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Introduction

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This was an arthroscopic and, as much as possible, noninvasive procedure. With aggressive rehabilitation, I expect to be back in form for the Shark Shootout [in December 2009].

Confident golfer Greg Norman after having an arthroscopic superior labral repair (SLAP lesion) and a partial rotator cuff repair (October 2009)

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Having made the decision to have surgery in September in order to facilitate my playing the Shark Shootout, I am disappointed. At the same time, I understand it would not be prudent to rush my return to competitive golf.

Norman’s new plan was to return to practice in February 2010 and competition in the following months

Adapted from various sources including www.shark.com

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In recent years, there have been many advances in the assessment and treatment of shoulder pain. In this chapter we review:

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  • functional anatomy

  • key features of the clinical history

  • how to conduct a swift and effective physical examination

  • investigations

  • treatment of important shoulder conditions

  • prescription for practical shoulder rehabilitation.

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A swift and effective physical examination and prescription for practical shoulder rehabilitation can be seen in the Clinical Sports Medicine masterclassShoulder examination”.

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Functional anatomy—static and dynamic

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The glenohumeral joint is an inherently unstable shallow ball and socket joint, often described as the equivalent of a golf ball (head of humerus) on a tee (glenoid). In fact, the relationship between the humeral head and the glenoid cavity more accurately parallels a sea lion balancing a ball on its nose. Thus, effective shoulder function and stability require both static constraints—the glenohumeral ligaments, glenoid labrum, and capsule—and dynamic constraints, predominantly the rotator cuff and scapular stabilizing muscles (Fig. 21.1).

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Figure 21.1

Anatomy of the shoulder region

(a) Surface anatomy from the front

Graphic Jump Location
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Static stabilizers

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The main static stabilizers of the shoulder in the functional position (abducted) are the anterior and posterior bands of the inferior glenohumeral ligament. They are attached to the labrum, which, in turn, attaches directly to the margin of the glenoid fossa. The anterior band of the inferior glenohumeral ligament prevents anterior translation, and the posterior band prevents posterior translation of the humeral head. The superior margin of the anterior band of this ligament attaches to the glenoid fossa anteriorly at the two o’clock position. ...

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