Shoulder

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.

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.

Conditions

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.

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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.

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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.

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Shoulder Joint 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.

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Arthritis of the Shoulder

The term arthritis literally means inflammation of a joint, but is generally used to describe any condition in which there is damage to the cartilage. Damage of the cartilage in the shoulder joint causes shoulder arthritis. Inflammation is the body's natural response to injury. The warning signs that inflammation presents are redness, swelling, heat and pain.

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Frozen Shoulder

Frozen shoulder is a painful shoulder condition that limits movement and causes stiffness in the joint. It is also called adhesive capsulitis and may progress to the state where you may find it very hard to move your arm. Frozen shoulder is more common in older adults between 40 and 60 years, and occurs more often in women than men.

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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. The common symptoms of shoulder instability include pain with certain movements of the shoulder; popping or grinding sound may be heard or felt, swelling and bruising of the shoulder may be seen immediately following subluxation or dislocation. Visible deformity and loss of function of the shoulder occurs after subluxation or sensation changes such as numbness or even partial paralysis can occur below the dislocation as a result of pressure on nerves and blood vessels.

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Shoulder Separation

Acromioclavicular joint (AC joint) dislocation or shoulder separation is one of the most common injuries of the upper arm. It commonly occurs in athletic young patients and results from a fall directly onto the point of the shoulder. It involves separation of the AC joint and injury to the ligaments that support the joint. The AC joint forms where the clavicle (collarbone) meets the shoulder blade (acromion).

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Dislocated Shoulder

Playing more overhead sports activities and repeated use of shoulder at workplace may lead to sliding of the upper arm bone, the ball portion, from the glenoid–the socket portion of the shoulder. The dislocation might be a partial dislocation (subluxation) or a complete dislocation causing pain and shoulder joint instability. Shoulder joint often dislocates in the forward direction (anterior instability) and it may also dislocate in backward or downward direction.

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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.

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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. The elbow joint is very important for the movement of your arms and for coordination of daily activities. Injury in the distal humerus can cause impairment in the function of the elbow joint. Distal humerus fracture is a rare condition which occurs when there is break in the lower end of the humerus. The treatment of distal humerus fracture aims at restoration of normal anatomy.

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Shoulder Trauma (Fractures & Dislocations)

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 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.

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Fracture of the Shoulder Blade (Scapula)

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 height onto one’s back. They can also occur from a fall on an outstretched arm if the humeral head impacts on the glenoid cavity.

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Procedures

Replacement

Shoulder Joint Replacement

Shoulder joint replacement is a surgical procedure performed to replace a damaged shoulder joint with artificial implants. It is usually performed to relieve shoulder pain when the joint is severely damaged by osteoarthritis, rheumatoid arthritis, post-traumatic arthritis, rotator cuff tear arthropathy, avascular necrosis (tissue death), fracture and failed former shoulder replacement surgery.

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Partial Shoulder Replacement

Partial shoulder replacement, also called shoulder hemiarthroplasty is a surgical procedure during which the upper bone in the arm (humerus) is replaced with a prosthetic metal implant, whereas the other half of the shoulder joint (glenoid or socket) is left intact. This surgical procedure is indicated in severe, persistent conditions of shoulder osteoarthritis in which the only the humeral head or ball of the joint is damaged. Osteoarthritis is a degenerative condition in which the cartilage that allows smooth movement in the joints wears away causing the adjacent bone to rub against each other resulting in pain and stiffness.

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Conventional Shoulder Replacement

The term arthritis literally means inflammation of a joint, but is generally used to describe any condition in which there is damage to the cartilage. Damage of the cartilage in the shoulder joint causes shoulder arthritis. In an arthritic shoulder

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Reverse Shoulder Replacement

Reverse total shoulder replacement, is an advanced surgical technique specifically designed for rotator cuff tear arthropathy, a condition where the patient suffers from both shoulder arthritis and a rotator cuff tear. The shoulder joint is a ball and socket joint formed by the union of the head of the upper arm bone (humerus) and the shoulder socket (glenoid). The rotator cuff is a group of four tendons that join the head of the humerus to the deeper shoulder muscles to provide stability and mobility to the shoulder joint.

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Total Shoulder Replacement

Coming soon

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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. A dislocation occurs when the head of the upper arm bone (humerus) is forced out of the shoulder socket (glenoid).

Other Surgeries

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.

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Biceps Tendon Repair

The biceps muscle is located in front of your upper arm. It helps in bending your elbow as well as in rotational movements of your forearm. Also, it helps to maintain stability in the shoulder joint. The biceps muscle has two tendons, one of which attaches it to the bone in the shoulder and the other attaches at the elbow. The biceps tendon at the elbow is called the distal biceps tendon and if there is a tear in this tendon, you will be unable to move your arm from the palm-down to palm-up position.

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Rotator Cuff Repair

ArthroFLEX ® is an acellular dermal extracellular matrix (ADM)intended for supplemental support and covering for softtissue repair. Matracell®, a patented and validated process by LifeNet Health, renders the ArthroFLEX allograft dermis acellular, without compromising biomechanical or biochemical properties. This process allows the matrix to retain its growth factors, native collagen scaffold, and elastin, which are required for healing.

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Shoulder Surgery

Shoulder reconstruction is a surgical procedure performed in patients with shoulder instability to improve stability, restore 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.

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Garey Orthopedic Medical Group2776 N. Garey Avenue
Pomona, CA 91767

(909) 593-7437 (909) 593-7437