Dynamic capsuloligamentous anatomy of the glenohumeral joint

Warner, Jon J.P.; Caborn, David N.M.; Berger, Richard; Fu, Freddie H.; Seel, Michael J.

doi:10.1016/s1058-2746(09)80048-7

Cited by 102 publications

(54 citation statements)

References 27 publications

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“…A second sensor was fixed to the humerus, distal to the humeral head. A pulley system and weights were used to apply 13.4 N to each rotator cuff tendon to simulate rotator cuff muscle tension as might be experienced in vivo during a clinical exam [7,17,41].…”

Section: Methodsmentioning

confidence: 99%

Multidirectional kinematics of the glenohumeral joint during simulated simple translation tests: Impact on clinical diagnoses

Moore

Musahl

McMahon

et al. 2004

Journal Orthopaedic Research

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At the end ranges of motion, the glenohumeral capsule limits translation of the humeral head in multiple directions. Since the 6-degree of freedom kinematics of clinical tests are commonly utilized to diagnose shoulder injuries, the objective of this study was to determine the magnitude and repeatability of glenohumeral joint kinematics during a simulated simple anteroposterior translation test in the anterior and posterior directions. A magnetic tracking system was used to determine the kinematics of the humerus with respect to the scapula in eight cadaveric shoulders. At 60" of glenohumeral abduction and 0" of flexionkxtension, a clinician applied anterior and posterior loads to the humerus at O", 30", and 60" of external rotation until a manual maximum (simulating a simple translation test) was achieved. Prior to each test, the reference position of the humerus shifted posteriorly 1.8 k 2.0 and 4.1 ? 3.8 mm at 30" and 60" of external rotation, respectively. Anterior translation decreased significantly (p < 0 05) from 18.2 t 5.3 mm at 0" of external rotation to 15.5 f 5.1 and 9.9k 5.5 mm at 30" and 60", respectively. However, no significant differences were detected between the posterior translations of 13.4f6.4, 17.1 2 5.0, and 15.8 k6.0 mm at O", 30", and 60" of external rotation, respectively.Coupled translations (perpendicular to the direction of loading) at 0" (6.1 k 4.0 and 3.8 ? 2.9 mm), 30" (4.7 t 2.7 and 5.9 k 3.1 mm), and 60" (2.3 2 2.3 and 5.0 k 3.5 mm) of external rotation were in the inferior direction in both the anterior and posterior directions, respectively. Based on the data obtained, performing a simulated simple translation test should result in coupled inferior translations and anterior translations that are a function of external rotation. The low standard deviations demonstrate that the observed translations should be repeatable. Furthermore, capsular stretching or injury to the anterior-inferior region of the capsule should be detectable during clinical examination if excessive coupled translations exist or no posterior shift of the reference position with external rotation is noted.

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Section: Methodsmentioning

confidence: 99%

Multidirectional kinematics of the glenohumeral joint during simulated simple translation tests: Impact on clinical diagnoses

Moore

Musahl

McMahon

et al. 2004

Journal Orthopaedic Research

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show abstract

“…Coined by Lippett and coworkers, this term refers to the component of the joint reaction force that acts perpendicular to the glenoid fossa [28], compressing the humeral head. Concavity-compression was previously reported as being important in maintaining anterior joint stability at the mid-range of shoulder motion when the static restraints are lax [28,45]. This study indicated concavity-compression was also quite important at an end-range of motion, the apprehension position.…”

Section: Discussionmentioning

confidence: 51%

A novel cadaveric model for anterior-inferior shoulder dislocation using forcible apprehension positioning

McMahon

Chow²,

Sciaroni³

et al. 2003

JRRD

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Abstract-A novel cadaveric model for anterior-inferior shoulder dislocation using forcible apprehension positioning is presented. This model simulates an in vivo mechanism and yields capsulolabral lesions. The scapulae of 14 cadaveric entire upper limbs (82 ± 9 years, mean ± standard deviation) were each rigidly fixed to a custom shoulder-testing device. A pneumatic system was used with pulleys and cables to simulate the rotator cuff and the deltoid muscles (anterior and middle portions). The glenohumeral joint was then positioned in the apprehension position of abduction, external rotation, and horizontal abduction. A 6-degree-of-freedom load cell (Assurance Technologies, Garner, North Carolina) measured the joint reaction force that was then resolved into three orthogonal components of compression force, anteriorly directed force, and superiorly directed force. With the use of a thrust bearing, the humerus was moved along a rail with a servomotor-controlled system at 50 mm/s that resulted in horizontal abduction. Force that developed passively in the pectoralis major muscle was recorded with an independent uniaxial load cell. Each of the glenohumeral joints dislocated anterior-inferior, six with avulsion of the capsulolabrum from the anterior-inferior glenoid bone and eight with capsulolabral stretching. Pectoralis major muscle force as well as the joint reaction force increased with horizontal abduction until dislocation. At dislocation, the magnitude of the pectoralis major muscle force, 609.6 N ± 65.2 N was similar to the compression force, 569.6 N ± 37.8 N. A cadaveric model yielded an anterior dislocation with a mechanism of forcible apprehension positioning when the appropriate shoulder muscles were simulated and a passive pectoralis major muscle was included. Capsulolabral lesions resulted, similar to those observed in vivo.

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“…2,7 Of equal importance is the intimate relationship between the RTC tendons and the capsuloligamentous tissues of the glenohumeral joint in which activation of the RTC results in tensioning of the capsuloligamentous structures, further enhancing dynamic stability. 8,9 Working hand-in-hand, stimulation of the neuromuscular system located within the capsuloligamentous tissue can infl uence the activation of the RTC musculature and similarly enhance dynamic stability. The RTC has been shown to be the primary stabilizer of the glenohumeral joint through mid-ROM and assists the static structures with stability at end-ranges of motion.…”

Section: Neuromuscular Control System Of the Shoulder Joint Complexmentioning

confidence: 99%

Neuromuscular Static and Dynamic Stability of the Shoulder: The Key to Functional Performance

Davies¹,

Krauscher²,

Brinks³

1996

Postsurgical Orthopedic Sports Rehabilitation

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Dynamic capsuloligamentous anatomy of the glenohumeral joint

Cited by 102 publications

References 27 publications

Multidirectional kinematics of the glenohumeral joint during simulated simple translation tests: Impact on clinical diagnoses

Multidirectional kinematics of the glenohumeral joint during simulated simple translation tests: Impact on clinical diagnoses

A novel cadaveric model for anterior-inferior shoulder dislocation using forcible apprehension positioning

Neuromuscular Static and Dynamic Stability of the Shoulder: The Key to Functional Performance

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