The shoulder joint is a ball-and-socket joint that primarily consists of three parts; the shoulder blade (scapula), the collarbone (clavicle) and the upper arm (humerus). The head of the humerous rests in a shallow socket in the shoulder blade called the glenoid. Typically, the humeral head is much larger than the socket and a soft fibrous tissue rim (labrum) surrounds the socket to assist in stabilising the joint. The rim deepens the socket by up to 50%, thus giving the humeral head a better fit in the socket.
Shoulder joint replacements are usually performed in order to relieve pain and when all non-operative treatments have failed.
Reverse total shoulder replacement is an advanced surgical technique specifically designed for rotator cuff tear arthropathy, a condition where the patient suffers from both shoulder arthritis and a rotator cuff tear.
Shoulder hemiarthroplasty, also called partial shoulder replacement, 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.
The rotator cuff is the group of tendons in the shoulder joint that provide support and enable a wider range of motion. One of the most common causes of shoulder pain in middle-aged and elderly adults is due to injury of these tendons. This condition is known as a rotator cuff tear.
A rotator cuff tear results from pressure on the rotator cuff from part of the shoulder blade known as the scapula, as the arm is lifted. It may occur with repeated use of the arm for overhead activities, while playing sports or during motor accidents.
Rotator cuff tear causes severe pain, weakness of the arm, and a cracking sensation upon moving your shoulder in certain positions. There may be stiffness, swelling, loss of movement and tenderness in the front of the shoulder.
Your surgeon will diagnose a rotator cuff tear injury based on a physical examination, X-rays, and other imaging studies. This may include a MRI, as it provides the best imaging of a rotator cuff tear.
Rotator cuff repair may be performed by open surgery or arthroscopic procedure. In an arthroscopy procedure, space for rotator cuff tendons will be increased and the cuff tear is repaired using suture anchors. These anchor sutures help in attaching the tendons to the shoulder bone. Following the surgery you may be advised to practice motion and strengthening exercises.
Shoulder impingement is the condition of inflammation of the tendons of the shoulder joint. It is one of the most common causes of pain in the adult shoulder. The shoulder is a ‘ball-and-socket’ joint. A ‘ball’ at the top of the upper arm bone (humerus) fits neatly into a ‘socket’ (glenoid) which is part of the shoulder blade (scapula). Shoulder impingement is also known as swimmer’s shoulder, tennis shoulder or rotator cuff tendinitis.
Impingement occurs when the shoulder blade (scapula) puts pressure on the rotator cuff as the arm is lifted. It is more likely to occur in young and middle-aged people who engage in physical activities that require repeated overhead arm movements. The pain may be due to a “bursitis” or inflammation of the bursa overlying the rotator cuff or a “tendonitis” of the cuff itself. In some circumstances, a partial tear of the rotator cuff may cause impingement pain.
Individuals with shoulder impingement may experience severe pain at rest and during activities, weakness of the arm and difficulty in raising the hand overhead.
Diagnosis involves physical examination by a doctor who will examine the range of movement in the affected shoulder. X-rays and MRI scans may be ordered to see the injury and associated inflammation.
Shoulder impingement can be treated with rest, ice packs, anti-inflammatory drugs, and by avoiding activities that involve the shoulder. Physical therapy may be advised to strengthen the muscles and steroid injections may be given if pain persists.
Arthroscopic surgery is recommended if the rotator cuff tendons are torn and to remove any bony spurs.
Frozen shoulder, also called adhesive capsulitis is a condition characterized by pain and loss of motion in the shoulder joint. It is most common in older adults aged between 40 and 60 years and is more prevalent in women than men.
Frozen shoulder is caused by inflammation of the ligaments that hold the shoulder bones to each other. The shoulder capsule becomes thick, tight, and stiff bands of tissue called adhesions may develop.
Individuals at risk of developing frozen shoulder are those who:
Frozen shoulder may cause pain, stiffness and limit movement of the shoulder.
Frozen shoulder condition can be diagnosed by the presenting symptoms and radiological diagnostic procedures such as X-rays or MRI scans.
Conservative treatment options include:
Your surgeon may recommend shoulder arthroscopy when conservative treatments do not work. During surgery, the scar tissue will be removed and any tight ligaments will be dissected. Following surgery physical therapy is recommended to ensure full range of motion and muscle strength.
Shoulder instability is a chronic condition that causes frequent dislocations 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 as subluxation, whereas the complete separation is referred as dislocation.
The risk factors that increase the chances of developing shoulder instability include:
The common symptoms of shoulder instability include pain with certain movements of the shoulder and a popping or grinding sound that may be heard or felt. Swelling and bruising of the shoulder may be seen immediately following subluxation or dislocation. Visible deformity and loss of function of the shoulder occurs after subluxation. Sensation changes such as numbness or even partial paralysis can occur below the dislocation as a result of pressure on nerves and blood vessels.
The goal of conservative treatment for shoulder instability is to restore stability, strength, and full range of motion. Conservative treatment measures may include the following:
When these conservative treatment options fail to relieve shoulder instability, your surgeon may recommend shoulder stabilization 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 situation, with much smaller incisions. Arthroscopy is a surgical procedure in which an arthroscope, a small flexible tube with a light and video camera at the end, is inserted into a joint to evaluate and treat the condition. The benefits of arthroscopy compared to open shoulder surgery include; smaller incisions, minimal soft tissue trauma and less pain which equates to a faster recovery.
To find more shoulder conditions head to the orthopaedic connection website of American Academy of Orthopaedic Surgeons..