INTRODUCTION
Biomechanics/Anatomy
Glenohumeral Joint Anatomy
Joint Articulation: Convex humeral head and concave glenoid fossa
Joint Type: Diarthrodial ball and socket joint; Humeral head is four times larger than the glenoid fossa
Athrokinematics:
  • During flexion and internal rotation of the humerus the convex humeral head rolls anteriorly and glides posteriorly on the concave glenoid fossa
  • During extention and external rotation of of the humerus the convex humeral head rolls posteriorly and glides anteriorly on the concave glenoid fossa
  • During humeral elevation(flexion, scaption and abduction) the convex humeral head rolls superiorly and glides inferiorly on the concave glenoid fossa
Capsular Pattern of Restriction: External rotation, abduction, internal rotation
Close-Packed Position: Max abduction and external rotation or extension and internal rotation
Open-Packed Position: 60⁰ abduction and 30⁰ horizontal adduction


humerus.jpg
Glenoid Labrum Anatomy
The labrum is a soft fibrous tissue rim that helps to stabilize the glenohumeral joint and adds 50% more depth to the glenoid fossa. The labrum also serves as an attachment site for the superior and inferior glenohumeral ligaments and the long head of the biceps brachii.

glenoid.jpg
Mechanism of Injury
  • SLAP (Superior Labrum Anterior to Posterior) lesion
    • Fall on an outstretched hand (FOOSH)
    • Improper stretching prior to excessive throwing (repeated bouts of excessive ER)

slap.gif
  • Bankart lesion
    • Humeral head dislocation
bankhart.jpg
  • Posterior Labral lesion
    • Posterior humeral head dislocation
poster.png

SIGNS and SYMPTOMS

Signs: Objective Measures
¡ Shoulder instability
¡ Decreased ROM
¡ Decreased strength

Symptoms: Subjective Measures
¡ Pain with overhead reaching
¡ Catching, locking, popping, grinding, clicking
¡ May have night pain
¡ Pain with ADLs
¡ Diffuse ache
¡ Scapular pain

Practical Presentation

SLAP lesion is most commonly seen in overhead throwing athletes such as baseball players and tennis players. Bankart lesion is typically seen in individuals that have sustained a shoulder dislocation in the anterior direction, where as a posterior labral lesion is typically seen in individuals that have sustained a shoulder dislocation in the posterior direction. Posterior labral lesion can commonly be seen in football players.


TREATMENT APPROACH/INTERVENTION
See the following links for specific duration, protocols and exercises for SLAP, Bankart and Posterior Labral Tears
SLAP Lesion
Bankart Lesion
Posterior Labral Lesion

Modalities
RICE (Rest, Ice, Compression and Elevation)
Ultrasound
Iontophoresis
Game Ready System

Adjunct Treatment and/or Alternative Treatment
NSAIDS
Glucosamine
Hyaluronic Acid
Chiropractic care

References
Picture Credits:
http://www.scoi.com/sholanat.htm
http://www.chanorthopaedics.com.sg/
http://slaplesion.net/
http://www.drmaffet.com/shoulder-surgery-houston/shoulder-instability/attachment/bankart-lesion-2/
http://www.doereport.com/generateexhibit.php?ID=10705&ExhibitKeywordsRaw=&TL=4294967295&A



http://nemsi.uchc.edu/clinical_services/orthopaedic/shoulder/labral_tears.html
Loudon, Janice, Marcie Swift, and Stephania Bell. "Shoulder Joint Complex." The Clinical Orthopedic Assessment Guide. Champaign, IL: Human Kinetics, 2008. 151, 179. Print.