The shoulder and its instability

To give continuity to the applications of the upper limb, today’s post will deal with one of the most complex joints of the human body, the shoulder. As you will see below, there are so many structures that form part of this joint that it is so difficult to work with. A brief but useful anatomical summary will be given, and this time not only the muscular and bony part, but also the mobility. With your assessment you will be able to adapt the necessary bandage to help with each injury.

A multitude of injuries can be found in the shoulder, from fractures, through dislocations and subluxations, tendinopathies or other types of tendon injuries, muscle strains, bursitis, more specific injuries such as frozen shoulder, compression syndrome, capsulitis, slap injury and a long etcetera. It will therefore be a frequent cause of sessions at the physiotherapist.

dolor de hombro

What bones and joints make up the shoulder?

The shoulder is made up of 3 bones: the scapula, the humerus and the clavicle.

The joints that make up the shoulder are roughly 5:

  1. Glenohumeral: formed by the head of the humerus and the cavity where it is housed (glenoid cavity). It allows movement in the three planes (flexion/extension, abduction/adduction and rotations) and provides stability.
  2. Scapulothoracic: this is not a joint as such, but is described as an area of movement between the scapula and the posterior and lateral part of the thorax. It is essential for quality and range of motion.
  3. Sternoclavicular: junction of the sternum with both clavicles. This joint is responsible for providing mobility in all shoulder movements between 0 and 90º.
  4. Acromioclavicular: where the acromion (part of the scapula located superiorly and externally) articulates with the lateral part of the scapula.
  5. Subdeltoid: false joint as such at the bony level, but biomechanically it acts by sliding between the humeral head covered by the supraspinatus and the deltoid muscle. It only acts in flexion and abduction of the shoulder.

What muscles form the shoulder?

According to the bibliography there are many ways of classifying the muscles that form part of the shoulder, whether they are superficial or deep, whether they are reinforcing or articular, located on the anterior or posterior face, whether they are palpated on the arm, on the scapula… In today’s post we have decided not to classify the muscles, we are only going to list them and then further on. Each function will then be related to the group of muscles necessary to carry it out.

Therefore, the shoulder muscles are: deltoid, teres major, teres minor, subscapularis, supraspinatus, infraspinatus, coracobrachialis, biceps, brachialis anterior, triceps, latissimus dorsi, subclavian, serratus major, trapezius, angularis, rhomboid minor and rhomboid major.

What are the movements of the shoulder?

The shoulder is the most mobile joint in our body, but this quality, which might seem positive, becomes negative because it creates instability. This instability always or almost always manifests itself in the form of pain and functional disability. To understand shoulder pathology, it is necessary to know beforehand how the shoulder moves and which muscles are involved in each movement.

The shoulder has movements in all 3 planes of space. It has flexion, extension, adduction, abduction, internal and external rotation, and circumduction. This movement combines consecutively the movements of flexion, abduction, extension and adduction.

To understand the real mobility of the shoulder, one has to think of the shoulder with the attachment of the scapula, one movement is associated with the other. A small reminder will be made in the form of a table (according to Kendall’s) of which muscles are involved in each movement.

tabla movimientos del hombro

The internal rotators are the muscles with the greatest volume and strength and are involved in most day-to-day actions. Most of them are located on the anterior aspect of the shoulder and the most relevant are the pectoralis major, anterior deltoid and subscapularis.

How do you tape for shoulder stability?

If you take into account all the previous theory that has been shown, you could choose a huge number of injuries and then make a taping from there. However, it is a good option to make a shoulder stability application and thus generally address a symptomatology.

In the following, we will describe a neuromuscular taping for shoulder instability, specifically for an anterior shoulder instability. These symptoms can appear due to several processes, some of them can be dislocation or subluxation of the humeral head to anterior, an imbalance of the musculature with predominance of the anterior, Bankart injury (tearing of the labrum and glenohumeral ligaments), laxity of the ligaments, tendon rupture, forced and extreme movements of the shoulder (throwing sports or swimming)… in conclusion, a generic bandage that could be used for many pathologies.

Kinesiology tape for Shoulder Stability

In the following video you can see all the steps and check the position of the patient to perform a kinesiology tape. Prior to the technique, two I-strips are measured from the pectoralis major to the scapula. The bandage is cut, the edges are rounded and the patient’s skin is prepared. The patient should be in a sitting or standing position, with the shoulder in neutral position and the elbow extended.

Functional taping for shoulder stability

In the event that the patient needs more stability because the shoulder is not yet functional, or in the event of a sports competition (in which the injury must be avoided and the joint fixed), a functional bandage will be applied. It can be performed alone as shown in the following video or combined with the one described above.

It is advisable in case of inflammation or sensitivity on the part of the patient to place a foam block over the acromioclavicular joint to protect it and provide comfort to the patient.

After collecting a lot of information about the shoulder that you want to be useful and showing some of the most commonly used bandages for instability. It is important to remember that both are standard bandages, the important thing is to know the function of the bandage and to adapt it to the patient’s injury. In this case there are many possible adaptations, such as, for example, making a kinesiology tape to some musculature and adding the functional tape on top, or combining two kinesiology tapes, one for muscular application and the other for instability, reinforcing the functional bandage with more tape or using a kinesiology star instead of foam…an endless number of combinations, the important thing is to listen to the patient, know the anatomy and physiology of their body and provide a solution to their injury.

 

 

Carried out by the Technical Department of Calvo Izquierdo S.L.

 

 

How to cite this blog:

  • Calvo Izquierdo. BLOG: The shoulder and its instability [Internet]. Calvo Izquierdo SL. 2023. Available at: https://calvoizquierdo.es/blog-the-shoulder-and-its-instability/

Bibliography:

  • Kase, J. Wallis, T. Kase (2003) Clinical therapeutic applications of the kinesio taping method, 2nd edition.
  • Bové, A. (2000) El vendaje funcional . Harcourt. 3rd edition.
  • Selva, F. (2015) Neuromuscular Taping Manual of practical applications. Physi-Rehab-Kineterapy-Eivissa. 2nd edition.
  • Castillo, J. (2020) Bases y aplicaciones del vendaje neuromuscular. Formación Alcalá. 2nd edition.
  • Aguirre, T. Agirre, J. (2018) Vendaje neuromuscular kinesiotape en fisioterapia. Biocorp Europa. 1st edition.
  • Sijmonsma, J. (2007) Taping Neuro Muscular. Aneid Press, 1st Spanish edition.
  • Kendall’s (2007) Musculos, pruebas funcionales postura y dolor. Marbán. 5th edition.
  • Martínez, JL. Martínez, J. Fuster, I. (2006) Lesiones en el hombro y fisioterapia. Aran. 1st edition.
  • Oliveira, C. Navarro, R. Navarro, R. Ruiz, JA. Jimenez, JT. Brito, E. (2007) Biomechanics of the shoulder and its injuries. Canarias médica y quirúrgica. January-April 2007.

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