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Shoulder Procedures

Shoulder Joint Replacement

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. Replacement of both the humeral head and the socket is called a total shoulder replacement.

Reverse Shoulder Replacement

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

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.

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. 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. Arthroscopy is used to treat disease conditions and injuries involving the bones, cartilage, tendons, ligaments, and muscles of the shoulder joint.

Distal Clavicle Excision

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.

Partial Shoulder Replacement

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.

Pectoralis Major Tears/Repairs

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 pectoralis major is a powerful muscle that aids in rotating the arm inward and move it closer to the body.

Proximal Biceps Tenodesis

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.

Shoulder Resurfacing

Shoulder Resurfacing

Shoulder resurfacing is a surgical procedure, in which only the diseased part of your joint is replaced rather than the complete joint as in shoulder replacement.

Complex Fracture Repair of the Shoulder

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.

Triceps Repair

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. The triceps tendons connect the triceps muscles to the shoulder blade and elbow in your arm.

Intraarticular Shoulder Injection

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.

Exercises for Shoulder Impingement Syndrome

Exercises for Shoulder Impingement Syndrome

Shoulder impingement syndrome is a common condition seen in athletes and individuals who perform a lot of overhead arm movements. This activity results in irritation of the rotator cuff tendon as it repeatedly rubs against the acromion, which is the bony process of the shoulder blade. Here are some exercises for shoulder impingement syndrome that may help relieve your symptoms:

Shoulder Conditions

AC Joint Dislocation/Acromioclavicular Joint Dislocation

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.

Arthritis 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.

Bicep Tendon Rupture

Bicep Tendon Rupture

A biceps tendon rupture can either be partial, where it does not completely tear or complete, where it splits in two and is torn away from the bone.

Frozen Shoulder

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.

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.

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. The scapula, on the other hand, is not easily fractured because of its protective cover by the surrounding muscles and chest tissue.

Clavicle Fracture

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.

Shoulder Pain

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.

Periprosthetic Shoulder Infection

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.

Shoulder Bursitis

Shoulder Bursitis

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 Impingement

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 Tendonitis

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.

Shoulder Anatomy

Anatomy of the shoulder

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 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.
  • American Academy of Orthopaedic Surgeons
  • American Association of Hip and Knee Surgeons
  • International Congress for Joint Reconstruction
  • American Society for Surgery of the Hand
  • Orthopaedic Trauma Association