Shoulder Conditions
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.
Shoulder Instability
Shoulder instability is a chronic condition that causes frequent dislocation of the shoulder joint. A dislocation occurs when the end of the humerus (ball portion) partially or completely dislocates from the glenoid (socket portion) of the shoulder.
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.
Shoulder Dislocation
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.
Shoulder Fracture
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.
Frozen Shoulder
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.
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.
Clavicle Fracture
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.
Shoulder Pain
Pain in the shoulder may suggest an injury, which is more common in athletes participating in sports such as swimming, tennis, pitching, and weightlifting. The injuries are caused due to the over usage or repetitive motion of the arms.
Shoulder Impingement
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.
SLAP Tears
The term SLAP (superior–labrum anterior-posterior) lesion or SLAP tear refers to an injury of the superior labrum of the shoulder.
Shoulder Trauma
Shoulder injuries most commonly occur in athletes participating in sports such as swimming, tennis, pitching, and weightlifting. The injuries are caused due to the over usage or repetitive motion of the arms.
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.
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.
Calcification Tendinitis
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).
Shoulder Procedures
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.
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.
Shoulder Arthroscopy
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 Stabilization
Shoulder stabilization surgery is performed to improve stability and function to the shoulder joint and prevent recurrent dislocations. It can be performed arthroscopically, depending on your particular condition, with much smaller incisions.
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.
Shoulder Labrum Reconstruction
The shoulder joint is a ball and socket joint. A ball at the top of the upper arm bone (the humerus) fits neatly into a socket, called the glenoid, which is part of the shoulder blade (scapula). The labrum is a ring of fibrous cartilage surrounding the glenoid, which helps in stabilizing the shoulder joint. The biceps tendon is attached inside the shoulder joint at the superior labrum of the joint.
SLAP Repair
A SLAP repair is an arthroscopic shoulder procedure to treat a specific type of injury to the labrum called a SLAP tear.
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.
Latarjet Procedure
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.
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.
Capsular Release
A capsular release of the shoulder is surgery performed to release a tight and stiff shoulder capsule, a condition called frozen shoulder or adhesive capsulitis. The procedure is usually performed arthroscopically through keyhole-size incisions.
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.
Triceps Repair
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.
Intraarticular Shoulder Injection
The shoulder is prone to different kinds of injuries and inflammatory conditions. An intraarticular shoulder injection is a minimally invasive procedure to treat pain and improve shoulder movement. It may be performed with the help of ultrasound or fluoroscopic imaging which allows your physician to precisely target the intraarticular space.
Shoulder Anatomy
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.
Humerus
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.