14.8 Rehabilitation of the shoulder
The “specific properties” of the shoulder joint are complex and particularly demanding at a functional level.
The shoulder must be capable of providing significant mobility of the upper limb whilst providing a stable
base.
The limited congruence of the joint surfaces (the humeral head within the glenoid cavity), although
partially compensated by the labrum, exposes the joint to misalignment that the passive capsular/ligament
elements cannot control.
Neuromuscular control must constantly compensate for the deficiencies in passive stability by maintaining
coordinated forces capable of opposing the unstable component resulting from intrinsic forces
(contraction of muscles generating translational forces: pectoralis major, biceps brachii, coracobrachialis,
triceps brachii (caput longum), or extrinsic forces (fall, contact, etc.).
Owing to the numerous advances in the fields of biomechanics, physiology and physiopathology, the
therapeutic approach to shoulder pathologies has evolved considerably in recent years.
In this chapter, we will discuss three pathological conditions of the shoulder, for which neuromuscular
electrostimulation is a preferred treatment among the established rehabilitation techniques.
These three conditions are:
1. Rotator cu tendinopathy
2. Shoulder instability
3. Adhesive capsulitis
The protocols proposed have been developed on the basis of the following publications:
• Flatow EL, Soslowsky LJ, Ateshian GA, Pawluk RJ, Bigliani LU, Mow VC: Shoulder joint anatomy and the
eect of subluxations and size mismatch on patterns of glenohumeral contact.; Orthop Trans 15: 803;
1991
• Harryman DT, Sidles JA, Clark JM, McQuade KJ, Gibbs TD, Matsen FA: Translation of the humeral head on
the glenoid with passive glenohumeral motion; J Bone Joint Surg 72A: 1334; 1990
• Matsen F, Lippit S, Iserin A; Mécanismes patho-anatomiques de l’instabilité gléno-humérale
[‘Pathoanatomical mechanisms of glenohumeral instability’] ‘Expansion scientifique française’, Paris,
Cahier d’enseignement de la SOFCOT [Teaching book of the French Society of Orthopaedic Surgery], pp
7 – 13
• Gibb TD, Sidles JA, Harryman DT,McQuade KJ, Matsen FA; The eect of capsular venting on glenohumeral
laxity; Clin Orthop 268: 120 – 6; 1991
• Howell SM, Galinat BJ; The glenoid-labral socket. A constrained articular surface. Clin Orthop 243: 122;
1989
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