Shoulder & Elbow Surgery

Overview

Definitions & Anatomy

  • Bones. The collarbone (clavicle), the shoulder blade (scapula), and the upper arm bone
    (humerus).
  • Joints. The place where movement occurs, include the following:
    • Sternoclavicular joint (where the clavicle meets the sternum)
    • Acromioclavicular (AC) joint (where the clavicle meets the acromion)
    • Shoulder joint (glenohumeral joint). A ball-and-socket joint that facilitates forward, circular, and backward movement of the shoulder.
  • Joint capsule. A group of ligaments that connect the humerus to the socket of the shoulder joint on the scapula to stabilize the shoulder and keep it from dislocating.
  • Ligaments. A white, shiny, flexible band of fibrous tissue that holds joints together and
    connects various bones, including the following:

    • Joint capsule. A group of ligaments that connect the humerus to the socket of the
      shoulder joint on the scapula to stabilize the shoulder and keep it from
      dislocating.
    • Ligaments that attach the clavicle to the acromion
    • Ligaments that connect the clavicle to the scapula by attaching to the coracoid
      process
  • Acromion. The roof (highest point) of the shoulder that is formed by a part of the
    scapula.
  • Tendons. The tough cords of tissue that connect muscles to bones. The rotator cuff
    tendons are a group of tendons that connect the deepest layer of muscles to the
    humerus.
  • Muscles. Help support and rotate the shoulder in many directions. Facilitate movement
    of the shoulder.
  • Rotator cuff. Name of a group of the 4 muscles and tendons that rotate the shoulder.
  • Bursa. A closed space between 2 moving surfaces that has a small amount of
    lubricating fluid inside; located between the rotator cuff muscle layer and the outer layer
    of large, bulky muscles.

Conditions

Elbow

Biceps Tendon Rupture

Normally, a biceps tendon is connected to the arm bone and helps to move your arm in a flexing position. When the bicep tendon ruptures, the tendon tears and the muscle cannot pull on the bone. It becomes detached to the bone, pain and weakness present.

Bursitis

The rotator cuff helps guide the shoulder through many motions by allowing lift and rotation to the arm while stabilizing the ball of the shoulder within the socket. The rotator cuff consists of a group of four muscles and their tendons that wrap around to form a “cuff” over the upper end of the arm at the shoulder. There is an area of space over the top of the rotator cuff where the bursa lives. This bursa is a fluid sac between the acromion bone and the tendon. A common condition called, Bursitis, is inflammation of this fluid sac and occurs with repetitive overhead activity or overuse of the arm. The term impingement refers to pinching of the rotator cuff tendons and bursa against the acromion bone above it.

Elbow Arthritis

Elbow arthritis is a very common and often progresses to a condition in which the cartilage that normally lines the surface of the elbow joint becomes worn over time and eventually wears away. This condition often is the result of overuse, injury, and sometimes
inflammatory diseases, such as rheumatoid arthritis. While this progressive “wear and tear” of your elbow may be associated with pain, it also commonly leads to significant stiffness about the elbow. The elbow’s normal range of motion becomes limited, thus making it difficult for you to use your arm to carry out normal daily activities.

Elbow Spurs

A common element related to repetitive overhead activity at work or through sports can generate a tremendous amount of forces in the elbow joint. These forces may lead to the formation of elbow spurs or loose fragments of cartilage or bone from the elbow joint surfaces. Often patients will report feeling catching or locking in the elbow joint because these chips can float through the elbow joint. Patients with elbow loose bodies or spurs complain of these locking episodes as well as difficulty in fully extending or flexing the elbow.

Golfer’s Elbow

Medial epicondylitis or golfer’s elbow, is similar to its counterpart, tennis elbow, except for location of where the pain is located on the elbow as well as what activity leading up to the injury has caused this pain. Both conditions are caused by overuse of the muscles and tendons of the forearm, leading to inflammation and pain around the elbow joint. The pain of golfer’s elbow is usually at the elbow joint on the inside of the arm; a shooting sensation down the forearm is also common while gripping objects. Golfer’s elbow and tennis elbow, are both forms of tendonitis. Due to the force of the muscle, the points of insertion of the tendon on the bone, are often on pointed prominences.

Olecranon Fracture

This is a fracture to the most prominent bone of the elbow. Often referred to as the “funny bone,” the olecranon is actually the bone at the end of the ulna, one of the two forearm bones, and is attached to the powerful triceps muscle of the arm. Since the triceps muscle is used to straighten the elbow, an olecranon fracture can greatly impair a patient’s ability to straighten the elbow joint.

Tennis Elbow

Similar to Golfer’s elbow, Lateral Epicondylitis, or Tennis Elbow, is one of the most common elbow injuries in sports. Exactly what causes tennis elbow is unknown, but it is thought to be due to small tears of the tendons that attach the muscles of the forearm to the arm bone at the elbow joint. The lateral epicondylitis usually involves the wrist extensors, a muscle group involved in the function to cock back your wrist and stabilization as in gripping a racquet, baseball bat, or club.

UCL Tear

The ulnar collateral ligament or UCL, is the main ligament stabilizing the inner aspect of the elbow joint during the act of throwing. It provides the stability which is necessary to throw a ball or to work and lift overhead. When an injury to the ulnar collateral ligament occurs, the instability can cause severe disruption. Sometimes an UCL tear can be from chronic repetitive overhead throwing motions or from one single traumatic event such as falling on an outstretched arm. If the UCL tear occurs gradually, there may be a progressive ache or soreness along the inner aspect of the elbow and a throwing athlete may notice decreased velocity and control with throwing. If it occurs quickly, there is often a “pop” followed immediately by swelling and pain. Sometimes the nerves that surround the UCL can be injured too. In this occurrence, a patient may develop a numbness or tingling sensation in the middle and ring fingers.

Shoulder

AC Joint Separation

A shoulder separation or acromioclavicular (AC Joint) separation is an injury to the area or junction between the shoulder and collar bone. It involves a ligament or soft-tissue injury to that area but may also include a fracture. Although this injury is usually sports related, it can happen in trauma such as falls or car accidents. A shoulder separation occurs after a fall or a sharp blow to the top of the shoulder. This is not the same as a shoulder dislocation, which occurs at the large joint where the arm attaches to the shoulder, although the two may appear to be the same.

Bankart Lesion

Bankart lesion(s) of the shoulder is a tear of the labrum that causes gross instability and a recurrence of shoulder dislocations. This type of injury often occurs when the shoulder pops out of joint, thereby tearing the labrum and is quite common in younger patients.

Biceps Tendon Rupture

A biceps tendon rupture usually occurs from an injury where the attachment separates from the bone or the tendon tears. Normally, biceps tendons are connected strongly to the bone and usually do not tear spontaneously. However, when the biceps tendon tears and ruptures, this tendon is detached. Following a biceps tendon rupture, the muscle cannot pull on the bone, and certain movements may be weakened and painful.

Broken Collarbone

A broken collarbone or fractured clavicle, is the bone that connects the breastbone from the upper chest to the shoulder blade. This type of fracture usually occurs in trauma (falling, direct blow to the collarbone, or automobile accidents. It is not uncommon for this break to also occur in babies, adolescents, and athletes.

Bursitis

A common condition in which there is inflammation of the fluid sac above the rotator cuff muscles and occurs with repetitive overhead activity or overuse of the arm. The term impingement refers to pinching of the rotator cuff tendons and bursa against the acromion bone above it.

Labral Tear

The shoulder socket itself is extremely shallow and unstable. The bones of the shoulder are not held in place adequately, thereby requiring extra support. To help compensate for this instability, the shoulder joint has a cuff of cartilage (labrum) that forms a cup for the end of the arm bone to move within. The labrum in the shoulder joint wraps around the shallow shoulder socket, thus making the socket deeper, and provides more stability. When a labral tear occurs, the cartilage rim that attaches to arm and shoulder becomes unstable. This usually occurs from sports-related activities like throwing or where a shoulder or arm injury has occurred. The labrum itself may simply become brittle with age and may fray and tear as part of the aging process.

Shoulder Arthritis

Degenerative joint disease or “wear and tear” is characterized by progressive wearing away of the cartilage of the joint. As the protective cartilage is worn away by shoulder arthritis, bare bone is exposed within the joint. Shoulder arthritis can also occur in inflammatory diseases such as rheumatoid arthritis. Rheumatoid arthritis is a systemic condition that causes an inflammation of the lining of a joint. This inflammation can, over time, invade and destroy the cartilage and bone.

Shoulder Dislocation or Separation

A shoulder dislocation is an injury that occurs when the top of the arm bone (humerus) loses contact with the socket of the shoulder (scapula). This is also similar to an acromioclavicular (AC) joint separation.

Shoulder Impingement Syndrome

Shoulder impingement syndrome occurs when the tendons of the rotator cuff become compressed between the head of the humerus bone and a part of the shoulder blade. This syndrome can lead to a chronic inflammatory condition that may eventually develop into the weakening of the rotator cuff tendons. Ultimately, this situation could result in a torn rotator cuff.

SLAP Lesion (Tear)

Superior Labral Anterior to Posterior or SLAP lesion can occur from a variety of injuries that cause damage to the superior portion of the labrum where the bicep tendon inserts. This usually occurs from repetitive over arm motion such as throwing a ball, falling on an outstretched arm, or lifting a heavy object. When the superior labrum is detached or torn at the site of the biceps tendon insertion, it is termed a superior labrum anterior to posterior tear (SLAP).

Throwing Injuries

There are many common throwing shoulder injuries including labral tears, bursitis, tendonitis, rotator cuff tears,biceps tendon injuries, capsular contractures, and shoulder blade (scapula) dyskinesis (abnormal movement) or true winging. Common conditions which throwing athletes develop is from the loss of internal rotation from scarring of the joint capsule, scapula dyskinesis, labral tears, and rotator cuff tears known as GIRD or glenohumeral internal rotation deficit. It is the most common condition affecting the throwing shoulder. The constant, repetitive overhead throwing motion imparts high, outward, extension to the athlete’s shoulder and elbow. This can lead to either a progressive structural change, or a chronic or acute injury. Although of note, it is the continuation of overhead throwing most often results in subsequent injury and symptom recurrence.

Treatments

Elbow

Bicep Tendon Rupture Surgery
Bursitis / Impingement Surgery
Elbow Arthritis Surgery
Elbow Surgery
Non-Operative Treatments
Olecranon Fracture Surgery
Radial Head Fracture Surgery
Throwing Injury Surgery

Shoulder

Acromioplasty
Biceps Tenodesis
Bicep Tendon Rupture Surgery
Broken Collar Bone Surgery
Closed Reduction Shoulder
Labrum Surgery
Non-Operative Treatments
Rotator Cuff Surgery
Shoulder Arthritis Surgery
Shoulder Arthroscopy
Shoulder Replacement Surgery