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Journal of Athletic Training logoLink to Journal of Athletic Training
. 2000 Jul-Sep;35(3):351–363.

The Role of the Sensorimotor System in the Athletic Shoulder

Joseph B Myers 1, Scott M Lephart 1
PMCID: PMC1323397  PMID: 16558648

Abstract

Objective:

To discuss the role of the sensorimotor system as it relates to functional stability, joint injury, and muscle fatigue of the athletic shoulder and to provide clinicians with the necessary tools for restoring functional stability to the athletic shoulder after injury.

Data Sources:

We searched MEDLINE, SPORT Discus, and CINAHL from 1965 through 1999 using the key words “proprioception,” “neuromuscular control,” “shoulder rehabilitation,” and “shoulder stability.”

Data Synthesis:

Shoulder functional stability results from an interaction between static and dynamic stabilizers at the shoulder. This interaction is mediated by the sensorimotor system. After joint injury or fatigue, proprioceptive deficits have been demonstrated, and neuromuscular control has been altered. To restore stability after injury, deficits in both mechanical stability and proprioception and neuromuscular control must be addressed. A functional rehabilitation program addressing awareness of proprioception, restoration of dynamic stability, facilitation of preparatory and reactive muscle activation, and implementation of functional activities is vital for returning an athlete to competition.

Conclusions/Recommendations:

After capsuloligamentous injury to the shoulder joint, decreased proprioceptive input to the central nervous system results in decreased neuromuscular control. The compounding effects of mechanical instability and neuromuscular deficits create an unstable shoulder joint. Clinicians should not only address the mechanical instability that results from joint injury but also implement both traditional and functional rehabilitation to return an athlete to competition.

Keywords: proprioception, neuromuscular control, functional stability

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Selected References

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  1. Allegrucci M., Whitney S. L., Lephart S. M., Irrgang J. J., Fu F. H. Shoulder kinesthesia in healthy unilateral athletes participating in upper extremity sports. J Orthop Sports Phys Ther. 1995 Apr;21(4):220–226. doi: 10.2519/jospt.1995.21.4.220. [DOI] [PubMed] [Google Scholar]
  2. Blasier R. B., Carpenter J. E., Huston L. J. Shoulder proprioception. Effect of joint laxity, joint position, and direction of motion. Orthop Rev. 1994 Jan;23(1):45–50. [PubMed] [Google Scholar]
  3. Bulbulian R., Bowles D. K. Effect of downhill running on motoneuron pool excitability. J Appl Physiol (1985) 1992 Sep;73(3):968–973. doi: 10.1152/jappl.1992.73.3.968. [DOI] [PubMed] [Google Scholar]
  4. Cain P. R., Mutschler T. A., Fu F. H., Lee S. K. Anterior stability of the glenohumeral joint. A dynamic model. Am J Sports Med. 1987 Mar-Apr;15(2):144–148. doi: 10.1177/036354658701500209. [DOI] [PubMed] [Google Scholar]
  5. Carpenter J. E., Blasier R. B., Pellizzon G. G. The effects of muscle fatigue on shoulder joint position sense. Am J Sports Med. 1998 Mar-Apr;26(2):262–265. doi: 10.1177/03635465980260021701. [DOI] [PubMed] [Google Scholar]
  6. Cavagna G. A., Dusman B., Margaria R. Positive work done by a previously stretched muscle. J Appl Physiol. 1968 Jan;24(1):21–32. doi: 10.1152/jappl.1968.24.1.21. [DOI] [PubMed] [Google Scholar]
  7. Cavallo R. J., Speer K. P. Shoulder instability and impingement in throwing athletes. Med Sci Sports Exerc. 1998 Apr;30(4 Suppl):S18–S25. doi: 10.1097/00005768-199804001-00004. [DOI] [PubMed] [Google Scholar]
  8. Cleland J. On the Actions of Muscles passing over more than One Joint. J Anat Physiol. 1867;1(1):85–93. [PMC free article] [PubMed] [Google Scholar]
  9. David T. S., Drez D. J., Jr Electrothermally-assisted capsular shift. IEEE Eng Med Biol Mag. 1998 May-Jun;17(3):102–104. doi: 10.1109/51.677176. [DOI] [PubMed] [Google Scholar]
  10. Davies G. J., Dickoff-Hoffman S. Neuromuscular testing and rehabilitation of the shoulder complex. J Orthop Sports Phys Ther. 1993 Aug;18(2):449–458. doi: 10.2519/jospt.1993.18.2.449. [DOI] [PubMed] [Google Scholar]
  11. Demont R. G., Lephart S. M., Giraldo J. L., Swanik C. B., Fu F. H. Muscle preactivity of anterior cruciate ligament-deficient and -reconstructed females during functional activities. J Athl Train. 1999 Apr;34(2):115–120. [PMC free article] [PubMed] [Google Scholar]
  12. Dietz V., Noth J., Schmidtbleicher D. Interaction between pre-activity and stretch reflex in human triceps brachii during landing from forward falls. J Physiol. 1981 Feb;311:113–125. doi: 10.1113/jphysiol.1981.sp013576. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Djupsjöbacka M., Johansson H., Bergenheim M. Influences on the gamma-muscle-spindle system from muscle afferents stimulated by increased intramuscular concentrations of arachidonic acid. Brain Res. 1994 Nov 14;663(2):293–302. doi: 10.1016/0006-8993(94)91276-9. [DOI] [PubMed] [Google Scholar]
  14. Djupsjöbacka M., Johansson H., Bergenheim M., Sjölander P. Influences on the gamma-muscle-spindle system from contralateral muscle afferents stimulated by KCl and lactic acid. Neurosci Res. 1995 Feb;21(4):301–309. doi: 10.1016/0168-0102(94)00864-c. [DOI] [PubMed] [Google Scholar]
  15. Djupsjöbacka M., Johansson H., Bergenheim M., Wenngren B. I. Influences on the gamma-muscle spindle system from muscle afferents stimulated by increased intramuscular concentrations of bradykinin and 5-HT. Neurosci Res. 1995 Jun;22(3):325–333. doi: 10.1016/0168-0102(95)00906-a. [DOI] [PubMed] [Google Scholar]
  16. Dunn T. G., Gillig S. E., Ponsor S. E., Weil N., Utz S. W. The learning process in biofeedback: is it feed-forward or feedback? Biofeedback Self Regul. 1986 Jun;11(2):143–156. doi: 10.1007/BF00999982. [DOI] [PubMed] [Google Scholar]
  17. Emery R. J., Mullaji A. B. Glenohumeral joint instability in normal adolescents. Incidence and significance. J Bone Joint Surg Br. 1991 May;73(3):406–408. doi: 10.1302/0301-620X.73B3.1670438. [DOI] [PubMed] [Google Scholar]
  18. Glousman R., Jobe F., Tibone J., Moynes D., Antonelli D., Perry J. Dynamic electromyographic analysis of the throwing shoulder with glenohumeral instability. J Bone Joint Surg Am. 1988 Feb;70(2):220–226. [PubMed] [Google Scholar]
  19. Gowan I. D., Jobe F. W., Tibone J. E., Perry J., Moynes D. R. A comparative electromyographic analysis of the shoulder during pitching. Professional versus amateur pitchers. Am J Sports Med. 1987 Nov-Dec;15(6):586–590. doi: 10.1177/036354658701500611. [DOI] [PubMed] [Google Scholar]
  20. Grana W. A., Muse G. The effect of exercise on laxity in the anterior cruciate ligament deficient knee. Am J Sports Med. 1988 Nov-Dec;16(6):586–588. doi: 10.1177/036354658801600605. [DOI] [PubMed] [Google Scholar]
  21. Guanche C., Knatt T., Solomonow M., Lu Y., Baratta R. The synergistic action of the capsule and the shoulder muscles. Am J Sports Med. 1995 May-Jun;23(3):301–306. doi: 10.1177/036354659502300308. [DOI] [PubMed] [Google Scholar]
  22. Harryman D. T., 2nd, Sidles J. A., Clark J. M., McQuade K. J., Gibb T. D., Matsen F. A., 3rd Translation of the humeral head on the glenoid with passive glenohumeral motion. J Bone Joint Surg Am. 1990 Oct;72(9):1334–1343. [PubMed] [Google Scholar]
  23. Hayashi K., Nieckarz J. A., Thabit G., 3rd, Bogdanske J. J., Cooley A. J., Markel M. D. Effect of nonablative laser energy on the joint capsule: an in vivo rabbit study using a holmium:YAG laser. Lasers Surg Med. 1997;20(2):164–171. doi: 10.1002/(sici)1096-9101(1997)20:2<164::aid-lsm7>3.0.co;2-o. [DOI] [PubMed] [Google Scholar]
  24. Hayashi K., Thabit G., 3rd, Massa K. L., Bogdanske J. J., Cooley A. J., Orwin J. F., Markel M. D. The effect of thermal heating on the length and histologic properties of the glenohumeral joint capsule. Am J Sports Med. 1997 Jan-Feb;25(1):107–112. doi: 10.1177/036354659702500121. [DOI] [PubMed] [Google Scholar]
  25. Hovelius L. Anterior dislocation of the shoulder in teen-agers and young adults. Five-year prognosis. J Bone Joint Surg Am. 1987 Mar;69(3):393–399. [PubMed] [Google Scholar]
  26. Hutton R. S., Atwater S. W. Acute and chronic adaptations of muscle proprioceptors in response to increased use. Sports Med. 1992 Dec;14(6):406–421. doi: 10.2165/00007256-199214060-00007. [DOI] [PubMed] [Google Scholar]
  27. Jobe F. W., Moynes D. R., Tibone J. E., Perry J. An EMG analysis of the shoulder in pitching. A second report. Am J Sports Med. 1984 May-Jun;12(3):218–220. doi: 10.1177/036354658401200310. [DOI] [PubMed] [Google Scholar]
  28. Jobe F. W., Tibone J. E., Perry J., Moynes D. An EMG analysis of the shoulder in throwing and pitching. A preliminary report. Am J Sports Med. 1983 Jan-Feb;11(1):3–5. doi: 10.1177/036354658301100102. [DOI] [PubMed] [Google Scholar]
  29. Johansson H., Sjölander P., Sojka P. A sensory role for the cruciate ligaments. Clin Orthop Relat Res. 1991 Jul;(268):161–178. [PubMed] [Google Scholar]
  30. Knatt T., Guanche C., Solomonow M., Lu Y., Baratta R., Zhou B. H. The glenohumeral-biceps reflex in the feline. Clin Orthop Relat Res. 1995 May;(314):247–252. [PubMed] [Google Scholar]
  31. Kronberg M., Broström L. A., Németh G. Differences in shoulder muscle activity between patients with generalized joint laxity and normal controls. Clin Orthop Relat Res. 1991 Aug;(269):181–192. [PubMed] [Google Scholar]
  32. Lattanzio P. J., Petrella R. J. Knee proprioception: a review of mechanisms, measurements, and implications of muscular fatigue. Orthopedics. 1998 Apr;21(4):463–passim. doi: 10.3928/0147-7447-19980401-19. [DOI] [PubMed] [Google Scholar]
  33. Lattanzio P. J., Petrella R. J., Sproule J. R., Fowler P. J. Effects of fatigue on knee proprioception. Clin J Sport Med. 1997 Jan;7(1):22–27. doi: 10.1097/00042752-199701000-00005. [DOI] [PubMed] [Google Scholar]
  34. Lephart S. M., Henry T. J. Functional rehabilitation for the upper and lower extremity. Orthop Clin North Am. 1995 Jul;26(3):579–592. [PubMed] [Google Scholar]
  35. Lephart S. M., Pincivero D. M., Giraldo J. L., Fu F. H. The role of proprioception in the management and rehabilitation of athletic injuries. Am J Sports Med. 1997 Jan-Feb;25(1):130–137. doi: 10.1177/036354659702500126. [DOI] [PubMed] [Google Scholar]
  36. Litchfield R., Hawkins R., Dillman C. J., Atkins J., Hagerman G. Rehabilitation for the overhead athlete. J Orthop Sports Phys Ther. 1993 Aug;18(2):433–441. doi: 10.2519/jospt.1993.18.2.433. [DOI] [PubMed] [Google Scholar]
  37. Marks R., Quinney H. A. Effect of fatiguing maximal isokinetic quadriceps contractions on ability to estimate knee-position. Percept Mot Skills. 1993 Dec;77(3 Pt 2):1195–1202. doi: 10.2466/pms.1993.77.3f.1195. [DOI] [PubMed] [Google Scholar]
  38. McCann P. D., Wootten M. E., Kadaba M. P., Bigliani L. U. A kinematic and electromyographic study of shoulder rehabilitation exercises. Clin Orthop Relat Res. 1993 Mar;(288):179–188. [PubMed] [Google Scholar]
  39. Moore J. C. The Golgi tendon organ: a review and update. Am J Occup Ther. 1984 Apr;38(4):227–236. doi: 10.5014/ajot.38.4.227. [DOI] [PubMed] [Google Scholar]
  40. Moseley J. B., Jr, Jobe F. W., Pink M., Perry J., Tibone J. EMG analysis of the scapular muscles during a shoulder rehabilitation program. Am J Sports Med. 1992 Mar-Apr;20(2):128–134. doi: 10.1177/036354659202000206. [DOI] [PubMed] [Google Scholar]
  41. Myers J. B., Guskiewicz K. M., Schneider R. A., Prentice W. E. Proprioception and neuromuscular control of the shoulder after muscle fatigue. J Athl Train. 1999 Oct;34(4):362–367. [PMC free article] [PubMed] [Google Scholar]
  42. Nichols T. R., Houk J. C. Improvement in linearity and regulation of stiffness that results from actions of stretch reflex. J Neurophysiol. 1976 Jan;39(1):119–142. doi: 10.1152/jn.1976.39.1.119. [DOI] [PubMed] [Google Scholar]
  43. Nottage W. M. Laser-assisted shoulder surgery. Arthroscopy. 1997 Oct;13(5):635–638. doi: 10.1016/s0749-8063(97)90192-4. [DOI] [PubMed] [Google Scholar]
  44. Nuber G. W., Jobe F. W., Perry J., Moynes D. R., Antonelli D. Fine wire electromyography analysis of muscles of the shoulder during swimming. Am J Sports Med. 1986 Jan-Feb;14(1):7–11. doi: 10.1177/036354658601400102. [DOI] [PubMed] [Google Scholar]
  45. Nyland J. A., Caborn D. N., Johnson D. L. The human glenohumeral joint. A proprioceptive and stability alliance. Knee Surg Sports Traumatol Arthrosc. 1998;6(1):50–61. doi: 10.1007/s001670050072. [DOI] [PubMed] [Google Scholar]
  46. Nyland J. A., Shapiro R., Stine R. L., Horn T. S., Ireland M. L. Relationship of fatigued run and rapid stop to ground reaction forces, lower extremity kinematics, and muscle activation. J Orthop Sports Phys Ther. 1994 Sep;20(3):132–137. doi: 10.2519/jospt.1994.20.3.132. [DOI] [PubMed] [Google Scholar]
  47. Pedersen J., Lönn J., Hellström F., Djupsjöbacka M., Johansson H. Localized muscle fatigue decreases the acuity of the movement sense in the human shoulder. Med Sci Sports Exerc. 1999 Jul;31(7):1047–1052. doi: 10.1097/00005768-199907000-00019. [DOI] [PubMed] [Google Scholar]
  48. Pezzullo D. J., Karas S., Irrgang J. J. Functional plyometric exercises for the throwing athlete. J Athl Train. 1995 Mar;30(1):22–26. [PMC free article] [PubMed] [Google Scholar]
  49. Pope M. H., Johnson R. J., Brown D. W., Tighe C. The role of the musculature in injuries to the medial collateral ligament. J Bone Joint Surg Am. 1979 Apr;61(3):398–402. [PubMed] [Google Scholar]
  50. Pousson M., Van Hoecke J., Goubel F. Changes in elastic characteristics of human muscle induced by eccentric exercise. J Biomech. 1990;23(4):343–348. doi: 10.1016/0021-9290(90)90062-8. [DOI] [PubMed] [Google Scholar]
  51. Rossi A., Grigg P. Characteristics of hip joint mechanoreceptors in the cat. J Neurophysiol. 1982 Jun;47(6):1029–1042. doi: 10.1152/jn.1982.47.6.1029. [DOI] [PubMed] [Google Scholar]
  52. Sainburg R. L., Poizner H., Ghez C. Loss of proprioception produces deficits in interjoint coordination. J Neurophysiol. 1993 Nov;70(5):2136–2147. doi: 10.1152/jn.1993.70.5.2136. [DOI] [PMC free article] [PubMed] [Google Scholar]
  53. Schaefer S. L., Ciarelli M. J., Arnoczky S. P., Ross H. E. Tissue shrinkage with the holmium:yttrium aluminum garnet laser. A postoperative assessment of tissue length, stiffness, and structure. Am J Sports Med. 1997 Nov-Dec;25(6):841–848. doi: 10.1177/036354659702500619. [DOI] [PubMed] [Google Scholar]
  54. Sharpe M. H., Miles T. S. Position sense at the elbow after fatiguing contractions. Exp Brain Res. 1993;94(1):179–182. doi: 10.1007/BF00230480. [DOI] [PubMed] [Google Scholar]
  55. Skinner H. B., Wyatt M. P., Hodgdon J. A., Conard D. W., Barrack R. L. Effect of fatigue on joint position sense of the knee. J Orthop Res. 1986;4(1):112–118. doi: 10.1002/jor.1100040115. [DOI] [PubMed] [Google Scholar]
  56. Skinner H. B., Wyatt M. P., Stone M. L., Hodgdon J. A., Barrack R. L. Exercise-related knee joint laxity. Am J Sports Med. 1986 Jan-Feb;14(1):30–34. doi: 10.1177/036354658601400106. [DOI] [PubMed] [Google Scholar]
  57. Smith R. L., Brunolli J. Shoulder kinesthesia after anterior glenohumeral joint dislocation. Phys Ther. 1989 Feb;69(2):106–112. doi: 10.1093/ptj/69.2.106. [DOI] [PubMed] [Google Scholar]
  58. Solomonow M., Guanche C., Wink C., Knatt T., Baratta R. V., Lu Y. Mechanoreceptors and reflex arc in the feline shoulder. J Shoulder Elbow Surg. 1996 Mar-Apr;5(2 Pt 1):139–146. doi: 10.1016/s1058-2746(96)80009-7. [DOI] [PubMed] [Google Scholar]
  59. Swanik C. B., Henry T. J., Lephart S. M. Chronic brachial plexopathies and upper extremity proprioception and strength. J Athl Train. 1996 Apr;31(2):119–124. [PMC free article] [PubMed] [Google Scholar]
  60. Symeonides P. P. The significance of the subscapularis muscle in the pathogenesis of recurrent anterior dislocation of the shoulder. J Bone Joint Surg Br. 1972 Aug;54(3):476–483. [PubMed] [Google Scholar]
  61. Tibone J. E., Fechter J., Kao J. T. Evaluation of a proprioception pathway in patients with stable and unstable shoulders with somatosensory cortical evoked potentials. J Shoulder Elbow Surg. 1997 Sep-Oct;6(5):440–443. doi: 10.1016/s1058-2746(97)70050-8. [DOI] [PubMed] [Google Scholar]
  62. Townsend H., Jobe F. W., Pink M., Perry J. Electromyographic analysis of the glenohumeral muscles during a baseball rehabilitation program. Am J Sports Med. 1991 May-Jun;19(3):264–272. doi: 10.1177/036354659101900309. [DOI] [PubMed] [Google Scholar]
  63. Vangsness C. T., Jr, Ennis M., Taylor J. G., Atkinson R. Neural anatomy of the glenohumeral ligaments, labrum, and subacromial bursa. Arthroscopy. 1995 Apr;11(2):180–184. doi: 10.1016/0749-8063(95)90064-0. [DOI] [PubMed] [Google Scholar]
  64. Warner J. J., Lephart S., Fu F. H. Role of proprioception in pathoetiology of shoulder instability. Clin Orthop Relat Res. 1996 Sep;(330):35–39. doi: 10.1097/00003086-199609000-00005. [DOI] [PubMed] [Google Scholar]
  65. Whitley J. D., Terrio T. Changes in peak torque arm-shoulder strength of high school baseball pitchers during the season. Percept Mot Skills. 1998 Jun;86(3 Pt 2):1361–1362. doi: 10.2466/pms.1998.86.3c.1361. [DOI] [PubMed] [Google Scholar]
  66. Wilk K. E., Arrigo C. A., Andrews J. R. Current concepts: the stabilizing structures of the glenohumeral joint. J Orthop Sports Phys Ther. 1997 Jun;25(6):364–379. doi: 10.2519/jospt.1997.25.6.364. [DOI] [PubMed] [Google Scholar]
  67. Wilk K. E., Arrigo C. Current concepts in the rehabilitation of the athletic shoulder. J Orthop Sports Phys Ther. 1993 Jul;18(1):365–378. doi: 10.2519/jospt.1993.18.1.365. [DOI] [PubMed] [Google Scholar]
  68. Wilk K. E., Voight M. L., Keirns M. A., Gambetta V., Andrews J. R., Dillman C. J. Stretch-shortening drills for the upper extremities: theory and clinical application. J Orthop Sports Phys Ther. 1993 May;17(5):225–239. doi: 10.2519/jospt.1993.17.5.225. [DOI] [PubMed] [Google Scholar]
  69. Wojtys E. M., Wylie B. B., Huston L. J. The effects of muscle fatigue on neuromuscular function and anterior tibial translation in healthy knees. Am J Sports Med. 1996 Sep-Oct;24(5):615–621. doi: 10.1177/036354659602400509. [DOI] [PubMed] [Google Scholar]
  70. Woo S. L. Mechanical properties of tendons and ligaments. I. Quasi-static and nonlinear viscoelastic properties. Biorheology. 1982;19(3):385–396. doi: 10.3233/bir-1982-19301. [DOI] [PubMed] [Google Scholar]
  71. Worrell T. W., Corey B. J., York S. L., Santiestaban J. An analysis of supraspinatus EMG activity and shoulder isometric force development. Med Sci Sports Exerc. 1992 Jul;24(7):744–748. [PubMed] [Google Scholar]

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