Anatomy
The shoulder is the most mobile joint in the human body, yet is the most insecure. It is a ball and socket joint formed by the upper end of the arm bone (humerus) joining with the shoulder blade (scapula). It is surrounded by a bag like tissue called the capsule. A group of tendons called the rotator cuff are closely related to the shoulder. They serve as dynamic restraints. There is a discrepancy between the radius of curvature of the ball and its socket which renders the shoulder potentially unstable. This is akin to a golf ball perched on a tee. This inherently unstable joint is rendered stable by soft tissue restraints, the bony orientation and a negative suction force between the components. A great deal of movement is possible at the shoulder to allow the arm to be positioned in space. The price for this great range of movement is instability which is described below. Closely related to the joint are important nerves and blood vessels of the upper limb in their course downwards from the chest to the arm. asd
1) Instability-
Shane Warne’s shoulder dislocation a couple of years is one of the most famous in recent memory. The ball shaped upper end of the arm bone slides pops out of its socket either completely (dislocation) or partially (subluxation). This occurs in sports when there is a fall on the outstretched hand. A frank dislocation results and sudden pain is felt when the ball comes out of joint. It predominantly comes out at the front. The arm held as if it is paralyzed, until it is set right by the player or in a hospital. This is a dramatic event. Once the shoulder has dislocated, there is a tendency for it to recurrently dislocate in young sportsmen less than 25 years of age. This tendency for recurrent dislocation merits rehabilitation and surgical treatment. Arthroscopic stabilization offers these sportsmen a minimally invasive surgical technique. The results of this mode of surgery are matching the old “gold standard” of Open stabilization. Rehabilitation is faster after an arthroscopic procedure as the amount of pain is less. It is important to bear in mind that instability need not necessarily result only from a fall. It can also occur in sportsmen who use their arm to throw in overhead sports like cricket, Javelin, volley ball. In these sportsmen, the joint may not dislocate frankly but there is a dead arm feeling or pain. The fielder in cricket, who suffers from pain and has to throw the ball in from the boundary in an overhead manner, avoids this and instead throws it in underarm. Instability commonly occurs in a front ward direction but can occur to the back or in more than one direction (multi directional). These are less common. Instability towards the front and back needs surgical stabilization by preferably, arthroscopic means. However multidirectional instability (in more than one direction) is best treated by a rehabilitation process.
2) Tendonitis and impingement
3) Rotator cuff tears
Labral tears
- The labrum is a circular band of cartilage attached to the glenoid cavity (socket) to make it deeper. It can be torn in sportsmen who use the arm for throwing, serving, smashing; swimming etc. Pain is felt toward the front of the shoulder. The other symptoms may be clicking or locking. There may be associated instability, rotator cuff partial tears. Arthroscopic surgery is the only option. All associated abnormalities should be addressed simultaneously. |
