Arthritis of the Shoulder
The term arthritis literally means inflammation of a joint but is generally used to describe any condition in which there is damage to the cartilage. Damage of the cartilage in the shoulder joint causes shoulder arthritis. Inflammation is the body's natural response to injury. The warning signs that inflammation presents are redness, swelling, heat, and pain.
Shoulder instability is a chronic condition that causes frequent dislocation of the shoulder joint. The common symptoms of shoulder instability include pain with certain movements of the shoulder, popping or grinding sound that may be heard or felt, swelling and bruising of the shoulder seen immediately following subluxation or dislocation.
Shoulder tendonitis is a condition characterized by inflammation of the tendons which connect the muscles to the shoulder bones. Tendonitis of the rotator cuff tendons is known as rotator cuff tendonitis. If the biceps tendon is affected, the condition is known as bicipital tendonitis.
Overhead Athlete's Shoulder
An overhead athlete is at increased risk of injury due to the mechanism associated with rapid shoulder elevation, external rotation, and abduction. An overhead throwing motion is an intricate and skillful movement that presents a special challenge of needing the glenohumeral joint to surpass its physiologic limits during overhead sports activities.
Acromioclavicular (AC) Arthritis
The acromioclavicular joint is part of the shoulder joint. It is formed by the union of the acromion, a bony process of the shoulder blade, and the outer end of the collar bone or clavicle. The joint is lined by cartilage that gradually wears with age as well as with repeated overhead or shoulder level activities such as basketball. The condition is referred to as AC arthritis or acromioclavicular arthritis.
Acromioclavicular (AC) Joint Osteoarthritis
Osteoarthritis also called degenerative joint disease, is the most common form of arthritis. It occurs most often in older people. AC joint osteoarthritis affects the tissue covering the ends of bones (cartilage) in the AC joint of the shoulder. The cartilage becomes damaged and worn out causing pain, swelling, stiffness and restricted movement in the AC joint.
Rotator Cuff Tear
A rotator cuff is a group of tendons in the shoulder joint that provides support and enables a wide range of motion. A major injury to these tendons may result in rotator cuff tears. It is one of the most common causes of shoulder pain in middle-aged and older individuals.
The term SLAP (superior –labrum anterior-posterior) lesion or SLAP tear refers to an injury of the superior labrum of the shoulder. The most common symptom is a pain at the top of the shoulder joint. In addition, a catching sensation and pain most often with activities such as throwing may also occur.
Sports that involve overhead movements and repeated use of the shoulder at your workplace may lead to sliding of the upper arm bone from the glenoid. The dislocation might be a partial dislocation (subluxation) or a complete dislocation causing pain and shoulder joint instability. The shoulder joint often dislocates in the forward direction (anterior instability), and sometimes in the backward or downward direction.
Shoulder Labral Tear
Traumatic injury to the shoulder or overuse of the shoulder (throwing, weightlifting) may cause the labrum to tear. In addition, aging may weaken the labrum leading to injury. Your doctor may initially suggest conservative approaches such as prescribing anti-inflammatory medications and advise rest to relieve symptoms until diagnostic scans are performed.
A break in a bone that makes up the shoulder joint is called a shoulder fracture. The clavicle and end of the humerus closest to the shoulder are the bones that usually get fractured. The scapula, on the other hand, is not easily fractured because of its protective cover by the surrounding muscles and chest tissue.
Rotator Cuff Pain
Bicep Tendon Rupture at Shoulder
The biceps muscle is present on the front of your upper arm and functions to help you bend and rotate your arm. The biceps tendon is a tough band of connective fibrous tissue that attaches your biceps muscle to the bones in your shoulder on one side and the elbow on the other side.
Frozen shoulder, also called adhesive capsulitis, is a condition in which you experience pain and stiffness in your shoulder. The symptoms appear slowly, worsen gradually and usually take one to three years to resolve on their own.
Anterior Shoulder Instability
Anterior shoulder instability, also known as anterior glenohumeral instability, is a condition in which damage to the soft tissues or bone causes the head of the humerus (upper arm bone) to dislocate or sublux from the glenoid fossa, compromising the function of the shoulder.
Shoulder impingement is the inflammation of the tendons of the shoulder joint. It is one of the most common causes of pain in the shoulder. Shoulder impingement is also called swimmer’s shoulder, tennis shoulder or rotator cuff tendinitis.
The shoulder is a highly mobile ball and socket joint. The ball of the upper arm bone (humerus) is held in place at the socket (glenoid) of the shoulder blade (scapula) by a group of ligaments. A partial dislocation of the shoulder joint is termed as a subluxation.
Little League Shoulder
Little league shoulder is an injury to the growth plate of the upper arm bone at the shoulder joint of children. It is an overuse injury caused by repeated pitching or throwing, especially in children between the ages of 10 to 15 years.
The break or fracture of the clavicle (collarbone) is a common sports injury associated with contact sports such as football and martial arts, as well as impact sports such as motor racing. A direct blow over the shoulder that may occur during a fall on an outstretched arm or a motor vehicle accident may cause the clavicle bone to break.
Fractures of the glenoid are rare but can occur due to major trauma or during high-energy sports activities. The symptoms of a glenoid fracture may include shoulder pain, swelling, a deformity at the site of the fracture and inability to move the arm.
Proximal Humerus Fractures
Fractures of the proximal humerus are common in elderly individuals suffering from osteoporosis. In younger individuals, a severe trauma such as a fall from a height on an outstretched hand or motor vehicle accident can cause these fractures.
Bicep Tendon Rupture
The biceps muscle is located in the front side of your upper arm and functions to help you bend and rotate your arm. The biceps tendon is a tough band of connective fibrous tissue that attaches your biceps muscle to the bones in your shoulder on one side and the elbow on the other side.
AC Joint Dislocation/Acromioclavicular Joint Dislocation
A dislocation occurs when the ends of your bones are partially or completely moved out of their normal position in a joint. A partial dislocation is referred to as a subluxation, whereas a complete separation is referred to as a dislocation.
Multidirectional Instability of the Shoulder
Instability may be described by the direction in which the humerus is subluxated or dislocated from the glenoid. When it occurs in several directions it is referred to as multidirectional instability.
Shoulder Labral Tear with Instability
The shoulder consists of a ball-and-socket joint formed by the upper end of the humerus (upper arm bone) and a cavity in the shoulder blade called the glenoid. The glenoid cavity is surrounded by a rim of cartilage called the labrum.
Subacromial Impingement Syndrome
SAIS is the inflammation and irritation of your rotator cuff tendons. This occurs when the tendons rub against the outer end of the shoulder blade (the acromion) while passing through the subacromial space during shoulder movement.
Posterior Shoulder Instability
Posterior shoulder instability, also known as posterior glenohumeral instability, is a condition in which the head of the humerus (upper arm bone) dislocates or subluxes posteriorly from the glenoid (socket portion of the shoulder) as a result of significant trauma.
Proximal Biceps Tendinitis
Proximal biceps tendinitis is the irritation and inflammation of the biceps tendon at the shoulder joint. The biceps muscle is the muscle of the upper arm which is necessary for the movement of the shoulder and elbow.
AC Joint Separation
AC joint separation, also known as shoulder separation, is a condition characterized by damage to the ligaments that connect the acromion to the collar bone. As a result, the bones do not line up properly, causing joint pain and instability.
Rotator Cuff Calcification
Rotator cuff calcification is the abnormal accumulation of calcium deposits in rotator cuff muscles and tendons. The rotator cuff is a group of 4 muscles and tendons in the shoulder joint that join the head of the humerus to the shoulder.
Partial Rotator Cuff Tear
A partial rotator cuff tear is an incomplete tear that involves damage to a part of the tendon. The tear can be at the top, bottom or inner side of the tendon and does not go all the way through the tendon completely.
Rotator Cuff Re-tear
Rotator cuff repair is a surgery to repair an injured or torn rotator cuff. A re-tear may occur a few years after surgery due to multiple reasons including aging, a massive previous tear (more than 5cm), fatty degradation of the tendons, inflammatory arthritis, and inappropriate rehabilitation.
Baseball and Shoulder Injuries
Shoulder injuries in baseball players are usually associated with pitching. While this overhand throwing activity can produce great speed and distance for the ball, when performed repeatedly, can place a lot of stress on the shoulder.
Throwing Injuries of the Shoulder
Throwing injuries of the shoulder are injuries sustained as a result of trauma by athletes during sports activities that involve repetitive overhand motions of the arm as in baseball, American football, volleyball, rugby, tennis, track and field events, etc.
Internal Impingement of the Shoulder
Internal shoulder impingement can be described as a pathological condition resulting from repetitive impingement of the internal surface of the rotator cuff by the bones at the back of the glenohumeral joint.
Proximal Biceps Tendon Rupture
The biceps muscle is the muscle of the upper arm which is necessary for the movement of the shoulder and elbow. It is made of a ‘short head’ and a ‘long head’ which function together.
Long Head Biceps Tendon Rupture
Your biceps muscle has two heads, a long head, and a short head, which are both attached to the shoulder. The long head of the biceps tendon is a tough band of connective fibrous tissue that attaches the long head of the biceps to the top of the shoulder socket.
Periprosthetic Shoulder Infection
A periprosthetic shoulder joint infection is a very rare, but devastating complication of shoulder replacement surgery characterized by infection of the tissues surrounding your shoulder prosthesis.
Calcification tendinitis is a problem with the shoulder’s tendons and muscles. This condition occurs due to the formation of calcium deposits in the tendons (tissue which attaches muscle to bone) of the rotator cuff (a group of muscles and tendons stabilizing the shoulder).
Arthroscopy is a minimally invasive diagnostic and surgical procedure performed for joint problems. Shoulder arthroscopy is performed using a pencil-sized instrument called an arthroscope. The arthroscope consists of a light system and camera that projects images of the surgical site onto a computer screen for your surgeon to clearly view.
Shoulder Joint Replacement
Total shoulder replacement surgery is performed to relieve symptoms of severe shoulder pain and disability due to arthritis. In this surgery, the damaged articulating parts of the shoulder joint are removed and replaced with artificial prostheses. Replacement of both the humeral head and the socket is called a total shoulder replacement.
Reverse Shoulder Replacement
Conventional surgical methods such as total shoulder joint replacement are not very effective in the treatment of rotator cuff arthropathy. Reverse total shoulder replacement is an advanced surgical technique specifically designed for rotator cuff tear arthropathy.
Rotator Cuff Repair
Rotator cuff repair is a surgery to repair an injured or torn rotator cuff. It is usually performed arthroscopically on an outpatient basis. An arthroscope, a small, fiber-optic instrument consisting of a lens, light source, and video camera.
A SLAP repair is a minimally invasive surgery that uses an arthroscope, a tube with a light and camera on the end that projects images onto a monitor for your surgeon to view inside your joint.
Revision Shoulder Replacement
Total shoulder replacement is the replacement of the head of the humerus (upper arm bone) and the glenoid cavity (cavity of the shoulder blade) into which the humerus fits, with artificial prostheses to relieve pain, swelling, and stiffness caused due to damage of cartilage at the articulating surfaces.
Minimally Invasive Shoulder Joint Replacement
Shoulder joint replacement is a surgical procedure that replaces damaged bone surfaces with artificial humeral and glenoid components to relieve pain and improve functional ability in the shoulder joint.
The shoulder joint provides a wide range of movement to the upper extremity, but overuse or trauma can cause instability to the joint. The Latarjet procedure is a surgical procedure performed to treat shoulder instability by relocating a piece of bone with an attached tendon to the shoulder joint.
When conservative treatment options such as medications, rest and ice application fail to relieve shoulder instability, your surgeon may recommend shoulder stabilization surgery.
Acromioclavicular (AC) Joint Reconstruction
The acromioclavicular (AC) joint is one of the joints present within your shoulder. It is formed between a bony projection at the top of the shoulder blade (acromion) and the outer end of the clavicle (collarbone). The joint is enclosed by a capsule and supported by ligaments.
Shoulder Labrum Reconstruction
Traumatic injury to the shoulder or overuse of the shoulder by excessive throwing or weightlifting can cause a labral tear. In addition, the aging process may weaken the labrum, leading to injury secondary to wear and tear.
Triceps repair is a surgical procedure that involves the repair of a ruptured (torn) triceps tendon. A tendon is a tough band of fibrous tissue which connects muscle to bone and works together with muscles in moving your arms, fingers, legs, and toes. The triceps tendons connect the triceps muscles to the shoulder blade and elbow in your arm.
Proximal Biceps Tenodesis
Proximal biceps tenodesis is the surgical reattachment of a torn proximal biceps tendon, which connects the upper part of your biceps muscle to the shoulder.
Acromioplasty is the surgical removal of a small part of the surface of the acromion (bony process on your shoulder blade). The shoulder joint is made up of a ball and socket joint, where the head of the humerus (upper arm bone) articulates with the socket of the scapula (shoulder blade), which is called the glenoid.
Arthroscopic Bankart Repair
The labrum can sometimes tear during a shoulder injury. A specific type of labral tear that occurs when the shoulder dislocates is called a Bankart tear. This is a tear to a part of the labrum called the inferior glenohumeral ligament and is common in the young who sustain a dislocation of the shoulder.
Distal Clavicle Excision
Distal clavicle excision is a procedure which involves removal of the outer end of the clavicle (collarbone) to treat shoulder pain and disability due to arthritis or impingement.
Pectoralis Major Tears/Repairs
The pectoralis muscle is a large fan-shaped muscle comprised of the pectoralis major and pectoralis minor muscles that stretch from the armpit to the collarbone and down across the lower chest region on both sides of the chest. The two sides of the chest connect at the breastbone or sternum.
Open Glenoid Bone Grafting
The glenoid, also called the glenoid cavity or glenoid fossa, is a shallow depression in the shoulder blade (scapula) that connects the upper arm bone (humerus) with the collar bone (clavicle).
ORIF of the Clavicle Fractures
A clavicle fracture refers to a broken collarbone and is a common injury associated with contact sports such as football and martial arts, as well as impact sports such as motor racing. A direct blow over the shoulder, a fall on an outstretched arm, or a motor vehicle accident may also cause the clavicle bone to break.
Subacromial decompression is a surgical procedure performed for the treatment of a condition called shoulder impingement. In shoulder impingement, the degree of space between the rotator cuff tendon and shoulder blade is decreased due to irritation and swelling of the bursa or due to development of bone spurs.
Arthroscopic Superior Capsular Reconstruction (SCR)
Superior Capsular Reconstruction is a surgical procedure to repair massive, irreparable rotator cuff tears. The surgery involves reconstruction of the superior capsule of the shoulder joint using an autograft (tissue from the same person) or an allograft (tissue from a donor).
Shoulder Fracture Care
A break in the bone that makes up the shoulder joint is called a shoulder fracture. The clavicle (collarbone) and end of the humerus (upper arm bone) closest to the shoulder are the bones that usually are fractured. The scapula, or shoulder blade, is not easily fractured because of its protective cover of surrounding muscles and chest tissue.
The shoulder is the most flexible joint in the body that enables a wide range of movements including forward flexion, abduction, adduction, external rotation, internal rotation, and 360-degree circumduction. Thus, the shoulder joint is considered the most insecure joint of the body, but the support of ligaments, muscles, and tendons function to provide the required stability.
Bones of the Shoulder
The shoulder joint is a ball and socket joint made up of three bones, namely the humerus, scapula, and clavicle.
The end of the humerus or upper arm bone forms the ball of the shoulder joint. An irregular shallow cavity in the scapula called the glenoid cavity forms the socket for the head of the humerus to fit in. The two bones together form the glenohumeral joint, which is the main joint of the shoulder.
Scapula and Clavicle
The scapula is a flat triangular-shaped bone that forms the shoulder blade. It serves as the site of attachment for most of the muscles that provide movement and stability to the joint. The scapula has four bony processes - acromion, spine, coracoid and glenoid cavity. The acromion and coracoid process serve as places for attachment of the ligaments and tendons.
The clavicle bone or collarbone is an S-shaped bone that connects the scapula to the sternum or breastbone. It forms two joints: the acromioclavicular joint, where it articulates with the acromion process of the scapula and the sternoclavicular joint where it articulates with the sternum or breast bone. The clavicle also forms a protective covering for important nerves and blood vessels that pass under it from the spine to the arms.
Soft Tissues of the Shoulder
The ends of all articulating bones are covered by smooth tissue called articular cartilage, which allows the bones to slide over each other without friction, enabling smooth movement. Articular cartilage reduces pressure and acts as a shock absorber during movement of the shoulder bones. Extra stability to the glenohumeral joint is provided by the glenoid labrum, a ring of fibrous cartilage that surrounds the glenoid cavity. The glenoid labrum increases the depth and surface area of the glenoid cavity to provide a more secure fit for the half-spherical head of the humerus.
Ligaments of the Shoulder
Ligaments are thick strands of fibers that connect one bone to another. The ligaments of the shoulder joint include:
Coracoclavicular ligaments: These ligaments connect the collarbone to the shoulder blade at the coracoid process.
Acromioclavicular ligament: This connects the collarbone to the shoulder blade at the acromion process.
Coracoacromial ligament: It connects the acromion process to the coracoid process.
Glenohumeral ligaments: A group of 3 ligaments that form a capsule around the shoulder joint and connect the head of the arm bone to the glenoid cavity of the shoulder blade. The capsule forms a watertight sac around the joint. Glenohumeral ligaments play a very important role in providing stability to the otherwise unstable shoulder joint by preventing dislocation.
Muscles of the Shoulder
The rotator cuff is the main group of muscles in the shoulder joint and is comprised of 4 muscles. The rotator cuff forms a sleeve around the humeral head and glenoid cavity, providing additional stability to the shoulder joint while enabling a wide range of mobility. The deltoid muscle forms the outer layer of the rotator cuff and is the largest and strongest muscle of the shoulder joint.
Tendons of the Shoulder
Tendons are strong tissues that join muscle to bone allowing the muscle to control the movement of the bone or joint. Two important groups of tendons in the shoulder joint are the biceps tendons and rotator cuff tendons.
Bicep tendons are the two tendons that join the bicep muscle of the upper arm to the shoulder. They are referred to as the long head and short head of the bicep.
Rotator cuff tendons are a group of four tendons that join the head of the humerus to the deeper muscles of the rotator cuff. These tendons provide more stability and mobility to the shoulder joint.
Nerves of the Shoulder
Nerves carry messages from the brain to muscles to direct movement (motor nerves) and send information about different sensations such as touch, temperature, and pain from the muscles back to the brain (sensory nerves). The nerves of the arm pass through the shoulder joint from the neck. These nerves form a bundle at the region of the shoulder called the brachial plexus. The main nerves of the brachial plexus are the musculocutaneous, axillary, radial, ulnar and median nerves.
Blood vessels of the Shoulder
Blood vessels travel along with the nerves to supply blood to the arms. Oxygenated blood is supplied to the shoulder region by the subclavian artery that runs below the collarbone. As it enters the region of the armpit, it is called the axillary artery and further down the arm, it is called the brachial artery.
The main veins carrying de-oxygenated blood back to the heart for purification include:
- Axillary vein: This vein drains into the subclavian vein.
- Cephalic vein: This vein is found in the upper arm and branches at the elbow into the forearm region. It drains into the axillary vein.
- Basilic vein: This vein runs opposite the cephalic vein, near the triceps muscle. It drains into the axillary vein.