Accessibility Tools

Shoulder

Shoulder Anatomy

The shoulder is the most flexible joint in the body enabling 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 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.

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 the thick strands of fibers that connect one bone to another. The ligaments of the shoulder joint include:

  • Coraco-clavicular ligaments: These ligaments connect the collarbone to the shoulder blade at the coracoid process.
  • Acromio-clavicular ligament: This connects the collarbone to the shoulder blade at the acromion process.
  • Coraco-acromial 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 water-tight 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.
Frozen Shoulder/ Adhesive Capsulitis

Frozen Shoulder/ Adhesive Capsulitis

Frozen shoulder, also called adhesive capsulitis, is a condition characterized by pain and loss of motion in the shoulder joint. It is more common in older adults aged between 40 and 60 years and is more common in women than men.

Biceps Tendon Rupture

Biceps Tendon Rupture

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.

Overuse and injury can cause fraying of the biceps tendon and eventual rupture.

Clavicle Fracture

Clavicle Fracture

Clavicle fracture, also called broken collarbone, is a very common sports injury seen in people who are involved in 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.

Humerus Fractures

Humerus Fractures

The humerus is the upper arm bone and it forms two joints —shoulder joint and elbow joint. The proximal humerus is the upper end of the arm bone that forms the shoulder joint. Fractures of the proximal humerus are common in elderly individuals suffering from osteoporosis.

Labral Tear

Labral Tear

Traumatic injury to the shoulder or overuse of shoulder (throwing, weightlifting) may cause labral tear. In addition, ageing may weaken the labrum leading to injury.

Rotator Cuff Tear

Rotator Cuff Tear

The rotator cuff is a group of tendons in the shoulder joint providing support and enabling a wide range of motion. Major injury to these tendons may result in tear of these tendons, a condition called rotator cuff tear. It is one of the most common causes of shoulder pain in middle aged adults and older individuals.

Shoulder Arthritis

Shoulder Arthritis

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.

Shoulder Bursitis

Shoulder Bursitis

A bursa is a small fluid-filled sac that is found between skin, muscles, tendons and bones. It lubricates and acts as a cushion in decreasing the friction, rubbing and irritation between these parts with movement. Bursitis refers to the inflammation or swelling of the bursa. It can affect the joints such as the hip, knee, elbow, shoulder and ankle.

Shoulder Dislocation

Shoulder Dislocation

Playing more overhead sports and repeated use of the shoulder at the workplace may lead to sliding of the upper arm bone, the ball portion, from the glenoid–the socket portion of the shoulder. The dislocation might be a partial dislocation (subluxation) or a complete dislocation causing pain and shoulder joint instability.

Shoulder Fracture

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.

Shoulder Impingement

Shoulder Impingement

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’, called the glenoid, which is part of the shoulder blade or scapula.

Shoulder Pain

Shoulder Pain

Pain in the shoulder suggests a shoulder 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.

Shoulder Trauma

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.

SLAP Tears

SLAP Tears

The term SLAP (superior –labrum anterior-posterior) lesion or SLAP tear refers to an injury of the superior labrum of the shoulder. The labrum is a ring of fibrous cartilage surrounding the glenoid for stabilization of the shoulder joint. The biceps tendon attaches inside the shoulder joint at the superior labrum of the shoulder joint.

Proximal Humerus Fractures

Proximal Humerus Fractures

The humerus is the upper arm bone and it forms two joints —shoulder joint and elbow joint. The proximal humerus is the upper end of the arm bone that forms the shoulder joint. Fractures of the proximal humerus are common in elderly individuals suffering from osteoporosis.

Shoulder Instability

Shoulder Instability

Shoulder instability is a chronic condition that causes frequent dislocations of the shoulder joint.

AC Joint Injuries (Shoulder Separation)

AC Joint Injuries (Shoulder Separation)

Acromioclavicular joint (AC joint) dislocation or shoulder separation is one of the most common injuries of the upper arm. It involves separation of the AC joint and injury to the ligaments that support the joint. The AC joint forms where the clavicle (collarbone) meets the shoulder blade (acromion).

Rotator Cuff Repair

Rotator Cuff Repair

The rotator cuff is a group of tendons in the shoulder that provide support and enable a wide range of motion of the shoulder joint. Major injuries can cause rotator cuff tears. A rotator cuff tear is one of the most common causes of shoulder pain in middle-aged adults and older individuals.

Shoulder Arthroscopy

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.

Total Shoulder Replacement

Total Shoulder Replacement

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.

Shoulder Labrum Reconstruction/Labral Repair

Shoulder Labrum Reconstruction/Labral Repair

Traumatic injury to the shoulder or overuse of the shoulder by excessive throwing or weightlifting can cause a labral tear. In addition, the ageing process may weaken the labrum, leading to injury secondary to wear and tear.

Shoulder Stabilization/ Labral Instability Repair

Shoulder Stabilization/ Labral Instability Repair

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.

Reverse Shoulder Replacement

Reverse Shoulder Replacement

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.

Revision Shoulder Surgery

Revision Shoulder Surgery

Revision surgery is usually performed under general anesthesia. You are positioned to allow all possible variations in the treatment plan. Incisions are made to gain optimal access to the problem, and usually follow previous incisions with extensions made as necessary.

Ultrasound Guided Shoulder Injections

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 of underlying pathology of the tissues and assists with diagnosis and planning the treatment of a condition.

Minimally Invasive Shoulder Surgery

Minimally Invasive Shoulder Surgery

Shoulder joint replacement is a surgical procedure to replace damaged bone surfaces with artificial components to relieve pain and improve functional ability in the shoulder joint. Shoulder joint replacement can be done by a traditional "open" approach or through a minimally invasive approach.

Biceps Repair/Tenodesis

Biceps Repair/Tenodesis

Arthroscopy to repair a proximal ruptured biceps tendon is performed in a hospital operating room under general anesthesia. The surgery is referred to as Arthroscopic Biceps Tenodesis. The surgeon will make several small incisions, about ¼ inch each, to the shoulder area.

Revision Shoulder Arthroplasty

Revision Shoulder Arthroplasty

Revision surgery is usually performed under general anesthesia. You are positioned to allow all possible variations in the treatment plan. Incisions are made to gain optimal access to the problem, and usually follow previous incisions with extensions made as necessary.