SHOULDER PAIN

SHOULDER

Shoulder Pain


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.


BOOK APPOINTMENT

Procedures


  • 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.

  • MINIMALLY INVASIVE SHOULDER JOINT REPLACEMENT

    Shoulder joint replacement is a surgical procedure that replaces damaged bone surfaces with artificial humeral and glenoid components to relieve pain and improve functional ability in the shoulder joint.

  • REVISION SHOULDER REPLACEMENT

    Revision surgery is usually performed under general anesthesia. You are positioned in such a way as 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.

  • 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 doctor to clearly view.

  • ROTATOR CUFF REPAIR

    Rotator cuff repair is a surgery to repair an injured or torn rotator cuff. It is usually performed arthroscopically on an outpatient basis. An arthroscope, a small, fiber-optic instrument consisting of a lens, light source, and video camera.

  • SHOULDER FRACTURE CARE

    A break in the bone that makes up the shoulder joint is called a shoulder fracture. The clavicle (collarbone) and end of the humerus (upper arm bone) closest to the shoulder are the bones that usually are fractured. The scapula, or shoulder blade, is not easily fractured because of its protective cover of surrounding muscles and chest tissue.

  • SHOULDER LABRUM RECONSTRUCTION

    The shoulder joint is a ball and socket joint. A ball at the top of the upper arm bone (the humerus) fits neatly into a socket, called the glenoid, which is part of the shoulder blade (scapula). The labrum is a ring of fibrous cartilage surrounding the glenoid, which helps in stabilizing the shoulder joint.

  • SHOULDER STABILIZATION

    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 condition, with much smaller incisions.

  • SLAP REPAIR

    A SLAP repair is an arthroscopic shoulder procedure to treat a specific type of injury to the labrum called a SLAP tear.

  • 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.

  • TREATMENT OF THROWING INJURIES OF THE SHOULDER

    Throwing injuries of the shoulder are injuries sustained as a result of trauma by athletes during sports activities that involve repetitive overhand motions of the arm as in baseball, American football, volleyball, rugby, tennis, track and field events, etc.

  • ARTHROSCOPIC BANKART REPAIR

    Bankart repair surgery is indicated for a Bankart tear when conservative treatment measures do not improve the condition but instead results in repeated shoulder joint dislocation.

  • 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.

  • BICEP TENDON RUPTURE AT SHOULDER

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

  • NON-SURGICAL SHOULDER TREATMENTS

    Shoulder injuries can often be treated by non-surgical methods

  • REVERSE SHOULDER REPLACEMENT

    Conventional surgical methods such as total shoulder joint replacement are not very effective in the treatment of rotator cuff arthropathy

  • CAPSULAR RELEASE

    A capsular release of the shoulder is surgery performed to release a tight and stiff shoulder capsule, a condition called frozen shoulder or adhesive capsulitis.

Conditions


  • ACHILLES TENDON RUPTURE

    The Achilles tendon is a strong fibrous cord present behind the ankle that connects the calf muscles to the heel bone. It is used when you walk, run and jump. The Achilles tendon ruptures most often in athletes participating in sports that involve running, pivoting and jumping.

  • ANKLE LIGAMENT INJURY

    An ankle ligament injury, also known as an ankle sprain, can be caused by a sudden twisting movement of the foot during any athletic event or during daily activities. When stretched beyond its limit, the ligament may partially or completely tear. The injury can range from mild to severe, depending on the condition of the injured ligament and the number of ligaments involved.

  • ANKLE SPRAIN

    A sprain is the stretching or tearing of ligaments. Ligaments connect adjacent bones and provide stability to a joint. An ankle sprain is a common injury that occurs when you suddenly fall or twist the ankle joint, or when you land your foot in an awkward position after a jump.

  • ATHLETE'S FOOT

    Athlete's foot, also known as tinea pedis, is a fungal infection that forms on the skin of the foot. It is characterized by itchy, moist, white, scaly lesions between the toes that can spread to the sole of the foot.

  • FOOT AND ANKLE ARTHRITIS

    Arthritis is the inflammation of joints as a result of degeneration of the smooth cartilage that lines the ends of bones in a joint. This degeneration of the cartilages leads to painful rubbing of the bones, swelling, and stiffness in the joints, resulting in restricted movements.

  • FOOT AND ANKLE TRAUMA

    Foot and ankle trauma refers to injuries that most commonly occur during sports, exercise or any other physical activity. Trauma may be a result of accidents, poor training practices or use of improper gear.

  • STRESS FRACTURES OF FOOT AND ANKLE

    A stress fracture is described as a small crack in the bone which occurs from an overuse injury of a bone. It commonly develops in the weight-bearing bones of the lower leg and foot. When the muscles of the foot are overworked or stressed, they are unable to absorb the stress and when this happens the muscles transfer the stress to the bone which results in stress fracture.

  • SESAMOID FRACTURE

    A sesamoid fracture is a break in the sesamoid bone. Sesamoids are two small, pea-shaped bones located in the ball beneath the big toe joint at the bottom of the foot. Sesamoid bones are connected to muscles and other bones by tendons that envelop these bones. Sesamoids help the big toe move normally and absorb the weight placed on the ball.

  • HEEL FRACTURES

    The calcaneus or heel bone is a large bone found at the rear of the foot. A heel fracture is a break in the heel bone due to trauma or various disease conditions.

  • LISFRANC (MIDFOOT) FRACTURE

    The Lisfranc joint or tarsometatarsal joint refers to the region in the middle of the foot. It is a junction between the tarsal bones (bones in the foot arch) and metatarsal bones (five long bones in the foot).

  • TALUS FRACTURES

    The talus is a small bone at the ankle joint that connects the heel bone and the shinbones, enabling up and down movement of the foot.

  • FOOT PAIN

    The foot is composed of bones, ligaments, tendons, and muscles. As your feet bear the weight of your entire body, they are more prone to injury and pain.

  • HEEL PAIN

    Heel pain is a common symptom of excessive strain placed on the structures that form the heel.

  • ACHILLES TENDINITIS

    The Achilles tendon is a tough band of fibrous tissue that runs down the back of your lower leg and connects your calf muscle to your heel bone.

  • ACHILLES TENDON BURSITIS

    Achilles tendon bursitis or retrocalcaneal bursitis is a condition that commonly occurs in athletes.

  • ANKLE FRACTURES

    Ankle injuries are very common in athletes and individuals performing physical work; often resulting in severe pain and impaired mobility.

  • ANKLE INSTABILITY

    The joints of the ankle are held in place and stabilized by strong bands of tissue called ligaments.

  • FIFTH METATARSAL FRACTURES

    The metatarsal bones are the long bones in your feet. There are five metatarsal bones in each foot.

  • FOOT FRACTURE

    Trauma and repeated stress can cause fractures in the foot. Extreme force is required to fracture the bones in the hindfoot.

  • METATARSAL AND PHALANGEAL (FOREFOOT) FRACTURES

    The forefoot is the anterior or front portion of the foot that functions in weight-bearing and maintaining balance while standing, walking or running.

  • OSTEOCHONDRAL INJURIES OF THE ANKLE

    The ankle joint is formed by the articulation of the end of the tibia and fibula (shinbones) with the talus (heel bone).

  • PLANTAR FASCIITIS

    Plantar fasciitis refers to the inflammation of the plantar fascia, a thick band of tissue that is present at the bottom of the foot.

  • SESAMOIDITIS

    Sesamoids are two small, pea-shaped bones located in the ball beneath the big toe joint at the bottom of the foot.

  • STIFF BIG TOE (HALLUX RIGIDUS)

    A stiff big toe, also called hallux rigidus, is a form of degenerative arthritis affecting the joint where the big toe (hallux) attaches to the foot.

  • TARSAL TUNNEL SYNDROME

    The tarsal tunnel is a narrow passageway that lies on the inside of your ankle and runs into the foot.

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