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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 Stabilisation
Shoulder stabilisation 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. Arthroscopic stabilisation is a surgical procedure to treat chronic instability of the shoulder joint.
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, fibre-optic instrument consisting of a lens, light source, and video camera.
SLAP Repair
A SLAP repair is an arthroscopic shoulder procedure to treat a specific type of injury to the labrum called a SLAP tear.
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.
Acromioclavicular (AC) Joint Reconstruction
Shoulder separation can usually be managed by non-surgical treatments. In cases of a severe separation of the AC joint, your surgeon may perform a surgical repair or use a tissue graft to reconstruct the damaged ligaments.
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.
AC Joint Stabilisation
Acromioclavicular (AC) joint stabilisation is a surgical procedure employed to treat severe cases of AC joint dislocation. AC joint dislocation is the separation of the collar bone or clavicle from the acromion (the top portion of the shoulder blade or scapula at the outer edge of the shoulder) due to severe trauma.
SC Joint Injury Reconstruction
Surgery to repair and restore function to the damaged SC joint is known as SC joint reconstruction.
Arthroscopic Bankart Repair
Bankart surgery can be performed by a minimally invasive surgical technique called arthroscopy.
Arthroscopic Frozen Shoulder Release
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”.
Sternoclavicular Joint Reconstruction
Sternoclavicular joint reconstruction is a surgical procedure employed to repair and restore full function of a damaged sternoclavicular joint.
Shoulder Labrum Reconstruction
During arthroscopic surgery for SLAP tears, your surgeon examines the labrum and the biceps tendon. If the damage is confined to the labrum without involving the tendon, then the torn flap of the labrum will be removed.
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.
Arthroscopic Acromioplasty
Arthroscopic acromioplasty is performed using an arthroscope, a small, fibre-optic instrument consisting of a lens, light source, and video camera. The camera projects images of the inside of the joint onto a large monitor, allowing your surgeon to look for any damage, assess the injury, and perform the repair.
Bony Instability Reconstruction of the Shoulder
Bony instability reconstruction of the shoulder is a surgical procedure to treat shoulder instability by relocating a piece of bone with an attached tendon to the shoulder joint.
Arthroscopic Scapulothoracic Bursectomy
Arthroscopic scapulothoracic bursectomy is a minimally invasive surgical procedure employed for the treatment of persistent scapulothoracic bursitis, also known as snapping scapula syndrome, in which inflamed scapulothoracic bursa is removed with the aid of an arthroscope.
Mumford Distal Clavicle Excision
A Mumford distal clavicle excision is a surgical procedure which involves excision or resection of the outer (distal) end of the clavicle, also called the collar bone.
ORIF of the Scapula Fractures
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.
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.
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).
Subacromial Decompression
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.
Pectoralis Major Tears/Repairs
A tear in the pectoralis major muscle occurs when the tendon attaching the muscle to the upper arm bone is damaged as a result of trauma or injury. In the case of a rupture, operative treatment is employed for repairing the torn muscle in active and young patients irrespective of the chronicity of the injury.
Latissimus Dorsi Tendon Transfer
Latissimus dorsi tendon transfer is a surgical procedure performed to reconstruct the irreparable rotator cuff tears in your shoulder. The procedure typically involves detaching the latissimus dorsi tendon from its original location and transferring it to the shoulder to repair the rotator cuff.
Lower Trapezius Tendon Transfer
Lower trapezius tendon transfer is a surgical procedure to treat massive, irreparable, posterosuperior rotator cuff tears of the shoulder.
Shoulder Resurfacing
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.
Non-surgical Shoulder Treatments
Shoulder injuries can often be treated by non-surgical methods including the following:
- Resting the Affected Shoulder
- Ice and Heat Treatment
- Medications
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.
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 Fracture Care
A broken clavicle usually heals without surgery, but if the bone ends have shifted out of place (displaced), surgery is recommended to align the bone ends and hold them stable during healing.
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.
Am I a Candidate for Shoulder Surgery?
More people are considering shoulder surgery to manage shoulder problems thanks to advances in technology and equipment. Surgery is now minimally invasive and can be performed on an outpatient basis with faster recovery and fewer complications.
Virtual Implant Positioning by Arthrex
The VIP (Virtual Implant Positioning) 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.
Conditions
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.
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.
SLAP Tears
The term SLAP (superior –labrum anterior-posterior) lesion or SLAP tear refers to an injury of the superior labrum of the shoulder.
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.
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.
Shoulder Labral Tear
Traumatic injury to the shoulder or overuse of the shoulder (throwing, weightlifting) may cause the labrum to tear. In addition, ageing may weaken the labrum leading to injury.
Shoulder Instability
Shoulder instability is a chronic condition that causes frequent dislocation of the shoulder joint.
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.
Shoulder Fracture
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.
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.
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.
Bicep Tendon Rupture
A biceps tendon rupture can either be partial, where it does not completely tear the tendon or complete, where the tendon completely splits in two and is torn away from the bone.
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.
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.
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.
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.
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 skilful movement that presents a special challenge of needing the glenohumeral joint to surpass its physiologic limits during overhead sports activities.
Snapping Scapula
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.
Glenoid Fractures
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.
Rotator Cuff Pain
The rotator cuff consists of a group of tendons and muscles that surround and stabilize the shoulder joint. These tendons allow a wide range of movement of the shoulder joint across multiple planes. Irritation or injury to these tendons can result in rotator cuff pain.
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.
Subluxation
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.
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. A partial dislocation is referred to as a subluxation whereas a complete separation is referred to as a dislocation.
Sternoclavicular Joint (SC joint)
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.
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. It is made of a ‘short head’ and a ‘long head’ which function together. The long head of the biceps tendon is attached at the top of the shoulder joint.
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.
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 ageing, a massive previous tear (more than 5cm), fatty degradation of the tendons, inflammatory arthritis, and inappropriate rehabilitation.
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.
Shoulder Tendonitis
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.
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.
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.
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. It forms a sleeve around the humeral head and glenoid cavity, providing additional stability to the shoulder joint while enabling a wide range of mobility.
Bicep Tendon Rupture at Shoulder
Overuse and injury can cause fraying of the biceps tendon and eventual rupture. A biceps tendon rupture can either be partial, where it does not completely tear the tendon or complete, where the tendon completely splits in two and is torn away from the bone.
Shoulder Disorders
The shoulder is the most flexible joint in the body that enables a wide range of movements. Ageing, trauma or sports activities can cause injuries and disorders that can range from minor sprains or strains to severe shoulder trauma
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.
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. 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.
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. The labrum adds depth to the cavity making the joint more stable and positions the ball within the socket.
AC Joint Dislocation/Acromioclavicular Joint Dislocation
AC joint dislocation is the separation of the collar bone or clavicle from the acromion (the top portion of the shoulder blade or scapula at the outer edge of the shoulder) due to severe trauma or injury. AC joint dislocation usually occurs as a result of a direct fall on to the top of the shoulder which causes the shoulder blade to be forced downwards and the collarbone to pop up.
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 stabilising the shoulder).
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.
Periprosthetic Shoulder Fracture
A periprosthetic shoulder fracture is a fracture that occurs in the bone adjacent to a shoulder prosthesis.
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.
Massive Retracted Rotator Cuff Tear
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.
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 breastbone. 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 fibres 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.
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