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Glenohumeral (shoulder) Joint

Glenohumeral (shoulder) Joint. By: Cameron, Debbie, Laura and Wendy. Humerus. Greater tubercle Lesser Tubercle Intertubercular Sulcus Head Anatomical Neck Surgical Neck Detloid tuberosity. Anterior Scapula. Acromion process. Superior angle. Coracoid process.

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Glenohumeral (shoulder) Joint

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  1. Glenohumeral (shoulder) Joint By: Cameron, Debbie, Laura and Wendy

  2. Humerus Greater tubercle Lesser Tubercle Intertubercular Sulcus Head Anatomical Neck Surgical Neck Detloid tuberosity

  3. AnteriorScapula Acromion process Superior angle Coracoid process Acromion process Coracoid process Borders: Superior Vertebral Axillary Angles: Superior Inferior Fossae: Subscapular Glenoid cavity Glenoid cavity Superior border Subscapular fossa Axillary border Vertebral border Inferior angle

  4. Posterior Scapula Acromion process Superior angle Superior border Fossae: Infraspinatous Supraspinatous Spine Glenoid cavity Angles: Superior Inferior Borders: Superior Vertebral Axillary Acromion process Supraspinatous fossa Glenoid cavity Axillary border spine Infraspinatous fossa Vertebral border Inferior angle

  5. Clavicle Acromial End Conoid Tubercle

  6. Cartilage Articular Cartilage Glenoid Labruim

  7. Ligaments Coracohumeral Glenohumeral Transverse humeral Coracoclavicular Conoid Superior transverse scapular Acromioclavicular Glenohumeral ligament

  8. Bursae Subscapular , Subacromial Subdeltoid, Subcoracoid

  9. Articular Capsule Articular Cavity is filled with Synovial fluid, which is secreted by the synovial membrane. Synovial membrane is the inner layer, Fibrous layer is the outer layer. Bursae also have synovial fluid inside them.

  10. Articular Capsule Synovial Membrane Fibrous Layer

  11. Red = origin Blue = insertion

  12. Red = origin Blue = insertion

  13. Innervation

  14. Innervation and Vascular Supply

  15. Vascular supply and Innervation

  16. Vascular Supply

  17. Anterior Surface Anatomy

  18. Posterior Surface Anatomy

  19. Physical Therapy Protocol Torn Rotator Cuff

  20. Ruptured Supraspinatus Tendon

  21. The Muscles of the Rotator Cuff S. I. T. S. Suprasinatous Infraspinatous Teres Minor Subscapularis

  22. Rotator Cuff Repair Rehab Protocol General Considerations: • Quality of tissue and integrity of repair • Acute vs. chronic tear • Chronic repairs typically harder to achieve ROM • Extent of repair • Early PROM of glenohumeral joint is important to prevent capsular adhesions and fibrosis. This is done in a range that SHORTENS involved mm • PT will start immediately following surgery, focus on ROM

  23. 0-2 Weeks Post-Op Protection, Dressing, PROM AROM, Pain control, Other Activities • Keep shoulder in a sling unless showering or during exercise. • Okay to shower after 2 days. • Stitches removed 8-10 days. • PROM=flexion, pendulums, pulleys. • Biceps curls, putty grip, neck stretches as tolerated. • STM, modalities for pain control. • Walking, bike.

  24. 2-4 Weeks Post-Op Protection, PROM, AROM Isometrics, Other Activities • Still in sling unless showering, meals, or exercise. • PROM for repaired tendons, only in direction that SHORTENS tendon. • AROM for Uninvolved tendons. AVOID STRESSING REPAIRED TENDONS!! • ISO. For Uninvolved tendons as tolerated. • LE conditioning, aquatic therapy.

  25. 4-8 Weeks Post-Op Protection, PROM, Mobs AROM, Other Activities • No sling needed. • GENTLE PROM into previously protected ranges. • Most plane motions should be 75% of normal. • Make sure and check glenohumeral joint for excessive loss of mobility. • Grade 1-2 w/o restrictions. • Pure ABD. and ER. • Slowly introduce against gravity ROM exercises into extension.

  26. 8-12 Weeks Post-Op PROM, Mobs, AROM, Other Activities • Cont. w/ Passive stretching to pain tolerance. • Grade 1-4 mobs. As tolerated. • Progress to high repetitions and then increase resistance. • MONITOR SHOULDER AND POSTURAL MECHANICS AS WELL AS PAIN WITH ALL EXERCISES. • Jogging, UBE for ROM.

  27. 3-6 Months Post-Op ROM Other Activities • If ROM is still limited, focus on achieving full ROM. • If ROM is not limited, focus on strengthing. • Motion in most planes should be almost normal. • More aggressive stretching and resistive exercises. • Rowing, UBE for strengthening, weightlifting with extreme caution NOT to stress repair!!!

  28. 6 Months(M.D. Visit) ROM Other Activities • Hard resistive exercises, aggressive stretching. • Swimming, weightlifting, throwing progression.

  29. Exercise Program

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