The shoulder connects the trunk to the upper limb and allows, thanks to its very great mobility, the most important in the human body, to place the upper limb in the three space dimensions and provide the hand with its function of prehension. The shoulder is a complex joint with a strong muscle structure (19 muscles in total) that allows to set in motion the three joints that make it, the main one being the glenohumeral joint (between the shoulder blade or scapula and the upper hand bone or humerus), the acromioclavicular (between scapula and clavicle) and the sternoclavicular (between clavicle and sternum) and the gliding of the scapula on the rib cage.
The shoulder joint is strong, flexible and highly mobile but it is probably the most strained in the human body during sportive or professional everyday activities involving pushing, pulling, carrying, lifting, throwing, holding back … This makes it particularly vulnerable to trauma and wear.
To put it simply – shoulder disorders can be divided into three major categories:
The ultimate athlete pathology. The great mobility of the shoulder joint is made possible by the particular osteo ligamentous architecture of the glenohumeral joint, a humeral head in the shape of a sphere (tennis ball) and a small and flat glenoid, slightly larger than a two-euro coin attached to each other by the glenoid cavity, the labrum and the glenohumeral ligaments. But the downside is a strong tendency for the humeral head to come out of joint, thus entailing a dislocation of the shoulder or subluxation, if it is partial. They are very common in sports traumatology among younger people (<40 years).
Learn more in our page on surgery for shoulder instability.
The most common and most commonly seen condition in everyday shoulder surgery. It affects the tendons of the rotator cuff. Unlike the hip and knee, the shoulder wears down from its ligaments, from a simple tendonitis or without rupture to unrepairable massive break off of the rotator cuff tendons and through various stages of repairable damage (most frequent after all). The rotator cuff tendinopathy is usually diagnosed after 40-45 years of age and the main symptom remains shoulder pain.
Read more in our page on the operation of the rotator cuff.
It affects the articulation between the humerus and the scapula. Two common types of arthritis can be diagnosed: shoulder osteoarthritis (OA) with intact rotator cuff (primitive, osteonecrosis of the humeral head, some fracture sequelae …) and shoulder osteoarthritis with destruction of the rotator cuff (on massive rupture of the tendons, some fracture sequelae…).
Find out more in our page on shoulder replacement.
Shoulder surgery treats all of the shoulder disorders. It has considerably gained ground with shoulder arthroscopy, both from the point of view of a better understanding of pathological mechanisms as from the technical benefits of treatment.
Today, shoulder surgery is mostly performed arthroscopically : for rotator cuff repair, acromioplasty, tenotomy and biceps tenodesis, arthroscopic Bankart repair, disjunction and acromioclavicular dislocation, acromioclavicular joint replacement etc.
The open treatment procedure i.e. open surgery, can be recommended, especially in procedures of shoulder stabilization with the shoulder bone block, although more recent arthroscopic techniques have been developing, and quite well throughout the entire prosthetic surgery.
Shoulder prostheses are divided into two groups: total anatomic shoulder prostheses to treat shoulder osteoarthritis where the tendons of the rotator cuff are still good, and inverted total shoulder arthroplasty for all cases of osteoarthritis, joint destruction with absent or severely deficient cuff tendons.