Shoulder Anatomy

The shoulder joint (also known as the glenohumeral joint) is the main joint of the shoulder. It is a ball and socket joint that allows the arm to rotate in a circular fashion or to hinge out and up away from the body. The capsule is a soft tissue envelope that encircles the glenohumeral joint and attaches to the scapula, humerus, and head of the biceps. It is lined by a thin, smooth synovial membrane.

The rotator cuff is a group of four muscles that surround the shoulder joint and contribute to the shoulder’s stability, strength and movement. The muscles of the rotator cuff are the supraspinatus, subscapularis, infraspinatus, and teres minor. The cuff adheres to the glenohumeral capsule and attaches to the humeral head.

The human shoulder is made up of three bones: the clavicle (collarbone), the scapula (shoulder blade), and the humerus (upper arm bone), as well as associated muscles, ligaments and tendons. The articulations between the bones of the shoulder make up the shoulder and its joints.

The shoulder joint, also known as the glenohumeral joint, is the major joint of the shoulder. Above this joint is the acromioclavicular joint. In human anatomy, the shoulder joint comprises the part of the body where the humerus attaches to the scapula, the head sitting in the glenoid cavity. The shoulder is the group of structures in the region of the joint.

The shoulder must be mobile enough for the wide range of actions of the arms and hands but also stable enough to allow for actions such as lifting, pushing and pulling. The shoulder is the most unstable joint in the body.

Common Shoulder Conditions and Injuries

Because the shoulder joint is the most unstable in the human body, it can be affected by a wide range of conditions. These conditions typically manifest through the overuse of the muscles, ligaments, and tendons that hold the shoulder joint together but can also be caused by sudden trauma.

Shoulder conditions and injuries typically take the form of a type of instability or impingement. Shoulder instability occurs when the joint moves out of its normal alignment, resulting in dislocation and a sensation of the joint slipping out of its socket. Shoulder impingements occur when the muscles rub excessively against the top of the shoulder blade (acromion).

Rotator cuff syndrome is a common cause of shoulder instability and impingement, and when severe, it can permanently limit shoulder function, making it difficult or impossible to raise the arm above the head. Other common shoulder conditions include:

  • Frozen shoulder (adhesive capsulitis) – Inflammation of soft tissues causes pain and extreme stiffness in the shoulder, making it feel frozen solid.
  • Shoulder bursitis impingement – Inflammation of the large bursa, a fluid-filled sac that aids in smooth movement between muscles and bones. It causes pain and tenderness, especially when trying to raise the arm overhead.
  • Proximal humerus fracture – This is the most common type of shoulder fracture and typically occurs after a fall onto an outstretched arm. This causes pain, limited arm movement, and deformity of the upper arm.

How Can A Shoulder Injury Be Diagnosed?

The diagnosis of shoulder injuries and conditions typically starts with a thorough history and physical examination by your doctor to determine whether the issue could be from the shoulder and to exclude neck or spine pathologies. Thorough testing is performed of your shoulder to examine movement, strength and stability.

If required, your doctor may advise you to undertake a form of diagnostic imaging. Imaging procedures used to diagnose shoulder injuries include:

  • X-rays
  • CT scans
  • MRI scans
  • Electromyography
  • Shoulder arthroscopy

Your orthopaedic surgeon at Melbourne Arm Clinic can perform a shoulder arthroscopy to help diagnose and repair problems inside the shoulder joint.

What Are The Treatment Options For Shoulder Injury?

There is a range of surgical and non-surgical treatment options for a shoulder injury. The appropriate treatment depends on the cause of the injury and the level of pain/discomfort experienced.

Common interventions include using a sling or shoulder immobiliser, undertaking physical or occupational therapy, or a form of surgery. Severe shoulder injuries often require all three of these interventions, including the use of non-steroidal anti-inflammatory medications.

Types of Shoulder Surgery

Rotator Cuff Surgery

Rotator cuff surgery typically involves the surgical reattachment of a torn tendon to the upper arm bone (humerus). A fully torn (ruptured) tendon is repaired by stitching the tendon back to its original position, while an incomplete tear usually requires smoothing and trimming, known as debridement.

Calcific Tendinitis Shoulder Surgery

Calcific tendinitis shoulder surgery involves an arthroscopic procedure to remove the calcific deposit. An x-ray usually follows surgery to ensure that all the calcium has been removed.

Shoulder Replacement Surgery

Shoulder replacement involves an open surgery where the damaged parts of the shoulder joint are taken out and replaced with prosthetic components. As this is more significant surgery, you will spend one day in the hospital and require physiotherapy afterwards.

AC Joint Separation Surgery

AC joint separation surgery involves stabilising the end of the collar bone to restore function and relieve pain. Full recovery from this surgery can take a few months, depending on the severity of the original injury.

Shoulder Arthritis Surgery

Surgical treatment for shoulder arthritis depends on the severity of the condition. Mild cases can be treated with an arthroscopic procedure to clean out the inside of the joint. Advanced cases of shoulder arthritis require shoulder replacement surgery.

Shoulder Arthroscopy

Shoulder arthroscopy is a minimally invasive procedure involving the use of a tiny camera and miniature surgical instruments. Multiple small incisions are made to allow the camera and instruments to be inserted, with the surgeon using a connected television screen to see what they are doing.

Shoulder Dislocation Surgery

Because shoulder dislocation (instability) can manifest differently, several different surgical approaches may be undertaken. This could include a bone transfer procedure (Latarjet), capsular shift, and shoulder arthroscopic surgery.

Frozen Shoulder Surgery

Frozen shoulder surgery, often called a capsular release, typically involves either arthroscopy and/or manipulation under anaesthesia to stretch and release the joint capsule that has become stiffened. Recovery times can vary from a few weeks to months, with a commitment to physiotherapy to return full shoulder/arm function as quickly as possible.

Shoulder Fracture Treatment

Significant shoulder fractures may require surgery to fix broken pieces of bone with screws, plates, wires, or pins. In some cases, shoulder replacement may be necessary.

Shoulder Surgery: FAQs

How much does shoulder surgery cost?

The cost of surgery is dependent on many variables including your health insurance status/fund and complexity of the procedure itself. We will discuss fees with you during your consultation.

How long after shoulder surgery before can you drive?

Depending on the type of shoulder surgery you receive and your recovery instructions.

How long does shoulder surgery take?

Most types of shoulder surgery won’t take longer than 2-3 hours. However, you also need to factor in the time spent in the recovery room. More significant surgeries like a shoulder replacement can require you to spend a day or two in the hospital.

How long does shoulder surgery takes to heal?

The recovery time after shoulder surgery depends on the severity of the original injury or condition and what type of surgical intervention was performed. Recovery requires time and appropriate post-operative rehabilitation.

Are there any complications with shoulder surgery?

As with any surgical intervention, there is a risk of complications arising. We will discuss these specifics with you at the time of your consultation.

When is shoulder surgery is necessary?

Shoulder surgery becomes necessary when non-surgical interventions either fail or are deemed inadequate to address the injury or condition. Shoulder surgery will only be recommended after careful consideration by your surgeon with the aid of diagnostics.

Devinder Garewal
SHOULDER SPECIALIST

Mr. Devinder Garewal

MBBS, BMedSci, FRACS (Orth), FAOrthA

Devinder completed his medical qualifications from the University of Melbourne and is a Fellow of the Royal Australiasian College of Surgeons and the Australian Orthopaedic Association.

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Shoulder Condition Videos

Watch as Melbourne Arm Clinic’s Devinder Garewal explains the different types of shoulder conditions and the most suitable treatment method. Learn about the surgical process and recovery steps for specific shoulder injuries.

Shoulder Stabilisation

Shoulder Arthritis

Rotator Cuff Repair

Subacromial Decompression & Bursectomy

Capsular Release Surgery

AC Joint Stabilisation

Latarjet Procedure

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Shoulder Joint

Elbow Icon

Elbow Joint

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Wrist Joint

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Hand Joints

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