. During upper extremity movement, the effects of static stabilizers are minimized and dynamic or active stabilizers become the dominant forces responsible for glenohumeral stability The simple act of arm elevation is a complex task that occurs via the combination of glenohumeral and scapulothoracic motion, together known as scapulohumeral rhythm. In the first 1200, glenohumeral arm abduction, the supraspinatus and deltoid work together and create a force couple that promotes stability, while raising the arm (deltoid contraction). In addition, the humerus must undergo 450 external rotation to not only clear the greater tuberosity posteriorly but also loosen the inferior glenohumeral ligament (IGHL) to allow maximum elevation. There are several anatomical updates regarding the rotator cuff and capsular footprint. The footprint of the supraspinatus on the greater tuberosity is much smaller than previously believed, and this area of the greater tuberosity is actually occupied by a substantial amount of the infraspinatus. The superior-most insertion of the subscapularis tendon extends a thin tendinous slip, which attaches to the fovea capitis of the humerus. The teres minor muscle inserts to the lowest impression of the greater tuberosity of the humerus and additionally inserts to the posterior side of the surgical neck of the humerus.

scholarly journals Changes in Abduction and Rotation Range of Motion in Response to Simulated Dorsal and Ventral Translational Mobilization of the Glenohumeral Joint

2002 ◽  
Vol 82 (6) ◽  
pp. 544-556 ◽  
Author(s):  
Ar-Tyan Hsu ◽  
Tom Hedman ◽  
Jia Hao Chang ◽  
Chuong Vo ◽  
Larry Ho ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Glenohumeral Joint ◽  
Physical Therapists ◽  
Frozen Shoulder ◽  
Testing System ◽  
Before And After ◽  
Medial Rotation ◽  
Fresh Frozen ◽  
Lateral Rotation ◽  
Improved Function

AbstractBackground and Purpose. Translational mobilization techniques are frequently used by physical therapists as an intervention for patients with limited ranges of motion (ROMs). However, concrete experimental support for such practice is lacking. The purpose of the study was to evaluate the effect of simulated dorsal and ventral translational mobilization (DTM and VTM) of the glenohumeral joint on abduction and rotational ROMs. Methods. Fourteen fresh frozen shoulder specimens from 5 men and 3 women (mean age=77.3 years, SD=10.1, range=62–91) were used for this study. Each specimen underwent 5 repetitions of DTM and VTM in the plane of scapula simulated by a material testing system (MTS) in the resting position (40° of abduction in neutral rotation) and at the end range of abduction with 100 N of force. Abduction and rotation were assessed as the main outcome measures before and after each mobilization procedure performed and monitored by the MTS (abduction, 4 N·m) and by a servomotor attached to the piston of the actuator of the MTS (medial and lateral rotation, 2 N·m). Results. There were increases in abduction ROM for both DTM (X̄=2.10°, SD=1.76°) and VTM (X̄=2.06°, SD=1.96°) at the end-range position. No changes were found in the resting position following the same procedure. Small increases were also found in lateral rotation ROM after VTM in the resting position (X̄=0.90°, SD=0.92°, t=3.65, P=.003) and in medial rotation ROM after DTM (X̄=0.97°, SD=1.45°, t=2.51, P=.026) at the end range of abduction. Discussion and Conclusion. The results indicate that both DTM and VTM procedures applied at the end range of abduction improved glenohumeral abduction range of motion. Whether these changes would result in improved function could not be determined because of the use of a cadaver model.

scholarly journals Four-Dimensional Computed Tomography Evaluation of Shoulder Joint Motion in Collegiate Baseball Pitchers

2021 ◽  
Author(s):  
Daisuke Momma ◽  
Alejandro A Espinoza Orías ◽  
Tohru Irie ◽  
Tomoyo Irie ◽  
Eiji Kondo ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Internal Rotation ◽  
Contact Area ◽  
Humeral Head ◽  
Glenohumeral Joint ◽  
External Rotation ◽  
Ct Scanning ◽  
4D Ct ◽  
Collegiate Baseball ◽  
Baseball Pitchers

Abstract The purpose of this study is to evaluate the glenohumeral contact area, center of glenohumeral contact area, and center of humeral head during simulated pitching motion in collegiate baseball pitchers using four-dimensional computed tomography (4D CT). We obtained 4D CT data from the dominant and non-dominant shoulders of eight collegiate baseball pitchers during the cocking motion. CT image data of each joint were reconstructed using a 3D reconstruction software package. The glenohumeral contact area, center of glenohumeral contact area, center of humeral head, and oblateness of humeral head were calculated from 3D bone models using customized software. The center of glenohumeral contact area translated significantly from anterior to posterior during maximum external rotation to maximum internal rotation. The center of humeral head translated from posterior to anterior during maximum external rotation to maximum internal rotation. There was a high negative correlation between anterior translation of the center of glenohumeral contact area and center of humeral head, and a positive correlation between the translation and the oblateness. 4D CT analyses demonstrated that the center of humeral head translated in the opposite direction to that of the center of glenohumeral contact area during external rotation to internal rotation in abduction in the dominant and non-dominant shoulders. This diametric translation can be explained by the oblateness of the humeral head. 4D CT scanning and the software for bone surface modeling of the glenohumeral joint enabled quantitative assessment of glenohumeral micromotion and identified humeral head oblateness as the cause of diametric change.

Stretching Positions for the Posterior Capsule of the Glenohumeral Joint

2008 ◽  
Vol 36 (10) ◽  
pp. 2014-2022 ◽  
Author(s):  
Tomoki Izumi ◽  
Mitsuhiro Aoki ◽  
Takayuki Muraki ◽  
Egi Hidaka ◽  
Shigenori Miyamoto
Keyword(s):  
Internal Rotation ◽  
Glenohumeral Joint ◽  
Cadaver Study ◽  
Posterior Capsule ◽  
Large Strains ◽  
Reference Length ◽  
Posterior Shoulder ◽  
Fresh Frozen ◽  
Extension Strain ◽  
Scapular Plane

Background Various stretches have been introduced for the posterior shoulder; however, little quantitative analysis to measure stretching of the posterior capsule has been performed. Hypothesis The current shoulder stretching program is not sufficient to stretch the entire posterior capsule. Study Design Controlled laboratory study. Methods Using 8 fresh-frozen cadaver shoulders (average age, 82.4 years), 8 stretching positions for the posterior capsule were simulated by passive internal rotation. Stretching positions of 0°, 30°, 60°, and 90° of elevation in the scapular plane; 60° of flexion; 60° of abduction; 30° of extension; and 60° of flexion and horizontal adduction were adopted. Strain was measured in the upper, middle, and lower parts of the capsule. The measurement of strain was instituted from reference length. Results With internal rotation, mean strain on the upper capsule was 3.02% at 0° of elevation and 3.35% at 30° of extension. Strain on the middle capsule at 0° and 30° elevation was 0.78% and 4.77%, respectively; on the lower capsule, it was 5.65% and 2.24% at 30° and 60° of elevation, respectively, and 2.88% at 30° of extension. Increase in strains of the upper, middle, and lower capsule with internal rotation at 0°, 30°, and 60° of elevation were statistically significant, respectively ( P < .01). Other shoulder positions demonstrated no positive strain values. Conclusions Based on the results of this cadaver study, large strains on the posterior capsule of the shoulder were obtained at a stretching position of 30° of elevation in the scapular plane with internal rotation for the middle and lower capsule, while a stretching position of 30° of extension with internal rotation was effective for the upper and lower capsule. Clinical Relevance The current posterior capsule stretching program of the shoulder was not sufficient to stretch the entire posterior capsule.

scholarly journals Posterior Glenohumeral Joint Capsule Contracture

2012 ◽  
Vol 4 (4) ◽  
pp. 230-236 ◽  
Author(s):  
Amitabh Dashottar ◽  
John Borstad
Keyword(s):  
Range Of Motion ◽  
Internal Rotation ◽  
Humeral Head ◽  
Glenohumeral Joint ◽  
Tensile Force ◽  
Joint Capsule ◽  
Posterior Capsule ◽  
Joint Mechanics ◽  
Cellular Processes ◽  
Standard Techniques

Glenohumeral joint posterior capsule contracture may cause shoulder pain by altering normal joint mechanics. Contracture is commonly noted in throwing athletes but can also be present in nonthrowers. The cause of contracture in throwing athletes is assumed to be a response to the high amount of repetitive tensile force placed on the tissue, whereas the mechanism of contracture in nonthrowers is unknown. It is likely that mechanical and cellular processes interact to increase the stiffness and decrease the compliance of the capsule, although the exact processes that cause a contracture have not been confirmed. Cadaver models have been used to study the effect of posterior capsule contracture on joint mechanics and demonstrate alterations in range of motion and in humeral head kinematics. Imaging has been used to assess posterior capsule contracture, although standard techniques and quantification methods are lacking. Clinically, contracture manifests as a reduction in glenohumeral internal rotation and/or cross body adduction range of motion. Stretching and manual techniques are used to improve range of motion and often decrease symptoms in painful shoulders.

Shoulder hydrodilatation for primary, post-traumatic and post-operative adhesive capsulitis

2020 ◽  
pp. 175857322097717
Author(s):  
Daoud Makki ◽  
Mustafa Al-Yaseen ◽  
Fayaz Almari ◽  
Puneet Monga ◽  
Lennard Funk ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Outcome Measures ◽  
Glenohumeral Joint ◽  
External Rotation ◽  
Adhesive Capsulitis ◽  
Frozen Shoulder ◽  
Capsular Release ◽  
Arthroscopic Capsular Release ◽  
Number Of Patients ◽  
Post Traumatic

Background Adhesive capsulitis (frozen shoulder) is characterised by pain and loss of range of motion of the glenohumeral joint. It can be present as primary (idiopathic) or secondary to surgery, trauma or other conditions that restrict the use of the shoulder joint. Various treatment options have been adopted including physiotherapy, manipulation under anaesthetic, hydrodilatation and arthroscopic or open capsular release but the optimal form of management remains uncertain. Objectives The purpose of the study was to assess the clinical outcome of glenohumeral hydrodilatation in three cohorts of patients with different aetiologies with adhesive capsulitis. Study design & methods We carried out a retrospective study of patient who underwent hydrodilatation for adhesive capsulitis between 2013 and 2015. The procedure was performed by a specialist musculoskeletal radiologist under radiological guidance. The injection consisted of steroids, local anaesthetics and NaCl solution with a target volume around 35 mL. Our outcome measures were range of motion, and pre- and post-operative pain. Patients were divided into three groups based on the presumed cause of their stiffness: idiopathic, post-traumatic and post-surgical. Results Two hundred fifty patients were included, with a mean age of 59 years (range: 20–79). Of these, 180 had idiopathic primary adhesive capsulitis (27 were diabetic), 23 were post-traumatic, and 20 following surgical procedures. Thirty-four required further intervention following initial hydrodilatation with 8 undergoing repeat hydrodilatation, and 26 requiring arthroscopic capsular release. The diabetic group accounted for 16 capsular releases and 4 repeat procedures, while the idiopathic group accounted for 9 and 4, respectively. One patient required capsular release in the surgical group. An improvement was recorded in ROM in all groups with mean abduction improving from 59° to 110°, flexion from 50° to 120° and external rotation from 20° to 50°. With regards to pain, the majority showed an improvement from severe or moderate pain to no or mild pain. Conclusions Results show that hydrodilatation resulted in an improvement in all outcome measures, with only a small number of patients, especially those with diabetes, needing further procedures or showing no improvement in range of motion and pain. There was no difference between the post-traumatic and post-surgical groups.

Remplissage Repair—New Frontiers in the Prevention of Recurrent Shoulder Instability

2012 ◽  
Vol 40 (11) ◽  
pp. 2462-2469 ◽  
Author(s):  
Francesco Franceschi ◽  
Rocco Papalia ◽  
Giacomo Rizzello ◽  
Edoardo Franceschetti ◽  
Angelo Del Buono ◽  
...  
Keyword(s):  
Humeral Head ◽  
External Rotation ◽  
Postoperative Recurrence ◽  
The Body ◽  
Bankart Repair ◽  
Recurrence Rates ◽  
Level Of Evidence ◽  
Before And After ◽  
The Status ◽  
Bankart Lesions

Background: An engaging Hill-Sachs lesion is a defect of the humeral head, large enough to cause locking of the humeral head against the anterior corner of the glenoid rim when the arm is at 90° of abduction and more than 30° of external rotation. Hypothesis: When Bankart lesions are associated with engaging Hill-Sachs defects, simultaneous Bankart repair and remplissage provide lower recurrence rates than does Bankart repair alone. Study Design: Cohort study; Level of evidence, 3. Methods: Fifty patients (36 men, 14 women) with combined engaging Hill-Sachs and Bankart lesions were evaluated, before and after arthroscopic management, at a minimum follow-up of 2 years. After imaging and arthroscopic assessment, 25 patients underwent remplissage and Bankart repair, and 25 patients received Bankart repair alone. Patients were evaluated using the UCLA, Constant, and Rowe scores, and range of motion was measured using a goniometer. Postoperatively, all patients underwent magnetic resonance imaging to assess the status of healing of the anterior labrum and whether the tenodesis of the infraspinatus covered the Hill-Sachs defect. Results: At the last appointment, active forward elevation, external rotation beside the body, internal rotation, and all administered scores were significantly improved compared with baseline assessment, with no statistically significant intergroup differences. A new posttraumatic dislocation occurred in 5 patients, all from the Bankart-only group (20%). Conclusion: Remplissage is a safe, relatively short procedure that allows the surgeon to address large humeral defects with a low postoperative recurrence rate. Humeral head large defects predispose to recurrent instability of the shoulder and deserve surgical management.

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