Anatomy of the glenohumeral joint

The glenohumeral joint is a ball-and-socket joint. This is one of the four joints that make up the shoulder complex. It is formed by the head of the humerus and the glenoid cavity of the scapula. The glenohumeral joint is considered the most mobile, least stable and most susceptible to dislocation.

Movements in the glenohumeral joint

Planes in anatomy

Abduction (abduction) - raising the shoulder in the frontal plane.
Flexion (flexion) - raising the shoulder anteriorly in the sagittal plane.
Extension (extension) - raising the shoulder posteriorly in the sagittal plane.
Internal rotation (internal rotation) - rotation of the shoulder inward (in the medial direction).
External rotation (external rotation) - rotation of the shoulder outward (in the lateral direction).
Abduction in the plane of the scapula is the elevation of the shoulder in the plane of the scapula, which is between the frontal and sagittal planes.
Horizontal adduction is the inward movement of the shoulder in the horizontal plane (usually accompanied by some degree of shoulder flexion).

How to relieve pain from a torn shoulder ligament?

Bystrumgel will help relieve inflammation and swelling of joints and soft tissues due to ruptures, sprains and bruises of ligaments, muscles, and tendons. It contains ketoprofen, which belongs to the group of non-steroidal anti-inflammatory substances. It has anti-edematous, anti-inflammatory, analgesic effects.

Bystrumgel has a pleasant aroma because it contains essential oils of orange flowers and lavender.

Pain relief when the integrity of the ligaments is damaged occurs 15-30 minutes after applying Bystrumgel to the skin in the area of the damaged structure. The drug can be used to eliminate unpleasant symptoms due to injuries of the musculoskeletal system.11

Joint capsule and ligaments

The joint capsule and ligaments of the glenohumeral joint provide passive support for the head of the humerus in contact with the glenoid cavity of the scapula.

Capsule of the glenohumeral joint

Laterally, the capsule of the glenohumeral joint is attached to the anatomical neck of the humerus.
Medially, the capsule is attached to the glenoid cavity and the articular labrum.
When the arm is in a resting position, the lower and anterior portions of the capsule are relaxed while the upper portion is taut.
The anterior portion of the capsule is strengthened by the superior, middle, and inferior glenohumeral (glenoid-shoulder) ligaments, which form a Z-shaped pattern on the capsule (some sources call this the articular-labial periarticular fibrous complex).
The rotator cuff muscles strengthen the joint capsule superiorly, posteriorly, and anteriorly.
Without ligaments and surrounding musculature, the joint capsule provides little support to the glenohumeral joint.
According to some sources, the overall strength of the capsule has an inverse relationship with the patient’s age: the older the person, the weaker the joint capsule.

Causes, symptoms and diagnostic features of shoulder ligament injuries

A bruise occurs when there is a direct impact on the joint, and damage to the ligamentous apparatus occurs under the influence of force that is applied at a distance from it. The mechanism of occurrence of these two types of injuries is essentially the same, but the significant difference is in the force that causes them. With dislocation it is much greater than with isolated damage to the ligamentous fibers.64

The main cause of rupture of the ligaments and muscles of the shoulder is movement, which is typical for this joint, but significantly exceeds the physiological amplitude. Damage to the ligamentous apparatus can also occur when performing movements unusual for the shoulder joint. But in both cases, the applied force, which causes partial or complete rupture of the elastic fibers, is insufficient to dislocate the shoulder.64

Most often, ligamentous injuries are diagnosed in people who play sports. Typically, a fall on a twisted or outstretched arm causes a rupture of the shoulder ligaments, and the symptom of such an injury is pain when moving. But it is difficult to determine which movements cause more discomfort.64

Diagnosis of injuries to the shoulder joint is difficult, especially if we are talking about hemorrhage into the joint cavity. This is due to the fact that it is surrounded by massive muscles, which make palpation difficult. A reliable diagnosis can be made by X-ray diagnostics, which helps exclude joint dislocation.64

Bursae of the shoulder joint

Bursae of the shoulder joint
The shoulder complex has many bursae, the largest being the subacromial bursa. It also includes the subdeltoid bursa as they are often continuous. The subdeltoid bursa allows the rotator cuff to slide easily under the deltoid muscle.

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Treatment of shoulder ligament rupture

When spraining, partial or complete separation of ligamentous fibers, it is necessary not only to relieve pain, but also to reduce the risk of developing inflammation. A long-term inflammatory process slows down regeneration processes, which can lead to the development of functional insufficiency of elastic fibers.74

It is difficult to say how long it will take for a shoulder ligament rupture to heal, since it all depends on the nature of the injury and the characteristics of the body. Treatment may include different methods: immobilization of the damaged joint, cryotherapy, internal administration and local use of non-steroidal anti-inflammatory drugs. If the acromioclavicular ligaments are damaged, surgical treatment (suturing the torn joint capsule) may be indicated. The operation is also performed if other methods of therapy do not cause positive dynamics, as well as in case of repeated damage to the ligamentous apparatus.64

30g

recommendations for use

Apply a small amount of gel (3-5 cm) 2-3 times a day, followed by rubbing into inflamed or painful areas of the body. The duration of use of the drug should not exceed 14 days without consulting a doctor.

instructions

50g

recommendations for use

instructions

100g

recommendations for use

instructions

Muscles of the glenohumeral joint

Muscles of the shoulder complex

Flexors

anterior portion of the deltoid muscle.

Extensors

triceps brachii;
teres major;
posterior portion of the deltoid muscle;
latissimus dorsi muscle.

Rotator cuff muscles

supraspinatus muscle;
infraspinatus muscle;
teres minor;
subscapularis muscle.

Internal rotators

subscapularis muscle;
teres major;
latissimus dorsi muscle;
pectoralis major muscle.

External rotators

teres minor;
infraspinatus muscle.

Abductors

deltoid;
supraspinatus muscle.

Adductors

pectoralis major muscle.

Subacromial impingement

Primary impingement syndrome

Repeated compression of the rotator cuff tendon and bursa between the shoulder and the acromion and/or coracoacromial ligament can lead to irritation and inflammation. When the rotator cuff tendon and/or bursa become inflamed, the subacromial space is further reduced, the tendon and bursa typically become compressed (pinched) in the subacromial space, and the condition is called subacromial impingement (16). People with primary impingement typically experience pain when lifting the affected arm (especially above shoulder level), due to pressure from the inflamed and irritated rotator cuff tendons and bursa. To prevent the onset or worsening of the primary impingement, several weight-bearing exercises may need to be modified.

Shoulder abductions are an excellent exercise for strengthening the medial deltoid and supraspinatus muscles. Typically, abductions are performed with the palms facing down (internal rotation at the shoulder joint), which leads to impingement of the rotator cuff (Figure 5). When the arm is raised, the rotator cuff tendons normally move with minimal pressure on the overlying acromion. However, when the arm rotates inward at the same time as it lifts, the greater tuberosity of the shoulder compresses the rotator cuff tendons and bursa against the acromion (8). Repeated compression leads to inflammation and damage to the rotator cuff tendons or bursa (16). To reduce the pressure as much as possible, you need to raise your arm with external rotation of the shoulder. Clients are encouraged to use a neutral grip with thumbs pointing toward the ceiling to externally rotate the shoulder (Figure 6). It is necessary to exclude the seated shoulder abduction machine, which requires internal rotation when lifting (Figure 5). It can be replaced with abductions with external rotation, with dumbbells.

Another exercise that leads to subacromial impingement is the chin row. When performing a chin-up, the arms are maintained in an internal rotation position throughout the lift. We recommend eliminating this exercise entirely or limiting the lift to 800 and not raising your elbows higher than your shoulder joints to prevent rotator cuff impingement.

Subacromial impingement is exacerbated by excessive flexion exercises (16). A pullover with free weights lying on your back (Figure 7) or in a machine presses the rotator cuff tendon and bursa to the acromion in the position of maximum flexion of the arms. This exercise can be performed more safely by simply limiting the flexion to normal physiological ranges or a comfortable range of motion. As an alternative for the latissimus muscles, you can offer straight arm extension while standing at the top block.

Figure 5. Seated shoulder abductions with shoulder inward rotation.

Figure 6. Abduction in the plane of the scapula (300 anterior to the frontal plane of the body).

Secondary impingement syndrome

Exercises that promote hyperelasticity of the anterior shoulder capsule (discussed above) also contribute to the development of secondary rotator cuff impingement syndrome (10, 12). If the arms do not remain centered in the shallow glenoid fossa of the scapula when moving, the rotator cuff tendons and bursa become re-compressed and inflamed. Additionally, the rotator cuff muscles have to work harder to regain stability and become prone to fatigue, tendinitis (microtrauma), inflammation and subsequent impingement. Because impingement develops secondary to hyperelasticity and instability, this condition is called secondary impingement (10, 12). In case of a secondary impact, it is advisable to avoid loading the anterior capsule stops, excluding exercises that combine external rotation of the arm with horizontal abduction. Therefore, modifications to the exercises prescribed for people with secondary impingement need to be made, as for anterior instability or hyperelasticity of the shoulder joint.

Figure 7. Pullover on the back.

Internal impingement syndrome

In a dangerous position in the shoulder joint, an internal collision of the articular part of the supraspinatus and infraspinatus tendon with the posterior part of the labrum may occur (Figure 1; 3, 9). Internal impingement most commonly occurs in throwing athletes due to repeated external rotation of the shoulder combined with abduction and horizontal abduction, which impinges the tendon against the labrum. Anterior shoulder instability is a predisposing factor to the development of internal impingement (2, 10). It is wise to avoid exercises that cause impingement pain in the posterior joint (not muscle soreness) and/or aggravate anterior instability. It is recommended to perform exercises in safe positions.

Figure 8. Stand with bent legs (left).

Figure 9. External rotation of the shoulder on a block with abduction to 90 0
(right).

Diagnostics

The diagnosis is made by a doctor based on a survey and examination of the patient. Because the symptoms of a shoulder sprain are similar to those of a shoulder dislocation and a fracture, it can sometimes be difficult to separate the two. To clarify the diagnosis, the following may be prescribed: X-ray examination of the shoulder joint, ultrasound of the shoulder joint, which allows one to assess changes in the condition of the soft tissues. For a more detailed assessment of changes in soft tissues, an MRI is sometimes prescribed, but this is rarely required.

Find out more about preparation for the MRI procedure and contraindications from Elena Aleksandrovna Mershina, Candidate of Medical Sciences, Head of the Tomography Department at the Central Clinical Hospital:

Symptoms

The main symptom is severe pain that occurs immediately after the injury. An attempt to move the hand causes it to intensify. Usually the pain is sharp at first, but over time it can change in nature, dull and become aching. Less common, but there are situations when the pain increases over time. One or two hours after the injury, swelling of the joint occurs, followed by possible bruising and increased temperature in the damaged area. A characteristic feature is that the tumor increases the size of the shoulder, but does not change its normal shape. To provide first aid to a victim with suspected sprain or rupture of the ligaments of the shoulder joint, it is recommended to do the following:

Remove the injured hand from clothing and carefully secure it using available means to prevent any movement.
Apply cold to the sore spot: compress or ice.

If the pain is severe, it is worth giving the victim painkillers, for example, analgin, paracetamol, spasgan.
Take the necessary measures to deliver the victim to a medical facility as soon as possible for a correct diagnosis.

Indications

The shoulder is the most mobile joint. This is one of the reasons that he is susceptible to injury and various diseases. Many of them are treated by arthroscopy.

The main indications for arthroscopic shoulder surgery are:

consequences of injuries;
damage to the articular surface;
osteoarthritis;
tendinitis of the long head of the biceps;
separation of the articular lip of the scapula;
the appearance of intra-articular bodies;
ligament or tendon ruptures;
habitual dislocation;
rotator cuff injury.

Arthroscopy is performed when shoulder pain or limited mobility of unknown origin occurs. In this case, the operation is diagnostic. If the source of the problem is identified, it can be immediately treated.

Advantages

Sometimes surgery on the shoulder joint is performed with an open surgical approach. But arthroscopy has several significant advantages. It can replace open surgery (arthrotomy) in the vast majority of clinical situations. In this case, the following operation:

carries fewer risks to human health;
less blood loss;
complications occur less often;
improves tolerability of the postoperative period;
shortens rehabilitation;
provides the best aesthetic effect.

During the operation, good visualization of intra-articular tissues is provided, which the doctor can examine under magnification. The deltoid muscle and tendons are not cut, which provides a good functional effect.