Introduction

Within the shoulder complex there are 3 joints which synergistically work together to allow for movement which is needed for sporting and generic needs. The joint in the shoulder were exploring today is the Gleno-humeral joint. The Gleno-humeral joint is a ball and socket joint which allows for a large range of motion. In general, we use this joint everyday but underestimate its complexity and ability to produce the movement in which we need.

Anatomy of the Gleno-humeral joint

The topographics of the gleno-humeral joint (GHJ) are: a humeral head, a fibrocartaliginous glenoid labrum (GL), glenoid cavity, ligaments and bursa’s. Overall, the fibrocartiliginous presence overlaying the glenoid rim adds joint stability to the GHJ due to an increase in the concavity-compression mechanism caused by the GL; therefore, causing a decrease in humeral head translation.

Amongst 10% of the patient population there have been three reported anatomical differentiations within the GHJ. Firstly, there are reports of a cord like middle gleno-humeral ligament with a nonexistent presence of anterior-superior labral tissue; this is commonly known as the Buford complex. Incidences of the Buford complex is said to be 2.5% within the military population.

Secondly, variations are sometimes seen with the size of the sub-labrum foreman and thirdly a variety of sub-labral recesses sizes. On the whole the Gleno-humeral joint is a complex joint which has a variety of rare anatomical differences between different people of the population. Therefore, treatments and rehabilitation strategies are always changing.

The MAIN movements of the Gleno-humeral joint

Flexion Extension Medial rotation Lateral rotation Abduction Adduction Horizontal flexion Horizontal abduction

Possible injuries to the joint

The shoulder is an extremely mobile joint which allows for a large range of motion. However, with a large range of motion comes the increase in likely hood of ascertaining an injury.

Commonly injuries to the shoulder occur in individuals who carry out daily overhead exercises on a regular basis (labourer). Moreover, in a sporting context damage to the shoulder joint commonly occurs from traumatic injuries to the area.

In general, there are several types of injury which can occur at this specific joint:

Bankart Lesion SLAP Lesion Bicep tendinopathy Rotator Cuff Tendinopathy Multidirectional instability (caused by either or both ligament laxity and rotator cuff hypoplasia. Bursitis of one of the four bursa’s known within the typical population. (Above is only a few injuries which may happen to the gleno-humeral joint)

On the whole, the shoulder joint is a compact joint; however, it is highly susceptible to injuries due the mobility of the joint itself.

References

References Abrams, G.D. & Safran, M.R. (2010) Diagnosis and management of superior labrum anterior posterior lesions in overhead athletes. British Journal of Sports Medicine. 44 (5), 311-319. Arai, R., Kobayashi, M., Toda, Y., Nakamura, S., Miura, T. & Nakamura, T. (2012) Fiber components of the shoulder superior labrum. Surgical & Radiologic Anatomy. 34 (1), 49-56. Kanatli, U., Ozturk, B.Y. & Bolukbasi, S. (2010) Anatomical variations of the anterosuperior labrum: prevalence and association with type II superior labrum anterior-posterior (SLAP) lesions. Journal Of Shoulder And Elbow Surgery. 19 (8), 1199-1203. Kibler, W.B., Sciascia, A.D., Hester, P., Dome, D. & Jacobs, C. (2009) Clinical Utility of Traditional and New Tests in the Diagnosis of Biceps Tendon Injuries and Superior Labrum Anterior and Posterior Lesions in the Shoulder. American Journal of Sports Medicine. 37 (9), 1840-1848. Knesek, M., Skendzel, J.G., Dines, J.S., Altchek, D.W., Allen, A.A. & Bedi, A. (2013) Diagnosis and Management of Superior Labral Anterior Posterior Tears in Throwing Athletes. American Journal of Sports Medicine. [Online] 41 (2), 444-461. Available from: SPORTDiscus with Full Text [Accessed 5 March 2014]. Meserve, B.B., Cleland, J.A. & Boucher, T.R. (2009) A Meta-analysis Examining Clinical Test Utility for Assessing Superior Labral Anterior Posterior Lesions. A Meta-analysis Examining Clinical Test Utility for Assessing Superior Labral Anterior Posterior Lesions. 37 (11), 2252-2259. Ockert, B., Braunstein, V., Sprecher, C., Shinohara, Y. & Milz, S. (2012) Fibrocartilage in various regions of the human glenoid labrum. An immunohistochemical study on human cadavers. Knee Surgery, Sports Traumatology, Arthroscopy. 20 (6), 1036-1041. Powell, S.E., Nord, K.D. & Ryu, R.K.N. (2012) The Diagnosis, Classification, and Treatment of SLAP Lesions. Operative Techniques in Sports Medicine. 20 (1), 46-56. Schuenke, M., Schulte, E., Schumacher, U., Ross, L.M., Lamperti, E.D., Voll, M. & Wesker, K. (2010) Atlas of Anatomy: General Anatomy and Musculoskeletal System. New York: Thieme. 225-235.

Written by Jake Shaw

I am a Sports Therapist who graduated from the University of Worcester. Whilst in my first year I was given the opportunity to work with a Paralympian GB athlete on a sports therapy basis.

Furthermore, during my time at university I was given the chance to study within the United States of America. Within the USA I was selected to assist with the clinical support of the american football, volleyball, hockey and gymnastics teams.

When coming to the end of my term abroad I was put on the Deans list and was offered a scholarship. Upon return from the USA I was placed with the Malvern Rugby Club medical team to assist in injury assessment and rehabilitation production.

Moreover, I was also fortunate to work with the U16's male & U13's female Worcester City football teams on an individual basis for a functional movement screening. Once graduating I started working with Belper Rugby Club and Mickleover Sports FC as the head Sports Therapist.

The vast exposure to multiple traumatic and chronic injuries has meant that I have a large portfolio of experience in treating a variety of injuries.