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 scapulais 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 claviclebone 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 tendonsare 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 cufftendons 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.
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 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. This means the ball has partially moved out of the glenoid as opposed to a dislocation, where the ball completely moves out of the glenoid.
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.
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.
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. This condition is mostly seen in baseball pitchers, but children in other sports who use improper throwing action are also at risk.
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 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. While pitching, the arm is thrown outward and backward to generate speed.
The sternoclavicular joint is the joint between the breastbone (sternum) and the collar bone (clavicle). The SC joint is one of the 4 joints that complete the shoulder and is the only joint that links the arm to the body. Like any other joints, the SC joint is covered by articular cartilage that helps the bones slide effortlessly against each other during arm and shoulder movement.
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. Throwing injuries are mostly seen in the shoulder and elbow and can occur due to improper techniques, training errors, muscle imbalance, and overuse of muscles.
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.
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. The labrum adds depth to the cavity making the joint more stable and positions the ball within the socket.
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. These are connected to the shoulder joint by two tendons called the proximal biceps tendons and to the elbow joint by a single distal biceps tendon.
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.
A tear in the rotator cuff can cause pain and disability. It can occur from degeneration of the rotator cuff due to overuse or from a sudden injury. Massive rotator cuff tears involve tears in two complete tendons of the rotator cuff. A tear of more than 5 cm is described as massive. A massive tear may be associated with degeneration and retraction of the tendon and can be difficult to repair if treatment is delayed.
Your shoulder consists of a ‘ball-and-socket joint’. The humerus (upper arm bone) has a rounded head (ball) that is attached to the glenoid cavity (socket) in the shoulder blade. Certain injuries can cause dislocation of the joint and damage to the humeral head. Damage to the back and outer portion of the humeral head can result in a defect called a Hill-Sachs lesion.
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.
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.
An ultrasound is a common imaging technique that employs high-frequency sound waves to create images of organs and other internal structures of the body. These images provide valuable information about the underlying pathology of tissues and assists with diagnosis and planning the treatment of a condition.
Total shoulder replacement surgery is performed to relieve these symptoms. 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.
Conventional surgical methods such as total shoulder joint replacement have been shown to be significantly ineffective in the treatment of rotator cuff arthropathy. Reverse total shoulder replacement is an advanced surgical technique specifically designed for rotator cuff tear arthropathy, a condition where you suffer from both shoulder arthritis and a rotator cuff tear.
A humerus fracture is a condition that occurs when there is a break in the humerus or upper arm bone that commonly occurs as a result of severe trauma. Fracture of the humerus can affect the movement and function of your arm as well as your work and activities of daily living. Humerus fractures are quite common and occur in individuals of all ages from children to the elderly.
Scapular fractures are uncommon and require a large amount of force to fracture. They are usually the result of intense trauma, such as a high-speed motor vehicle accident or a fall from a height onto one’s back. They can also occur from a fall on an outstretched arm if the humeral head impacts the glenoid cavity.
The sternoclavicular (SC) joint is the joint between the breastbone (sternum) and the collar bone (clavicle). Injuries to this joint are called sternoclavicular joint injuries and can include stretching or tearing of the ligaments. It is usually caused due to severe trauma or a direct blow to the side of your body such as in motor vehicle accidents or contact sports.
A superior labrum anterior and posterior tear or SLAP tear is an injury to the labrum. This injury may also involve the biceps tendon, which is attached to the top part of the labrum. The injury occurs from repeated use of the shoulder while throwing or a fall onto the shoulder.
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. A Bankart tear makes the shoulder prone to repeat dislocation in patients under 30 years of age.
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.
Shoulder instability is a chronic condition that causes the frequent dislocation of the shoulder joint. A dislocation occurs when the end of the humerus (the ball portion) partially or completely dislocates from the glenoid (the socket portion) of the shoulder. A partial dislocation is referred to as a subluxation while a complete separation is referred to as a dislocation.
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.
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).
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.
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. Most clavicle fractures occur in the shaft or middle portion of the bone.
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.
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.
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 system by Arthrex is a web-based system onto which patient data and CT scan images can be easily uploaded. No software needs to be downloaded. It allows your surgeon to accurately position the implant components utilizing planning software and guidance instrumentation when performing shoulder arthroplasty.
The ArCC procedure is highly effective for shoulder stiffness from a variety of causes—frozen shoulder/adhesive capsulitis that fails nonoperative treatment, stiffness post-fracture, post-surgery, or after arthroplasty.