Specialists

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Operative Treatment for Adhesive Capsulitis

Manipulation Under Anesthesia

Manipulation under anesthesia (MUA) has been used to treat adhesive capsulitis for many years. This treatment has commonly been described to prospective patients as “stretching the tight capsule” or “breaking up adhesions” within the shoulder joint. Arthroscopic visualization of the glenohumeral joint after this procedure, however, reveals that a MUA does not […]

Basic Science-Anatomy and Biomechanics

The humerus is the largest bone of upper extremity. The proximal humerus is composed of the humeral head, the greater and lesser tuberosities, the anatomic and surgical necks of the humerus. The humeral head is the most proximal, ball-like region of the humerus that is retroverted (28 to 40 degrees) and articulates with the glenoid […]

Cartilage

Key Points

Full-thickness articular cartilage defects have a limited capacity to heal. Thus, articular cartilage lesions and osteochondral defects in any joint present a challenging problem. Cartilage lesions are less likely to be seen in the glenohumeral joint than in the knee, therefore there has not been extensive research on shoulder cartilage repair. Making the […]

Treatment-Nonoperative

The initial treatment of bicipital tendinitis is conservative using the traditional methods of rest, ice, and nonsteroidal anti-inflammatory medications. As symptoms improve, range of motion exercises and strengthening can be added. The actual treatment is frequently directed more toward the treatment of underlying rotator cuff pathology. Subacromial injections or bicipital sheath injections may also be […]

Biomechanics

Few would dispute the critical role of the biceps brachii at the elbow joint and its function has been well documented at this position. It is with the LHB’s role at the shoulder where the arguments intensify. Many authors have suggested that the LHB has a role in humeral head depression—particularly with shoulder external rotation […]

Stiffness

Stiffness after surgery for open anterior instability is infrequently noted in literature and the incidence of this complication is probably under-reported. Certain repairs were designed to limit external rotation and hence the risk of recurrence, so loss of motion was not considered a complication.

In some settings (e.g., capsular reconstruction or revision surgery), limited external […]

Humeral Bone Deficiency

Humeral head defects are commonly present in patients with shoulder instability. The defects are usually small and carry the eponym Hill-Sachs lesion when secondary to anterior instability and reverse Hill-Sachs lesions when secondary to posterior instability.

Although quite ubiquitous in recurrent anterior shoulder instability, the management of large Hill-Sachs defects remains controversial especially in […]

Dynamic Stability Factors

Glenohumeral stability is mainly achieved through dynamic factors. Active contraction of the rotator cuff contributes to joint stabilization by coordinated muscular activity and by secondary tightening of the ligamentous constraints. This effect works in combination with the concavity-compression mechanism, in which muscle contraction causes compression of nearly congruent articular surfaces into one another.

The rotator […]

Biomechanics of Shoulder Stability-Static Stability Factor

The glenohumeral joint is inherently unstable, with the large humeral head articulating with the small and shallow glenoid. Static stability is provided by the orientation of the articular surfaces, the articular conformity of humerus and the glenoid, the glenoid labrum, the negative intra-articular pressure, the adhesion-cohesion of synovial joint fluid, and the glenohumeral joint capsule […]

Anatomy

The glenohumeral joint is formed by a unique articulation between a larger and nearly spherical humeral head with a shallow and much smaller glenoid. Minimal bony constraints combined with a unique anatomical architecture and functional arrangements allow the shoulder joint to have the largest range of motion in the body.

Despite its minimally constrained […]