The joint between the outer end of the collar bone
(clavicle) and shoulder blade (scapula) is called the
acromioclavicular joint.

The joint can be injured by a fall on to the point of the
shoulder that can disrupt the joint and tear the ligaments
which hold the joint in place. This allows the outer end of
the collar bone to become prominent beneath the skin
which can be seen and felt as a step or bump.

Symptoms and signs of an acromioclavicular joint injury
are pain over the cape of the shoulder and the arm feels
unsupported. There is loss of shoulder movement and
prominence of the outer end of the clavicle.

Arthritis of the shoulder is relatively rare compared with
osteoarthritis affecting the hip or knee, but the principles
of treatment are similar.  This condition presents with
progressive pain, stiffness and limitation of shoulder
function.

This

shoulder surgery

 is performed by keyhole surgery to increase the amount of space above the rotator cuff tendons. This procedure allows the tendons to pass freely beneath the bone of the front part of the shoulder blade as the arm is raised. It involves dividing a ligament above the tendon (the coracoacromial ligament) and shaving down spurs of bone that have often grown on the front corner of the shoulder blade (the acromion).

Frozen shoulder is a painful condition in which the
shoulder becomes painful and stiff due to inflammation and
thickening of the capsule (sack) around the shoulder joint.

What is the cause of frozen shoulder?
Often there is no known cause but a minor injury may
trigger the condition. Frozen shoulder is associated with
diabetes and is also seen in patients with Dupuytrenis
contracture. 

What are the symptoms and signs of frozen shoulder?
The condition is described as having three phases.
Initially the shoulder is painful and this may be very
severe. Gradually the shoulder becomes progressively
stiffer. Slowly the pain settles and movement returns
(“thawing”). This cycle may take up to 2 years

The rotator cuff tendon may tear due to abrasion caused
by a bone spur on the front corner of the shoulder blade
(acromion) or from an acute injury resulting in a painful,
weak shoulder.

What are the features of a rotator cuff tear?
Pain is often felt in the upper arm or over the cape of the
shoulder. The shoulder is often particularly painful at night
and this may prevent laying or sleeping comfortably on the
affected side. Certain movements such as reaching up to a
high shelf or putting the affected arm in the sleeve of a
garment are painful. The shoulder may feel weak for any
task that involves raising the arm above chest height.

Arthroscopy, commonly known as ‘keyhole surgery’,
involves the insertion of a special telescope with a
camera known as an arthroscope into the shoulder
joint. Usually only two or three 5mm puncture wounds
are required avoiding large wounds and scars. 

The arthroscope is inserted through one incision and
special instruments into the others. The procedure may
be performed under either a general anaesthetic or
regional anaesthetic to numb the shoulder. The technique
avoids the necessity to make large incisions and many
shoulder operations can now be performed arthroscopically
such as subacromial decompression, rotator cuff repair,
and stabilisation for dislocation.

Why does the shoulder dislocate?
The shoulder is a ball and socket joint. It has the greatest
tendency to dislocate (come out of joint) of any joint in the
body. This is due to the fact that the socket (glenoid) is
very shallow compared with the diameter of the ball. The
stability of the shoulder is improved by the presence of a
series of ligaments, a thick rim of tissue that deepens the
socket called the labrum and a strong but flexible sack,
the capsule, the surrounds and contains the whole
shoulder joint.

If the ligaments or the capsule stretch or the labrum is torn
off the socket then the joint may partly dislocate or sublux.
If the ball completely loses contact with the socket this is
known as a dislocation. Shoulder instability is a term that
is used to describe the shoulder either subluxing or
dislocating during movement or exercise

In which direction does the shoulder dislocate?
By far the most common is anterior dislocation (97%)
where the ball moves forward in relation to the socket.
The shoulder may also dislocate backwards (posteriorly)
or downwards (inferiorly) but this is much more rare.

What are the causes of shoulder dislocation?
There are three main categories of dislocation:

Traumatic dislocation.
The shoulder is injured with sufficient force such as with
a heavy fall or road traffic accident to cause the shoulder
to come out of joint. The shoulder may stay dislocated
and may need reducing (put back into joint) at hospital.
Following this injury the arm is normally immobilised in
a sling for a period of time and then a course of
physiotherapy is undertaken.

Such an injury often causes the labrum to be torn from
the front of the socket which can allow the shoulder to
become unstable and dislocate more easily with lesser
trauma in the future. If this occurs then surgery can be
considered to repair the torn part of the labrum. This
operation can be carried out either by arthroscopic
(keyhole) or open surgery.

A traumatic dislocation.
This occurs when the shoulder subluxes or dislocates
with minimal force such as when reaching up on to a
high shelf. It is usually painful but often the shoulder
usually goes back into joint itself. A traumatic dislocation
of the shoulder occurs in people who have lax joints
(being double jointed) and the first line of treatment is
directed towards strengthening and balancing the control
of shoulder movement through physiotherapy.  If this
fails then surgery may be necessary.

Positional non-traumatic dislocations.
This occurs due to abnormal pull of the muscles
surrounding the shoulder and may, for instance begin
as a party trick. It is normally painless and often occurs
in both shoulders. Treatment is by physiotherapy to
correct the abnormal muscle patterning.

The rotator cuff consists of four tendons that arise from
muscles attached to the scapula (shoulder blade). The
function of the cuff is to allow shoulder movement. The
tendon runs beneath an arch made up of bone and a
ligament. This is called the subacromial arch.

What is subacromial impingement?
Spurs of bone may develop over time on the front corner
of this bone called the acromion and cause abrasion of the
tendon and its surface covering called the bursa. This can
produce pain when raising the arm and is a condition called
subacromial impingement.

What are the features of subacromial impingement?
The pain often is felt over the cape of the shoulder and
upper arm and may be particularly noticeable at night.
Certain movements, such as reaching up to a high shelf
or putting the affected arm into the sleeve of a garment,
are painful.

The London Orthoapedic Clinic boasts extremely
experienced traumatologists which will diagnose
and treat a wide variety of Fractures.

All fractures of the Upper and Lower limb are extremely
common and a regular occurrence. Our consultants will
be available, especially with our after hours/emergency
service to fix all fractures.