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.
The term SLAP (superior –labrum anterior-posterior) lesion or SLAP tear refers to an injury of the superior labrum of the shoulder.
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.
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.
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.
Shoulder instability is a chronic condition that causes frequent dislocation of the shoulder joint.
The shoulder is the most flexible joint in the body, enabling a wide range of movements. It is a ball-and-socket joint made up of three bones, namely the humerus (upper arm bone), scapula (shoulder blade) and clavicle. The head of the humerus articulates with the socket of the scapula called the glenoid cavity. The clavicle bone or collarbone is an S-shaped bone that connects the scapula to the sternum or breastbone.
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.
The biceps muscle is located in the front side of your upper arm and functions to help you bend and rotate your arm.
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.
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.
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.
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.
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.
Changing the course of rotator cuff disease
Traditional approaches focus only on biomechanical repair, but do not address the underlying biology of the tendon. The Smith & Nephew Rotator Cuff System is a new technology for improving the treatment of rotator cuff disease. It includes a bio-inductive implant that addresses both the biomechanics and biology required to heal a rotator cuff tear.
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.
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.
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 doctor to clearly view. Arthroscopy is used to treat disease conditions and injuries involving the bones, cartilage, tendons, ligaments, and muscles of the shoulder joint.
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.
The rotator cuff is a group of 4 muscles in the shoulder joint including the supraspinatus, infraspinatus, teres minor, and subscapularis. These muscles originate in the scapula and attach to the head of the humerus through tendons. The rotator cuff forms a sleeve around the humeral head and glenoid cavity, providing stability to the shoulder joint while enabling a wide range of movements.
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.
Shoulder instability is a chronic condition that causes 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.
A SLAP repair is an arthroscopic shoulder procedure to treat a specific type of injury to the labrum called a SLAP tear.
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.
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 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.
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.
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.
An arthroscopic frozen shoulder release is a minimally-invasive shoulder surgery performed to relieve pain and restore normal function using a special instrument called an “arthroscope”.
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.
AC Joint Repair
with Arthrex® Dog Bone™ Button
Distal Clavicle Fracture: Open Reduction Internal Fixation With a Distal Clavicle Plate and TightRope® Button Technique
FiberTak® DR Anchor Bridge Technique
FiberTak® Instability Repair
FiberTape® Cerclage System
Knotless Rotator Cuff Repair
with Arthrex® SpeedFix™
Knotless Shoulder Labral Repair
with Arthrex® PushLock®
Knotless SutureTak® Instability Repair
Latarjet for Instability
Loop 'N' Tack™ Biceps Tenodesis
Proximal Biceps Repair Using SwiveLock® Tenodesis System
Proximal Humerus Fracture Repair
with Arthrex® SuturePlate™
Proximal Humerus Fracture: Open Reduction Internal Fixation With SuturePlate™ Humeral Fracture Plating Technique
Posterosuperior Rotator Cuff Tears: PASTA Bridge Technique With Knotless Corkscrew® and SwiveLock® Anchors
Posterosuperior Rotator Cuff Tears: Knotless Double-Row Repair With SpeedBridge™ Technique and SwiveLock® Anchors
Posterosuperior Rotator Cuff Tears: Superior Capsular Reconstruction
Rotator Cuff Repair
with Arthrex® SutureBridge™
Rotator Cuff Repair
with SpeedBridge™ Technique
Subscapularis SpeedFix™ Technique
Superior Capsular Reconstruction
Subscapularis Tendon Tears: SpeedFix™ Knotless Single-Row Rotator Cuff Repair With SwiveLock® Anchors
Virtual Implant Positioning™ (VIP) System