Glenohumeral (shoulder)
Joint
By: Cameron, Debbie, Laura and Wendy
Humerus
Greater tubercle
Lesser Tubercle
Intertubercular
Sulcus
Head
Anatomical Neck
Surgical Neck
Detloid
tuberosity
Anterior
Scapula
Acromion process
Coracoid process
Borders:
Superior
Vertebral
Axillary
Angles:
Superior
Inferior
Fossae:
Subscapular
Glenoid cavity
Superior
angle
Superior
border
Subscapular
fossa
Coracoid
process
Acromion
process
Glenoid
cavity
Axillary border
Vertebral
border
Inferior
angle
Posterior
Scapula
Acromion
process
Fossae:
Infraspinatous
Supraspinatous
Spine
Glenoid cavity
Angles:
Superior
Inferior
Borders:
Superior
Vertebral
Axillary
Acromion process
Glenoid
cavity
Axillary
border
Superior
border
Superior
angle
Supraspinatous
fossa
spine
Infraspinatous
fossa
Vertebral
border
Inferior angle
Clavicle
Acromial End
Conoid Tubercle
Cartilage
Articular Cartilage
Glenoid Labruim
Ligaments
•Coracohumeral
•Glenohumeral
•Transverse
humeral
•Coracoclavicular
•Conoid
•Superior
transverse
scapular
•Acromioclavicular
Glenohumeral
ligament
Bursae
Subscapular , Subacromial
Subdeltoid, Subcoracoid
Articular Capsule
Articular 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
Physical Therapy Protocol
Torn Rotator Cuff
Ruptured Supraspinatus Tendon
The Muscles of the Rotator Cuff
S. I. T. S.
Suprasinatous
Infraspinatous
Teres Minor
Subscapularis
Rotator Cuff Repair Rehab
Protocol
General 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, PROM
AROM, Pain control, Other
Activities
 Keep shoulder in a sling
 Biceps curls, putty grip,
unless showering or during
exercise.
 Okay to shower after 2
days.
 Stitches removed 8-10
days.
 PROM=flexion,
pendulums, pulleys.
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
 ISO. For Uninvolved
showering, meals, or
exercise.
 PROM for repaired
tendons, only in direction
that SHORTENS tendon.
 AROM for Uninvolved
tendons. AVOID
STRESSING REPAIRED
TENDONS!!
tendons as tolerated.
 LE conditioning, aquatic
therapy.
4-8 Weeks Post-Op
Protection, PROM, Mobs
AROM, Other Activities
 No sling needed.
 GENTLE PROM into
 Pure ABD. and ER.
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.
 Slowly introduce against
gravity ROM exercises into
extension.
8-12 Weeks Post-Op
PROM, Mobs,
AROM, Other Activities
 Cont. w/ Passive stretching
 Progress to high
to pain tolerance.
 Grade 1-4 mobs. As
tolerated.
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
 Rowing, UBE for
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.
strengthening,
weightlifting with extreme
caution NOT to stress
repair!!!
6 Months(M.D. Visit)
ROM
Other Activities
 Hard resistive exercises,
 Swimming, weightlifting,
aggressive stretching.
throwing progression.
Exercise Program