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Review
. 2020 Sep 10;5(8):508-518.
doi: 10.1302/2058-5241.5.200006. eCollection 2020 Aug.

Shoulder biomechanics in normal and selected pathological conditions

Patrick Goetti  1 , Patrick J Denard  2 , Philippe Collin  3 , Mohamed Ibrahim  4 , Pierre Hoffmeyer  5 , Alexandre Lädermann  6   7   8
Affiliations
Review

Shoulder biomechanics in normal and selected pathological conditions

Patrick Goetti et al. EFORT Open Rev. .

Abstract

The stability of the glenohumeral joint depends on soft tissue stabilizers, bone morphology and dynamic stabilizers such as the rotator cuff and long head of the biceps tendon. Shoulder stabilization techniques include anatomic procedures such as repair of the labrum or restoration of bone loss, but also non-anatomic options such as remplissage or tendon transfers.Rotator cuff repair should restore the cuff anatomy, reattach the rotator cable and respect the coracoacromial arch whenever possible. Tendon transfer, superior capsular reconstruction or balloon implantation have been proposed for irreparable lesions.Shoulder rehabilitation should focus on restoring balanced glenohumeral and scapular force couples in order to avoid an upward migration of the humeral head and secondary cuff impingement. The primary goal of cuff repair is to be as anatomic as possible and to create a biomechanically favourable environment for tendon healing. Cite this article: EFORT Open Rev 2020;5:508-518. DOI: 10.1302/2058-5241.5.200006.

Keywords: anatomy; glenohumeral instability; humerus; ligaments; rehabilitation; rotator cuff; scapula; therapeutic implications.

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Conflict of interest statement

ICMJE Conflict of interest statement: PJD reports support for travel to meetings for the study or other purposes from Southern Oregon Orthopedics, related to the submitted work; and consultancy for, grants/grants pending, patents (planned, pending or issued) and royalties from Arthrex Inc., and payment for lectures including service on speakers’ bureaus from Pacira, all outside the submitted work. PC reports consultant fees from Wright, Arthrex, Smith and Nephew and Conmed and receipt of royalties from Wright. PH reports Board membership of the Foundation for Osreoarticular Research and employment by EFORT Open Reviews, outside the submitted work. AL is a paid consultant for Wright, Arthrex and Medacta, and receives royalties from Wright. The other authors declare no conflict of interest relevant to this work.

Figures

Fig. 1
Fig. 1
(a) Anterior view of a left shoulder after dynamic anterior stabilization. (b) Lowering the inferior part of the subscapularis muscle done by biceps tendon in low-range motion is called ‘hammock effect’. It represents a muscular effect.
Fig. 2
Fig. 2
Anterior view of a left shoulder after dynamic anterior stabilization. At higher range of abduction, the biceps tendon is more horizontal and does not lower the inferior part of the subscapularis muscle anymore. It forms a veritable sling in front of the shoulder, called the sling effect.
Fig. 3
Fig. 3
Sagittal illustration of a right shoulder. Direction of the conjoint tendon in (a) the Latarjet and (b) Bristow procedure. Note that the conjoint tendon during Latarjet has to go around the inferior subscapularis (a). Contrarily, the conjoint tendon exits directly through the split during the Bristow procedure (b).
Fig. 4
Fig. 4
Right shoulder viewed through a posterior portal. Arthroscopic view of crescent configuration of the rotator cuff (RC). The cable surrounds the crescent. Note. BT, biceps tendon; H, humeral head.
See this image and copyright information in PMC

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