The anatomy of the Shoulder.

Sports Injuries.

Burners and Stingers

Burners and Stingers are terms used to describe neural injury to the upper limb. They describe the type of pain that at the time of injury may spread from the shoulder to the hand. Burners and stingers often happen in contact sports where they may also be called a dead arm.

> Dislocated Shoulder

The shoulder is a ball and socket joint and is the most mobile joint in the body. For every advantage the shoulder gains in mobility it loses in stability. It is highly vulnerable to dislocation and this may be described as a partial (subluxed) or complete dislocation and anterior, posterior or multidirectional.

> Shoulder Joint Tear

A shoulder joint labral tear is an injury to the labrum of the shoulder, or to the fibrous ring surrounding the glenoid or socket of the shoulder. A tear above the middle of the socket is called a SLAP tear, while below the middle is called a Bankart tear. These tears are often associated with complete or partial dislocation.

> SLAP tears

SLAP tears are injuries to the upper part of the shoulder joint. SLAP stands for Superior Labrum Anterior and Posterior which describes the location of the tear in the shoulder. The SLAP area of the labrum has the biceps tendon anchored to it which may be a cause of injury. A SLAP tear injury is often caused by repetitive movements above the level of the shoulder.

> Chronic Shoulder Instability

Once a shoulder has been injured by dislocation, it is highly vulnerable to repeat episodes. When a shoulder has dislocated multiple times it becomes loose and may dislocate spontaneously. This is chronic shoulder instability. Chronic instability is often associated with bone loss that may make arthroscopic repair less successful and require an open Latarjet procedure.

> Frozen Shoulder

A frozen shoulder starts with pain limiting movement. Limited movement leads to stiffness. Stiffness is caused by connective tissue adhesions and diminishing volumes of synovial fluid, the lubricant of all joints.

> Hills Sachs Lesion

When a shoulder dislocates, the ball of the joint (the humerus), falls out of the socket of the joint (the glenoid). In some instances of dislocation, the head of the humerus may be fractured by the glenoid as it dislocates. A Hill-Sachs lesion is when the humerus developed this impaction fracture during an episode of dislocation.

> Rotator Cuff Tears

There are 4 muscles which comprise the rotator cuff of the shoulder. These muscles help position the ball and socket of the shoulder during shoulder movement. Rotator cuff tears are very painful and debilitating and can be described as partial, full thickness and massive tears caused by trauma or degeneration. Early conservative management is effective, but often surgical repair is indicated.

> Biceps Tendon Tear at the Shoulder

The biceps muscle has two tendons which insert into the shoulder. The long head biceps tendon attaches to the top of the shoulder socket or glenoid, and the short head biceps tendon attaches to the coracoid process. Biceps tendon tears can be partial or complete and are most often associated with the long head of biceps tendon. Trauma or overuse are the usual mechanisms of injury and degree and duration of pain are indicators for surgery.

> Tendonitis of the Long Head of Biceps

Tendonitis of the long head of the biceps tendon is an inflammation or irritation condition resulting in weakness and pain. Symptoms can often be relieved by rest and medication.


> Fractured clavicle

A clavicle fracture is also known as a broken collar bone. Broken collar bones are very common and are usually caused by a direct blow to the bone itself or from falling on an outstretched arm. X-ray will confirm severity of the break. Non-displaced fractures can heal without surgery, whereas displaced fractures typically require surgery.

> Scapula (Shoulder Blade) Fractures

Shoulder blade fractures are very uncommon. Typically shoulder blade fractures occur in the lower or inferior aspect of the bone. Many of these fractures can be treated without surgery. Symptoms include extreme pain and swelling close to the site of injury.

> Shoulder Trauma (Fractures and Dislocations)

Shoulder injuries are very common. Clavicle injury can involve fracture of the bone or partial or complete dislocation at either the AC (acromio-clavicular) or SC (sterno-clavicular) end. Upper arm or proximal humerus fractures are also common which may also involve brachial plexus or neural damage causing burning or stinging pain in the patient. Partial or complete dislocation of the shoulder joint commonly occurs anteriorly and is advised to be repaired surgically if the patient wishes to preserve normal function.


> Arthritis of the Shoulder

Arthritis affects 1 in 7 people. It is an inflammatory condition of the joint causing pain, swelling, stiffness and degenerative changes in the anatomy of the joint itself. There are different types of arthritis. Osteo arthritis is a wear and tear type of arthritis; rheumatoid arthritis is an autoimmune disease effecting joints; post traumatic arthritis is caused by a fracture through a joint; and avascular necrosis is a condition where blood supply is cut off to an area. In each case of arthritis, there are conservative and surgical treatments available.

> Shoulder Replacement

Although shoulder replacements aren't as common as hip or knee replacements, they offer the same success in returning function and relieving pain. In total shoulder replacement, the damaged bone of the humerus and of the glenoid are replaced with metal and poly replacement components.

> Reverse Total Shoulder Replacement

Many patients with shoulder arthritis are diagnosed with a special type of shoulder arthritis called cuff tear arthropathy. Patients with cuff tear arthropathy will not benefit greatly from a total shoulder replacement because the cuff is a very important part of being able to lift the arm. Alternatively, a reverse total shoulder replacement changes the anatomy of the shoulder such that the deltoid muscle can function without a rotator cuff muscle, allowing the patient to lift their arm pain free. In all, reverse total shoulder replacements are becoming a more popular choice of shoulder replacement for all shoulder arthritis conditions.

> Tornier Reverse and Total Shoulder Replacement

The critical factors when looking at shoulder replacement are stability and function. The shoulder is not a weight bearing joint like the knee and so different considerations are important. Best suited for younger patients, the Tornier Aequalis Ascend Flex shoulder replacement is bone preserving and has a variable angle interface to maximise and restore biomechanical function.

> Biomet Personalized (PSI) Reverse and Total Shoulder Replacement

The critical factors when looking at shoulder replacement are stability and anatomical restoration. The shoulder is not a weight bearing joint like the knee and so different considerations are important. Best suited for older patients, the Biomet Comprehensive shoulder replacement can be used in conjunction with the Signature personalized (PSI) technology to get maximum stability from your prothesis placement.

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