Glenohumeral (shoulder) Joint

By: Cameron, Debbie, Laura and Wendy

Humerus

Greater tubercle

Lesser Tubercle

Intertubercular Sulcus

Head

Anatomical Neck

Surgical Neck

Detloid tuberosity

AnteriorScapula

Acromion processCoracoid processBorders:

SuperiorVertebralAxillary

Angles:SuperiorInferior

Fossae:

SubscapularGlenoid cavity

Coracoid process

Acromionprocess

Superiorborder

Superiorangle

Inferiorangle

Glenoidcavity

Axillary border

Vertebralborder

Subscapularfossa

Posterior Scapula

Fossae:

Infraspinatous

SupraspinatousSpineGlenoid cavityAngles:

SuperiorInferior

Borders:SuperiorVertebralAxillary

Acromion process

Supraspinatousfossa

Infraspinatousfossa

spine

Glenoid cavity

Superiorangle

Inferior angle

Vertebral border

Superiorborder

Acromionprocess

Axillaryborder

Clavicle

Acromial End

Conoid Tubercle

Cartilage

Articular Cartilage Glenoid Labruim

Ligaments

•Coracohumeral•Glenohumeral•Transverse

humeral•Coracoclavicular•Conoid•Superior

transverse

scapular•Acromioclavicular Glenohumer

alligament

Bursae

Subscapular , Subacromial Subdeltoid, Subcoracoid

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.

Articular Capsule

Synovial Membrane Fibrous Layer

Red = origin Blue = insertion

Red = origin Blue = insertion

Innervation

Innervation and Vascular Supply

Vascular supply and Innervation

Vascular Supply

Anterior Surface Anatomy

Posterior Surface Anatomy

Torn Rotator Cuff

Physical Therapy Protocol

Ruptured Supraspinatus Tendon

The Muscles of the Rotator Cuff

S. I. T. S.

Suprasinatous

Infraspinatous

Teres Minor

Subscapularis

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

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.

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.

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.

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.

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!!!

6 Months(M.D. Visit)

ROM Other Activities

Hard resistive exercises, aggressive stretching.

Swimming, weightlifting, throwing progression.

Exercise Program