rotator cuff pathology in volleyball players
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, MD, - , Team Doctor
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www.handsurgery.grDuring elevation, the upper trapezius is activated to oppose the lateral pull of the deltoid. The superior fibers of the serratus anterior are activated to maintain proximity between the scapula and thoracic cage and to oppose the pull of the deltoid muscle (figure 2B).Simultaneously, the rotator cuff muscles are firing to maintain the ICR of the glenohumeral axis, thus exerting a lateral force on the scapula. The combined lateral torque of the serratus anterior and rotator cuff is counterbalanced by the levator scapulae, rhomboids, and lower fibers of the trapezius.14-17 Thus, the lower fibers of the serratus anterior are free to drive the inferior scapular angle laterally, achieving upward scapular rotation about an imaginary axis extending from the sternoclavicular joint to the point of the root of the scapular spine.4,9,14,17,18
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www.handsurgery.grA variety of opposing muscular forces affects the function of the joint. It is important to recognize that, in its natural state, the shoulder is unbalanced in both the vertical and horizontal planes. Vertically, the power of the deltoid exceeds that of the rotator cuff muscles. RC acts as a humeral head depressor but mainly pulls the HH into the glenoid.7
IRER
www.handsurgery.grIn the horizontal plane the subscapularis anteriorly is balanced against the infraspinatus and teres minor posteriorly. The number of internal rotator muscles exceeds the number of external rotator muscles. As shoulder pathology ensues, the tenuous relationship that keeps the shoulder pain free and functional can be disrupted.
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20 overhead8/20 / 0/20 5
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2 ( 2-4 .)Jelinsky et al., 2008
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www.handsurgery.gr 19 placebo RCTs: ( 6 ) ( 6 ) , Andres and Murrell, 2008Level II, Systematic review
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PRPs !!!
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8 : 3 RCT, 5 case seriesKesikburun et al.: scores Ilhanli et al.: scores Rha et al.: 6
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IS IT JUST SCIENCE???
www.handsurgery.grIS IT JUST SCIENCE???
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(PASTA) > 50-75% Transtendinous vs.
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(PASTA) => => transtendinous
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Single row repairDouble row repair Suture bridgeTransosseous
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