J Korean Med Assoc.  2011 Jul;54(7):705-714.

Orthopedic disease and sports medicine in shoulder joint

• Kim SH

Abstract

Recent developments in biomechanics and technology have improved our understanding of the shoulder joints. While the shoulder joint is the one of the most mobile joints in the human body, its stability mostly relies on soft tissue structures such as the glenoid labrum and capsular ligament. Traumatic anterior instability is the most common instability related to sports injury. Younger individuals have a higher rate of recurrence after nonoperative treatment after the first-time episode of anterior instability. Arthroscopic repair of the Bankart lesion provides reliable outcomes in most of the anterior instability, while selected patients with significant bone loss may require bony augmentation procedures. Posterior instability has been underestimated. Sports injury is commonly associated with symptomatic posterior instability, and posterior labral lesions are commonly found. Arthroscopic reconstruction of the posteroinferior height and ligament balance is required. Superior labral lesions are a commonly diagnosed disease in the shoulder. Care must be taken to avoid unnecessary surgical procedures especially in nonathletic populations without significant traumatic episodes. Partial articular surface tears are common among sports related rotator cuff injuries. Symptomatic articular surface tears require arthroscopic treatment such as debridement or trans-tendon repair.

Keyword

Instability; Rotator cuff; Sports injury; Shoulder

MeSH Terms

Athletic Injuries
Biomechanics
Debridement
Human Body
Humans
Joints
Ligaments
Orthopedics
Recurrence
Rotator Cuff
Shoulder
Shoulder Joint
Sports
Sports Medicine

Figure

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  Figure 1 Bankart lesion.

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  Figure 2 Hill-Sachs lesion.

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  Figure 3 Postoperative view of arthroscopic Bankart repair.

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  Figure 4 The jerk test. (A) Stabilize the scapula with one hand, while the other hand holds the elbow with the arm in 90° abduction and internal rotation. Firm axial compression force is applied on the glenohumeral joint. (B) The arm is horizontally adducted while maintaining the firm axial load.

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  Figure 5 The Kim test was performed in sitting position with the arm in 90° abduction. (A) With examiner holding elbow and lateral aspect of the proximal arm, firm axial loading force is applied. (B) Simultaneous 45° upward diagonal elevation was applied on the distal arm, while downward and backward force is applied on the proximal arm.

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  Figure 6 Three types of the posteroinferior labral lesion in the magnetic resonance imaging-arthrogram. (A) Type I: separation without displacement. (B) Type II: incomplete avulsion-the Kim lesion. (C) Type III: loss of contour.

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  Figure 7 Arthroscopic finding of the posterior and inferior labral lesion. (A) Type I: incomplete detachment. (B) Type II: marginal crack or Kim lesion.

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  Figure 8 Superior labral lesion.

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  Figure 9 Partial thickness tear of the articular surface of the rotator cuff.

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