• Rotator Cuff Tears

    Rotator Cuff Tears

    A rotator cuff is a group of tendons in the shoulder joint that provides support and enables a wide range of motion. A major injury to these tendons may result in rotator cuff tears. It is one of the most common causes of shoulder pain in middle-aged 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.

  • 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.

  • 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.

  • 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

  • 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.

  • 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 Dislocation

    Shoulder Dislocation

    Sports that involve overhead movements and repeated use of the shoulder at your workplace may lead to sliding of the upper arm bone from the glenoid. The dislocation might be a partial dislocation (subluxation) or a complete dislocation causing pain and shoulder joint instability.

  • Tennis Elbow

    Tennis Elbow

    Tennis elbow is a common name for the elbow condition lateral epicondylitis. It is an overuse injury that causes inflammation and microtears of the tendons that attach to the lateral epicondyle.

  • 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.

  • Computer Navigation for Shoulder Replacement

    Computer Navigation for Shoulder Replacement

    Computer navigated shoulder replacement is an image-guided, minimally invasive surgical procedure in which the damaged or worn out articulating surfaces of the shoulder joint are removed and replaced with artificial prostheses under the assistance of advanced computer technology to relieve pain and restore normal functioning of the shoulder joint.

Anatomy of the shoulderThe 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 fibres 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.
  • Bankstown
    Hospital Medical Centre

    Suite 3
    Ground floor
    68 Eldridge Road
    Bankstown, NSW 2200

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  • St George Private Hospital

    Suite 14
    Level 5, St George Private Hospital
    Medical Centre
    1 South Street
    Kogarah NSW 2217

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