Article

The global range of motion of the arm is the result of a coordinated
motion of the shoulder complex including glenohumeral (GH), scapulothoracic,
sternoclavicular and acromioclavicular joints. METHODS: This study is a
non-systematic review of kinematic patterns in degenerated shoulders. It is a
based on our own research on the kinematics of the shoulder complex and clinical
experience. RESULTS:
For patients with subacromial impingement syndrome without
rotator-cuff tears, most kinematic studies showed a small superior humeral
translation relative to the glenoid and decreased scapular lateral rotation and
posterior tilt. These scapular kinematic modifications could decrease the
subacromial space and favor rotator-cuff tendon injury. For patients with
shoulder pain and restricted mobility, the studies showed a significant increase
in scapular lateral rotation generally seen as a compensation mechanism of GH
decreased range of motion. For patients with multidirectional GH instability, the
studies found an antero-inferior decentering of the humeral head, decreased
scapular lateral rotation and increased scapular internal rotation. CONCLUSION:
The clinical or instrumented assessment of the shoulder complex with a
degenerative pathology must include the analysis of scapula-clavicle and trunk
movements complementing the GH assessment. Depending on the individual clinical
case, scapular dyskinesis could be the cause or the consequence of the shoulder
degenerative pathology. For most degenerative shoulder pathologies, the
rehabilitation program should take into account the whole shoulder complex and
include first a scapular and trunk postural-correcting strategy, then
scapulothoracic muscle rehabilitation (especially serratus anterior and trapezius
inferior and medium parts) and finally neuromotor techniques to recover
appropriate upper-limb kinematic schemas for daily and/or sports activities.
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Langue : ANGLAIS