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.
Arthroscopic Subacromial Decompression Surgery
Subacromial decompression surgery is performed to treat shoulder impingement, one of the most common causes of shoulder pain. Shoulder impingement causes the bones and tendons of the shoulder to rub painfully against each other when the arm is raised.
Partial Shoulder Replacement
Partial shoulder replacement, also called shoulder hemiarthroplasty, is a surgical procedure during which the upper bone in the arm (humerus) is replaced with a prosthetic metal implant, whereas the other half of the shoulder joint (glenoid or socket) is left intact.
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, a condition where you suffer from both shoulder arthritis and a rotator cuff tear.
Revision Shoulder Replacement
Total shoulder replacement usually has good results, but a revision surgery may occasionally be necessary due to persistent pain, infection, stiffness, weakness, instability, hardware loosening, malposition or fracture.
Computer Navigation for Shoulder Replacement
Computer navigated shoulder replacement is an image-guided, minimally invasive surgical procedure in which the damaged or worn out articulating surfaces of the shoulder joint are removed and replaced with artificial prostheses under the assistance of advanced computer technology to relieve pain and restore normal functioning of the shoulder joint.
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.
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.
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 an arthroscopic shoulder procedure to treat a specific type of injury to the labrum called a SLAP tear.
AC Joint Repair
AC joint repair is a surgical procedure performed to repair damaged or torn ligaments and tendons of the acromioclavicular (AC) joint. Depending on the severity of the injury, the surgery can be done through tiny keyhole incisions arthroscopically, or as open surgery through a relatively larger skin incision.
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.
Shoulder Preservation Surgery
Shoulder preservation surgery is any surgical procedure that is aimed at preserving the structure and function of the shoulder. It may be a good option when non-surgical treatments fail to relieve shoulder symptoms as it is less invasive than shoulder joint replacement surgery.
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.
AC Joint Stabilisation
Acromioclavicular (AC) joint stabilization is a surgical procedure employed to treat severe cases of AC joint dislocation.
Shoulder Reconstruction Surgery
Shoulder reconstruction surgery is an operative procedure in which stretched or torn soft-tissue structures that surround the shoulder joint such as the capsule, ligaments, and cartilage, are repaired to secure the shoulder joint in place.
Complex Shoulder Reconstruction
Shoulder instability is a condition in which the structures that surround the shoulder joint, such as the ligaments, capsule and cartilage, become overstretched or injured. When this occurs, it can lead to shoulder joint dislocation.
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.
Sternoclavicular Joint Reconstruction
Sternoclavicular joint reconstruction is a surgical procedure employed to repair and restore full function of a damaged sternoclavicular joint.
The shoulder is an active joint is prone to injuries and may also get affected by conditions such as arthritis, which results in impaired functioning and related discomfort. The traditional method of treatment for such conditions is shoulder joint replacement.
Biologic Shoulder Resurfacing
Biologic shoulder resurfacing is a surgical procedure in which only the diseased part of your joint is replaced with a biological graft, rather than the complete joint with a metal or plastic prosthesis as seen in traditional shoulder replacement.
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.
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.
Malunion Surgery of the Shoulder
Malunion, also known as crooked healing, is the failure of a fractured bone to rejoin properly due to poor alignment of the fracture fragments. The condition results in abnormality and deformity of the bone (bent or twisted bone).
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.
Complex Fracture Repair of the Shoulder
Complex fracture repair of the shoulder is a surgical procedure that involves the use of surgical plates and screws to repair a severe fracture of the bones that form the shoulder joint. Complex shoulder fractures are usually accompanied by ligament and tendon injuries that may also need to be repaired.
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.
Distal Clavicle Excision
Distal clavicle excision is a procedure that involves removal of the outer end of the clavicle (collarbone) to treat shoulder pain and disability due to arthritis or impingement.
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.
Proximal Humerus Resection and Reconstruction
The proximal humerus is a common site for benign, primary malignant, or metastatic neoplasms. Resection of the proximal humerus becomes necessary for the control of primary and metastatic bone tumors.
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.
Non-surgical Shoulder Treatments
Rest plays an important role in restoring shoulder health and shouldn’t be taken lightly. Usually, a sling is worn to keep the arm immobile and stable. You should try to avoid using the injured arm as straining the injured shoulder may lead to future complications. Physical rest can also help keep inflammation under control.
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.
Ultrasound-Guided Shoulder Injections
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. The ultrasound provides a clear view of organs, tendons, muscles and joints, and any associated disorders.
Viscosupplementation for Shoulder Arthritis
Viscosupplementation is a minimally invasive procedure that involves the injection of a hyaluronic acid preparation into the shoulder to treat arthritis. Hyaluronic acid is a naturally occurring substance which is present in the joint fluid that acts as a shock absorber and enhances lubrication.
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).
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.
A break in a bone that makes up the shoulder joint is called a shoulder 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.
Fracture of the Shoulder Blade (Scapula)
The scapula (shoulder blade) is a flat, triangular bone providing attachment to the muscles of the back, neck, chest and arm. The scapula has a body, neck and spine portion.
Fractures of the glenoid are rare but can occur due to major trauma or during high-energy sports activities.
Proximal Humerus Fractures
The humerus is the bone that forms the upper arm. It articulates with the glenoid cavity of the scapula (shoulder blade) to form the shoulder joint and with the lower arm bones – the ulna and radius – to form the elbow joint. The proximal humerus is the upper end of the arm bone that forms the shoulder joint.
Shoulder instability is a chronic condition that causes frequent dislocation of the shoulder joint.
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.
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.
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.
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.
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.
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 Labral Tear with Instability
Shoulder instability results when the humeral head is not held firmly within the glenoid cavity and may lead to a dislocation. Tearing, stretching or peeling of the labrum can result in shoulder instability. It can also occur with defects of the shoulder capsule and ligaments.
The term SLAP (superior –labrum anterior-posterior) lesion or SLAP tear refers to an injury of the superior labrum of the shoulder.
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.
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.
Distal Biceps Injuries
The biceps is a large muscle present in front of the upper arm, extending from the shoulder joint to the elbow. The lower end of the biceps muscle called the distal biceps forms a tendon which attaches to the upper part of the radius in the elbow. Injuries to this tendon are called distal biceps injuries.
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.
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 Ligament Injuries
Shoulder ligament injuries are injuries to the tough elastic tissues present around the shoulder that connect bones to each other and stabilize the joint. The ligaments present in the shoulder are connected to the ends of the scapula, humerus, and clavicle bones which form the shoulder complex.
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.
Shoulder bursitis, also known as subacromial bursitis, is a condition characterized by pain and inflammation in the bursa of the shoulder. The bursa is a fluid-filled sac present between the bone and soft tissue that acts as a cushion and helps to reduce friction during movement.
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. While pitching, the arm is thrown outward and backward to generate speed.
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.
Snapping scapula or snapping scapula syndrome is also known as scapulothoracic syndrome or scapulocostal syndrome. It is a condition characterized by painful clicking, snapping, or grinding of the shoulder blade. The sound occurs as a result of rubbing of soft tissues between the thoracic wall and the scapula.
The term arthritis means inflammation of a joint and is associated with cartilage damage. Cartilage is a cushioned padding lining the bones that make up a joint in order to absorb stress during movement. Damage of the cartilage in the sternoclavicular joint of the shoulder causes sternoclavicular arthritis.
Sternoclavicular Joint Injury
The sternoclavicular joint, commonly called the SC joint, is located between the breastbone (sternum) and the collarbone (clavicle). Sternoclavicular joint injuries can occur due to severe trauma or direct blows to the body as seen in motor vehicle accidents or in contact sports, where there is stretching or tearing of the supporting ligaments, and sometimes even fractures or dislocations.
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.
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.
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. This condition is mostly seen in baseball pitchers, but children in other sports who use improper throwing action are also at risk.
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.
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.
Acromioclavicular Joint Sprains
The collarbone and the shoulder blade are connected by the acromioclavicular joint. This is supported by a strong band of ligaments called the acromioclavicular and coracoclavicular ligaments. These ligaments are tightly wound around the bones, providing strength and support to the joint.
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.