glenohumeral (shoulder) joint by: cameron, debbie, laura and wendy
TRANSCRIPT
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Glenohumeral (shoulder) Joint
By: Cameron, Debbie, Laura and Wendy
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Humerus
Greater tubercle
Lesser Tubercle
Intertubercular Sulcus
Head
Anatomical Neck
Surgical Neck
Detloid tuberosity
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AnteriorScapula
Acromion processCoracoid processBorders:
SuperiorVertebralAxillary
Angles:SuperiorInferior
Fossae:
SubscapularGlenoid cavity
Coracoid process
Acromionprocess
Superiorborder
Superiorangle
Inferiorangle
Glenoidcavity
Axillary border
Vertebralborder
Subscapularfossa
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Posterior Scapula
Fossae:
Infraspinatous
SupraspinatousSpineGlenoid cavityAngles:
SuperiorInferior
Borders:SuperiorVertebralAxillary
Acromion process
Supraspinatousfossa
Infraspinatousfossa
spine
Glenoid cavity
Superiorangle
Inferior angle
Vertebral border
Superiorborder
Acromionprocess
Axillaryborder
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Clavicle
Acromial End
Conoid Tubercle
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Cartilage
Articular Cartilage Glenoid Labruim
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Ligaments
•Coracohumeral•Glenohumeral•Transverse
humeral•Coracoclavicular•Conoid•Superior
transverse
scapular•Acromioclavicular Glenohumer
alligament
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Bursae
Subscapular , Subacromial Subdeltoid, Subcoracoid
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Articular CapsuleArticular 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.
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Articular Capsule
Synovial Membrane Fibrous Layer
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Red = origin Blue = insertion
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Red = origin Blue = insertion
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Innervation
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Innervation and Vascular Supply
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Vascular supply and Innervation
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Vascular Supply
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Anterior Surface Anatomy
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Posterior Surface Anatomy
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Torn Rotator Cuff
Physical Therapy Protocol
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Ruptured Supraspinatus Tendon
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The Muscles of the Rotator Cuff
S. I. T. S.
Suprasinatous
Infraspinatous
Teres Minor
Subscapularis
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Rotator Cuff Repair Rehab ProtocolGeneral 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
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0-2 Weeks Post-Op
Protection, Dressing, PROMAROM, 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.
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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.
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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.
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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.
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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!!!
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6 Months(M.D. Visit)
ROM Other Activities
Hard resistive exercises, aggressive stretching.
Swimming, weightlifting, throwing progression.
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Exercise Program
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