Anatomy and biomechanics of the shoulder in throwing, swimming, gymnastics, and tennis.

As the most mobile joint in the body, the shoulder is structurally insecure. The ball-shaped humeral head rotates and glides on a shallow scapular cup. A limited amount of passive stability is provided by the glenoid labrum, which slightly deepens the scapular cup, and by ligaments reinforcing the capsule on its superior and anterior surfaces. At peak maturity ligamentous restraint equals 50 to 80 kg. These structural limitations indicate that the primary source of joint stability must be balanced muscle control. Joint compression is the major factor. This is supplemented by active tangential restraint, which selectively opposes anterior, posterior, or superior displacement. The large external muscles used for purposeful motion and speed often create subluxating shear forces in addition to the desired actions. Impingement and attrition syndromes are common consequences. To counter this, as well as to provide selective rotation, there are the four muscles that constitute the rotator cuff. Joint compression is the major force generated by the supraspinatus and infraspinatus. The latter (accompanied by the teres minor) also provides a downward pull to oppose the upward displacement of early deltoid action. Anterior protection against excessive external rotation or extension is offered by the subscapularis. Athletic who use the arm for a propelling force strain the extremes of joint range in their drive for maximum performance. The threat of injury can be minimized by two actions, namely, modifying motion patterns, which may avoid impingement or make it a less frequent experience, and active protection, which is gained through specific strengthening of the rotator cuff muscles.