SHOULDER

The shoulder has a wider and more varied range of motion than any other joint in your body. Your shoulder allows you to do everything from painting the house to playing basketball, but this flexibility also makes the shoulder one of the most unstable joints in the body.

In fact, the shoulder is not a single joint. It is a complex arrangement of bones, ligaments, muscles, and tendons that is better referred to by the term shoulder girdle. The primary function of the shoulder girdle is to give strength and range of motion to the arm. The shoulder girdle includes three bones: the scapula, clavicle and humerus. It also has three joints: glenohumeral, acromioclavicular, and sternoclavicular.

ORTHOPAEDIC SERVICES FOR THE SHOULDER
(Click the links below for animated explanations of each service)

TYPICAL SHOULDER INJURIES AND ILLNESSES

SPRAINS AND SEPARATION

Your collarbone is joined to your shoulder blade by the acromioclavicular joint. Inside this joint are two strong ligaments that hold the clavicle and scapula together. When these ligaments are overstretched, the shoulder bones become separated. The severity of the injury ranges from a sprain to a complete tear involving one or both ligaments.

Nonsurgical treatments, such as a sling, cold packs, and medications can often help manage your pain. Some injuries, however, may require surgery to regain normal range of motion or restore stability.

DISLOCATION

The shoulder has a ball and socket joint known as the glenohumeral joint where the humerus bone of the upper arm meets the glenoid fossa portion of the scapula. When the rounded end of the humerus comes out of its socket, it is said to be dislocated.

A dislocated shoulder will cause significant pain, no matter which direction it pulls away from the joint. To treat a dislocation, your physician will manipulate the bone back into the socket in a process called reduction. This commonly occurs in the emergency room.

Your doctor may immobilize your shoulder in a sling for several weeks following treatment. After the pain and swelling go down, the doctor will most likely prescribe rehabilitation exercises for you. These help restore the shoulder’s range of motion and strengthen the muscles.

FRACTURES (CLAVICLE)

Clavicle is the scientific name for your collarbone. Each clavicle, one left and one right, is a long, slightly curved bone that spans from your shoulder to the sternum in the center of your rib cage.

When the clavicle is broken, as with any fracture, it is quite painful. It may also cause your shoulder to sag, prevent you from raising your arm, or feel like it is grinding when you move your arm.

Depending on the severity of the break, your fracture may heal without surgery. Conservative treatments include arm support such as a sling or figure-eight wrap, as well as a physician supervised program of physical therapy.

However, if your bones have moved out of place, your doctor may recommend surgery to realign the bone and hold it in proper position for healing.

ARTHRITIS

Osteoarthritis can happen in either of the two joints of the shoulder girdle. In this degenerative condition, the cartilage that helps cushion joints wears away leaving bone to rub against bone. The condition is painful and limits mobility.

Most arthritis treatment is non-surgical, except in severe cases. The standard approach to treating arthritis of the shoulder is to combine medicine (either oral or injected into the joint) and appropriate physical therapy to relieve pain and strengthen muscle to restore movement.

IMPINGEMENT (ROTATOR CUFF)

ABOUT SHOULDER IMPINGEMENT

The rotator cuff is a group of four muscles and their tendons that act to stabilize the shoulder. These muscles enable the wide range of motion in the shoulder. They emerge from the scapula or shoulder blade and connect to the head of the humerus bone, forming a “cuff” at the shoulder joint.

Small fluid-filled sacs called bursae are also present near the rotator cuff. These cushion the space between bones, tendons, and muscles around the joint facilitating movement.

Any inflammation of the tendons (tendinitis) in the rotator cuff or of the bursae (bursitis) can cause the muscles of the rotator cuff to be rubbed or squeezed against the bones. This type of impingement causes tenderness in the front of the shoulder, and sometimes stiffness as well.

Since the inflammation is normally caused by repetitive motions such as swimming, wall-paper hanging, or even weight lifting, your orthopaedist may suggest rest from aggravating activities. He may also prescribe medicines or a special physical therapy program to help alleviate the pain and restore normal range of motion.

SURGICAL OPTIONS

When nonsurgical treatment does not relieve pain, your doctor may recommend surgery to create more space for the rotator cuff.

ROTATOR CUFF TEARS

ABOUT ROTATOR CUFF TEARS

When your rotator cuff is torn, either through a trauma such as a fall or through repetitive overuse, you will experience pain, especially when lying on or lifting your arm. You may also notice a grinding sensation or weakness in your arm.

It is important to seek medical attention when you suspect a torn rotator cuff because using it despite injury can worsen the damage. There are numerous options available for treating a torn rotator cuff, and your doctor will help you choose the treatment plan that is right for you.

SURGICAL OPTIONS

Your doctor may recommend surgery if your pain does not improve with conservative treatment. After surgery, physical therapy will play a important role in getting you back to your daily activities safely and as quickly as possible.

REVERSE TOTAL SHOULDER REPLACEMENT

ABOUT REVERSE TOTAL SHOULDER REPLACEMENT

Your surgeon may recommend this type of reconstructive procedure when patient suffers from a previous failed total shoulder surgery or with large rotator cuff tears, developing a complex type of shoulder arthritis called “cuff tear arthropathy.” A traditional replacement device requires the rotator cuff muscles to function properly. When a patient experiences a large rotator cuff tear and arthritis, these muscles no longer work. The reverse total shoulder replacement depends on the deltoid muscle, instead of the rotator cuff, to control and position the arm. Following surgery, your surgeon will recommend a physical therapy (rehab) program to strengthen your shoulder and to improve flexibility of arm.

SUPERIOR LABRUM ANTERIOR AND POSTERIOR (SLAP) TEARS

ABOUT SLAP TEARS

While your shoulder joint is considered a “ball and socket” joint, the socket is actually quite small. It covers only about a third of the rounded head of the humerus bone. It can be compared to a golf ball sitting on a large golf tee.

Since the socket isn’t very large or deep, there is a special ring of cartilage that helps give the shoulder stability. It is called the glenoid labrum. A SLAP tear or occurs when there is damage to the uppermost area of the labrum. SLAP stands for superior labrum anterior to posterior, describing the way the rim tears.

Injuries to the superior labrum can be caused by a car accident or fall. It can also happen through repetitive shoulder motion, especially in throwing sports such as baseball. Additionally, a SLAP tear can result from normal wear over time.

ABOUT SLAP TEARS

Your doctor may recommend surgery if your pain does not improve with nonsurgical methods.

SHOULDER

TYPICAL SHOULDER INJURIES AND ILLNESSES

SPRAINS AND SEPARATION

DISLOCATION

FRACTURES (CLAVICLE)

ARTHRITIS

IMPINGEMENT (ROTATOR CUFF)

ABOUT SHOULDER IMPINGEMENT

SURGICAL OPTIONS

ROTATOR CUFF TEARS

ABOUT ROTATOR CUFF TEARS

SURGICAL OPTIONS

REVERSE TOTAL SHOULDER REPLACEMENT

ABOUT REVERSE TOTAL SHOULDER REPLACEMENT

SUPERIOR LABRUM ANTERIOR AND POSTERIOR (SLAP) TEARS

ABOUT SLAP TEARS

ABOUT SLAP TEARS

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