Anthony J. Berni, MD Orthopedic Surgeon

Anthony J. Berni, MD Orthopedic Surgeon

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Shoulder & Elbow

Normal Anatomy of The Shoulder Joint

The shoulder is the most flexible joint in the body making it the most susceptible to instability and injury. It is a 'ball-and-socket' joint. A ‘ball' at the top of the upper arm bone, humerus, fits neatly into a 'socket’, called the glenoid, which is part of the shoulder blade, scapula.The shoulder joint is made up several bones and soft tissues. It has three bones, the collarbone (clavicle), scapula, and humerus

Normal Anatomy of the Elbow

The arm in the human body is made up of three bones that join together to form a hinge joint called the elbow. The upper arm bone or humerus connects from the shoulder to the elbow forming the top of the hinge joint. The lower arm or forearm consists of two bones, the radius and the ulna. These bones connect the wrist to the elbow forming the bottom portion of the hinge joint.

Rotator Cuff Tear

The rotator cuff is a group of tendons in the shoulder joint that cover and provide support to the shoulder joint, enabling wider range of motion. A tear in the rotator cuff is one of the most common causes of shoulder pain in middle aged adults and older individuals. It may occur with repetitive movements while working or playing sports, during motor accidents, lifting a heavy object or a fall on an outstretched arm. As aging occurs, bone spurs may develop and can damage tendon tissue causing tears.

Shoulder Pain

Pain in the shoulder suggests a shoulder injury. Shoulder injuries are common in athletes participating in sports such as swimming, tennis, pitching, and weightlifting. The injuries are caused due to the over usage or repetitive motion of the arms.In addition to pain, shoulder injuries also cause stiffness, restricted movements, difficulty in performing routine activities, and popping sensation.

Subluxation (shoulder)

he shoulder is a highly mobile ball and socket joint. The ball of the upper arm bone (humerus) is held in place at the socket (glenoid) of the shoulder blade (scapula) by a group of ligaments. A partial dislocation of the shoulder joint is termed a subluxation. This means the ball has partially moved out of the glenoid as opposed to a dislocation where the ball completely moves out of the glenoid. A subluxation usually occurs from a fall or a direct blow to your shoulder. It can also be caused due to a previous shoulder injury or if the ligaments in your shoulder are loose. A subluxation has a tendency to recur due to laxity in the ligaments.

Shoulder Impingement

Various supporting structures aid in the smooth movement of the shoulder joint. The joint is held together and stabilized by a group of tendons called the rotator cuff. A fluid-filled sac called a bursa, located above the rotator cuff, helps in the frictionless movement of the shoulder. Shoulder impingement is one of the most common causes of pain in the adult shoulder.

SLAP Tears

The shoulder joint is a ball and socket joint. A 'ball' at the top of the upper arm bone (the humerus) fits neatly into a 'socket', called the glenoid, which is part of the shoulder blade (scapula). The term SLAP (superior –labrum anterior-posterior) lesion or SLAP tear refers to an injury of the superior labrum of the shoulder. The labrum is a ring of fibrous cartilage surrounding the glenoid for stabilization of the shoulder joint. The biceps tendon attaches inside the shoulder joint at the superior labrum of the shoulder joint. The biceps tendon is a long cord-like structure which attaches the biceps muscle to the shoulder and helps to stabilize the joint./p>

Arthritis of The Shoulder

The term arthritis means inflammation of a joint, and is associated with cartilage damage. Cartilage is a cushioned padding lining the bones that make up a joint in order to absorb stress during movement. Damage of the cartilage in the shoulder joint causes shoulder arthritis. When the cartilage gets damaged, the raw bones begin to painfully rub against each leading to inflammation. The proportion of cartilage damage inflammation varies with the type and stage of arthritis.

Frozen Shoulder

Frozen shoulder is the condition of painful shoulder limiting the movements because of pain and inflammation. It is also called as adhesive capsulitis and may progress to the state where an individual may find it difficult to move the shoulder. It is more common in older adults aged between 40 and 60 years and is more common in women than men.

Shoulder Instability

Shoulder instability is a chronic condition that causes frequent dislocations of the shoulder joint. A dislocation occurs when the end of the humerus (the ball portion) partially or completely dislocates from the glenoid (the socket portion) of the shoulder. A partial dislocation is referred to as a subluxation, whereas a complete separation is referred to as a dislocation.

Shoulder Joint Tear (Glenoid Labrum Tear)

The shoulder joint is a “ball and socket” joint that enables the smooth gliding and thereby the movements of arms. However, it is inherently unstable because of the shallow socket. A soft rim of cartilage, the labrum lines the socket and deepens it so that it accommodates the head of the upper arm bone better.

Dislocated Shoulder

The shoulder is made up of a ball and socket joint – the ball-shaped head of the upper arm bone (humerus) articulates in the socket of the glenoid cavity of the shoulder blade (scapula). Despite being the most flexible joint in the body, the bones of the shoulder are highly prone to dislocation. Repeated overhead sports and workplace activities may lead to sliding of the humerus out of the glenoid causing a dislocation.

Biceps Tendon Tear at the Elbow

The biceps muscle, located in the front of the upper arm allows you to bend the elbow and rotate the arm. Biceps tendons attach the biceps muscle to the bones in the shoulder and in the elbow.

Biceps tendon Rupture

The biceps muscle, located in the front of the upper arm allows you to bend the elbow and rotate the arm. Biceps tendons attach the biceps muscle to the bones in the shoulder and in the elbow.

Elbow Dislocation

The elbow is a hinge joint made up of 3 bones – humerus, radius and ulna. The bones are held together by ligaments to provide stability to the joint. Muscles and tendons move the bones around each other and help in performing various activities. Elbow dislocation occurs when the bones that make up the joint are forced out of alignment.

Erb's Palsy (Brachial Plexus Birth Palsy)

The brachial plexus is a bundle of nerves that originate at the spinal cord near the neck. These nerves innervate your shoulder, elbow, hand and wrist providing feeling and movement.Any form of trauma that pushes your head away from your shoulder can stretch or tear these nerves. An injury to the brachial plexus may stop signals to and from the brain and even paralyze the affected arm.

Elbow (Olecranon) Bursitis

The elbow contains a large, curved, pointy bone at the back called the olecranon, which is covered by the olecranon bursa, a small fluid-filled sac that allows smooth movement between the bone and overlying skin. Inflammation of this bursa leads to a condition called olecranon bursitis.

Ulnar Nerve Entrapment at the Elbow (Cubital Tunnel Syndrome)

Cubital tunnel syndrome, also called ulnar nerve entrapment is a condition caused by compression of the ulnar nerve in an area of the elbow called the cubital tunnel. The ulnar nerve travels down the back of the elbow behind the bony bump called the medial epicondyle and through a passageway called the cubital tunnel. The cubital tunnel is a narrow passageway on the inside of the elbow formed by bone, muscle, and ligaments with the ulnar nerve passing through its center. The roof of the cubital tunnel is covered with soft tissue called fascia. When the elbow is bent, the ulnar nerve can stretch and catch on the bony bump.

Osteochondritis Dissecans

Osteochondritis dissecans is a joint condition in which a piece of cartilage, along with a thin layer of the bone separates from the end of the bone because of inadequate blood supply. The separated fragments are sometimes called “joint mice”. These fragments may be localized, or may detach and fall into the joint space causing pain and joint instability.

Elbow Sprain

Elbow sprain is an injury to the soft tissues of the elbow. It is caused due to stretching or tearing (partial or full) of the ligaments which support the elbow joint. Ligaments are a group of fibrous tissues that connect one bone to another in the body.The Elbow is a complex hinge joint formed by the articulation of three bones - humerus, radius and ulna. The upper arm bone or humerus connects the shoulder to the elbow forming the upper portion of the hinge joint.

Tennis Elbow

ennis elbow is the common name used for the elbow condition called lateral epicondylitis. It is an overuse injury that causes inflammation of the tendons that attach to the bony prominence on the outside of the elbow (lateral epicondyle).It is a painful condition occurring from repeated muscle contractions at the forearm that leads to inflammation and micro tears in the tendons that attach to the lateral epicondyle. The condition is more common in sports activities such as tennis, painting, hammering, typing, gardening and playing musical instruments.

Golfer’s Elbow

Golfer’s elbow, also called Medial Epicondylitis, is a painful condition occurring from repeated muscle contractions in the forearm that leads to inflammation and microtears in the tendons that attach to the medial epicondyle. The medial epicondyle is the bony prominence that is felt on the inside of the elbow.Golfer’s elbow and Tennis elbow are similar except that Golfer’s elbow occurs on the inside of the elbow and Tennis elbow occurs on the outside of the elbow.

Elbow Injuries

Elbow Fractures: Fracture is a common injury to the elbow. Elbow fractures may result from a fall onto an outstretched wrist, a direct impact to the elbow or a twisting injury. Elbow fractures may cause severe pain, swelling, tenderness and painful movements. If a fracture is suspected, immediate intervention by your doctor is necessary. Surgery is often required if a bony displacement is observed.

Nursemaid’s Elbow

Dislocation of the radius bone present in the elbow is called nursemaid’s elbow. This condition is very common among children below 5 years of age as their bones and muscles are still in the developing stage. This condition usually occurs when a child is pulled up too hard by the arm but can also occur due to a fall or swinging your child from the arms.

Elbow Pain

The elbow is a hinge joint made up of 3 bones – humerus, radius and ulna. The bones are held together by ligaments to provide stability to the joint. Muscles and tendons move the bones around each other and help in performing various activities. The common causes of elbow pain include:

Shoulder Trauma

Shoulder injuries most commonly occur in athletes participating in sports such as swimming, tennis, pitching, and weightlifting. The injuries are caused due to the over usage or repetitive motion of the arms.Shoulder injuries cause pain, stiffness, restricted movements, difficulty in performing routine activities, and popping sensation.

Clavicle Fracture (Broken Collarbone)

Clavicle fracture or broken collarbone is a very common 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, fall on an outstretched arm or motor vehicle accident may also cause the clavicle bone to break. A broken clavicle causes difficulty in lifting your arm because of pain, swelling and bruising.

Fracture of the Shoulder Blade (Scapula)

The scapula (shoulder blade) is a flat, triangular bone providing attachment to the muscles of the back, neck, chest and arm. The scapula has a body, neck and spine portion.Scapular fractures are uncommon but do occur and require a large amount of force to fracture. They are usually the result of intense trauma, such as a high speed motor vehicle accident or a fall from a height onto one’s back.

Adult Forearm Fractures

The forearm is made up of 2 bones namely the radius and ulna. The primary function of your forearm is rotation i.e., the ability to turn your palms up and down. The fracture of the forearm affects the ability to rotate your arm, as well as bend and straighten the wrist and elbow. The breaking of the radius or ulna in the middle of the bone requires a strong force and it is most commonly seen in adults. In most of the cases, both bones are broken during a forearm fracture.

Forearm Fractures in Children

The radius (bone on the thumb side) and ulna (bone on the little-finger side) are the two bones of the forearm. Forearm fractures can occur near the wrist, near the elbow or in the middle of the forearm. Apart from this, the bones in children are prone to a unique injury known as a growth plate fracture. The growth plate, which is made of cartilage (flexible tissue) is present at the ends of the bones in children and helps in the determination of length and shape of the mature bone.

Distal Humerus Fractures of the Elbow

The elbow is a region between the upper arm and the fore arm. The elbow joint is made up of 3 bones. The distal (lower) end of the humerus bone in the upper arm joins with the radius and ulna bones in the fore arm to form the elbow joint.

Elbow Fractures in Children

The elbow is a joint that consists of three bones – the humerus (upper arm bone), radius (forearm bone) and ulna (forearm bone). An elbow fracture most commonly occurs when your child falls on an outstretched arm. It can lead to severe pain in the elbow and numbness in the hand. Fractures are more common in children due to their physical activities as well as their bone properties. Children’s bones have an area of developing cartilage tissue called a growth plate which is present at the end of long bones that will eventually develop into solid bone as the child grows.

Radial Head Fractures of The Elbow

The elbow is a junction between the forearm and the upper arm. The elbow joint is made up of 3 bones namely the humerus bone in the upper arm which joins with the radius and ulna bones in the forearm. The elbow joint is essential for the movement of your arms and to perform daily activities. The head of the radius bone is cup-shaped and corresponds to the spherical surface of the humerus. The injury in the head of the radius causes impairment in the function of the elbow. Radial head fractures are very common and occur in almost 20% of acute elbow injuries. Elbow dislocations are generally associated with radial head fractures. Radial head fractures are more common in women than in men and occur more frequently in the age group of 30 and 40 years.

Glenoid Fracture

The glenoid is the socket that forms the ball and socket joint of the shoulder. Fractures of the glenoid are rare but can occur due to major trauma or during high-energy sports activities.

Elbow Fractures

Three bones, the humerus, radius and ulna, make up the elbow joint. Elbow fractures may occur from trauma, resulting from various reasons; some of them being a fall on an outstretched arm, a direct blow to the elbow, or an abnormal twist to the joint beyond its functional limit.

Shoulder Injections

Ultrasound is a common imaging technique that employs high frequency sound waves to create images of organs and other internal structures of the body. These images provide valuable information of underlying pathology of the tissues and assists with diagnosis and planning the treatment of a particular condition. Ultrasound provides a clear view of the organs, tendons, muscles or joints and any associated disorders.

Revision Shoulder Replacement

Total shoulder replacement is the replacement of the head of the humerus (upper arm bone) and the glenoid cavity (cavity of the shoulder blade) into which the humerus fits, with artificial prostheses to relieve pain, swelling and stiffness caused due to damage of cartilage at the articulating surfaces.

Arthroscopic Bankart Repair

The shoulder joint (glenohumeral joint) is a ball and socket joint, where the head of the upper arm bone (humerus) attaches to the shoulder socket (glenoid cavity). The shoulder socket is extremely shallow and therefore needs additional support to keep the shoulder bones from dislocating. The labrum, a cuff of cartilage that encircles the shoulder socket, helps serve this purpose by forming a cup for the humeral head to move within. It provides stability to the joint, enabling a wide range of movements.

Shoulder Reconstruction

Shoulder reconstruction is a surgical procedure performed in patients with shoulder instability to improve stability, restore the function and prevent recurrent dislocations of the shoulder joint.Shoulder instability is a problem of loose shoulder joint that occurs when the structures that surround the shoulder joint such as the ligaments, capsule and cartilage become overstretched or injured. When this occurs, you may have shoulder joint dislocation.

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 to project images to a computer screen for your surgeon to view the surgical site. Arthroscopy is used to treat disease conditions and injuries involving the bones, cartilage, tendons, ligaments, and muscles of the shoulder joint.

Arthroscopic Biologic Total Shoulder Resurfacing

Shoulder arthritis is an inflammatory condition causing pain and stiffness in the joint. It can be successfully treated with total joint replacement surgery which is commonly performed on older patients. However, the surgery is not advisable for young active individuals due to concerns with durability of the implants used in replacement surgery. Joint replacement surgery uses metal and plastic prostheses to replace the damaged cartilage of the shoulder joint. Extensive activity in young individuals can cause loosening or failure of the prosthesis, requiring revision surgery.

Elbow Tendon & Ligament Repair

The elbow is a complex joint of the upper limb formed by the articulation of the long bone of the upper arm or humerus and the two bones of the forearm, namely, radius and ulna. It is one of the important joints of the upper limb and is involved in basic movements such as flexion and extension of the upper limb and rotation of the forearm.The elbow joint is supported by the ulnar collateral ligament, radial collateral ligament and the annular ligament. These ligaments provide stability and strength to the elbow joint.

Elbow Contracture

Elbow contracture refers to a stiff elbow with limited range of motion. It is a common complication following elbow surgery, fractures, dislocations, and burns.The normal functional range of motion for an elbow is 30-145 degrees. A stiff or contracted elbow may be diagnosed when the ability to extend or flex the arm is lessened by 30 degrees or more.

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  • J Berni MD Orthopedic Surgeon American Acaadmey Of Orthopaedic Surgeon
  • American board Of Orthopaedic Surgery
  • J Berni MD Orthopedic Surgeon Saint Louis University
  • J Berni MD Orthopedic Surgeon University Of Missouri-Health
  • J Berni MD Orthopedic Surgeon St Charles Orthopadeic Surgery Associate