The shoulder is the most flexible joint in the body, allowing a wide range of movements. It consists of three bones: the humerus (upper arm), scapula (shoulder blade), and clavicle (collarbone). The humerus fits into the glenoid cavity of the scapula, forming the glenohumeral joint. The scapula attaches muscles for movement and stability, while the clavicle connects the scapula to the sternum. Articular cartilage covers the bones for smooth movement, and the glenoid labrum adds stability by deepening the socket.
Ligaments, such as the coracoclavicular, acromioclavicular, and glenohumeral ligaments, connect the bones and stabilize the joint. The rotator cuff, made up of four muscles, provides additional stability and mobility. Tendons, including those of the rotator cuff and biceps, link muscles to bones, enabling movement. The brachial plexus, a bundle of nerves, transmits signals from the brain to the muscles. Blood is supplied by the subclavian artery, which becomes the axillary and brachial arteries. The veins, including the axillary, cephalic, and basilic veins, carry de-oxygenated blood back to the heart.
Shoulder Procedures
Rotator Cuff Repair
The rotator cuff consists of four muscles in the shoulder: supraspinatus, infraspinatus, teres minor, and subscapularis. These muscles provide shoulder stability and allow a wide range of motion. Tears can occur from trauma, overuse, or aging.
Rotator Cuff Repair is surgery to fix a torn cuff, often done arthroscopically, using small instruments and a camera. Large tears may require open surgery.
Indications for Surgery
Surgery is recommended if non-surgical treatments fail, there is severe pain or weakness, or if you wish to return to sports.
The surgery is done under general or regional anesthesia and includes these steps:
Post Operative Care
Post-Operative Care includes pain management, a brace or cast, physical therapy, and a return to activities after 6 months.
Risks and Complications
Risks include anesthesia issues, infection, nerve damage, stiffness, and re-tear.
Shoulder Labrum Reconstruction
The shoulder joint is a ball-and-socket joint, with the humeral head fitting into the glenoid socket of the scapula. The labrum is a ring of cartilage around the glenoid, stabilizing the joint. The biceps tendon attaches to the superior labrum.
Shoulder Labral Tears can result from trauma, overuse (such as throwing or weightlifting), or aging. Symptoms include pain, locking, reduced movement, and joint instability.
Types of Labral Tears
Diagnosis
Diagnosis involves physical tests, imaging (X-rays, CT, MRI), and sometimes arthroscopy.
Treatment
Treatment starts with conservative measures like rest, anti-inflammatory drugs, and exercises. If symptoms persist, arthroscopic surgery may be needed, where the torn labrum is repaired or removed, and the tendon reattached if necessary.
Postoperative Care
Post-Surgery Care includes immobilization, pain management, and physical therapy to regain shoulder movement, with athletes returning to sports in about 3 months.
Risks and Complications
Risks of surgery include nerve injury, infection, stiffness, re-tear, and failure of the repair.
Shoulder Arthroscopy
The shoulder joint is a ball-and-socket joint where the humerus (upper arm bone) fits into the glenoid (shoulder blade socket). Cartilage covers the bones to reduce friction, and tendons and ligaments provide stability.
Injury or disease to the shoulder’s bones or soft tissues can lead to pain, inflammation, and reduced mobility.
What is Shoulder Arthroscopy?
Arthroscopy is a minimally invasive procedure using an arthroscope (a small camera) to diagnose and treat shoulder problems affecting bones, cartilage, tendons, ligaments, and muscles.
Advantages
Indications for Shoulder Arthroscopy
Arthroscopy is used when conservative treatments fail to relieve:
Procedure
Performed under general or regional anesthesia, the surgeon makes small incisions and inserts the arthroscope to view the joint. Surgical tools are used through separate incisions to repair or remove damage.
Postoperative Care
Recovery time varies based on the procedure’s extent. Pain medications, a sling, and physical therapy are recommended for mobility and strength.
Risks and Complications
Possible complications include infection, bleeding, nerve or blood vessel damage, delayed healing, or shoulder stiffness. Active participation in physical therapy is essential to prevent stiffness.
AC Joint Repair
AC joint repair is surgery to fix damaged or torn ligaments and tendons in the acromioclavicular (AC) joint. It can be done through small incisions (arthroscopically) or with a larger incision (open surgery), depending on the injury.
The AC joint is where the scapula (shoulder blade) meets the clavicle (collarbone) at the acromion. It’s supported by ligaments that help with shoulder movement.
Indications for Surgery
Surgery is needed if pain or deformity persists after conservative treatments for an AC joint injury.
AC Joint Repair Procedure
Under general anesthesia, the surgeon will assess the injury and choose either arthroscopy or open surgery. The joint may be repaired using pins, anchors, or screws, which will stay in place until healing is complete.
Risks and Complications
Risks include infection, bleeding, nerve or vessel damage, blood clots, persistent pain, and the need for further surgery.
Shoulder Stabilization
Shoulder instability is a chronic condition causing frequent dislocations of the shoulder joint. Dislocations happen when the ball of the humerus (upper arm bone) moves out of the socket (glenoid) of the shoulder. Partial dislocations are called subluxations, while complete separations are known as dislocations. Chronic instability results from repeated dislocations, often due to tears in the labrum, rotator cuff, or ligaments (e.g., Bankart lesion).
Arthroscopic surgery offers benefits over open surgery, such as less pain, fewer complications, a shorter hospital stay, and the ability to treat other joint issues.
Indications for Surgery
When conservative treatments like medications, rest, and ice fail, surgery may be recommended for shoulder stabilization.
Procedure
Shoulder stabilization surgery is designed to prevent recurrent dislocations and improve shoulder stability. It can be done arthroscopically with small incisions, making it minimally invasive. An arthroscope, a small fiber-optic instrument, is used to visualize the joint, and tiny surgical tools repair tears in the rotator cuff or ligaments. The procedure may include using sutures, anchors, or thermal shrinkage to tighten ligaments.
Postoperative Care
After surgery, a continuous passive motion machine may be used to improve shoulder mobility. Pain medications and a shoulder sling (for 4-6 weeks) will help manage recovery. A rehabilitation program with strengthening exercises is needed for 6-9 months, and sports activities can resume in 18 to 36 weeks.
Risks and Complications
Risks include infection, stiffness, arthritis, muscle weakness, and potential nerve or blood vessel injury.