Category Archives: Orthopedics (muscles, joints, bones)

– Common shoulder injuries and repair part 1: shoulder dislocation, bankart lesion and shouder instability, bankart repair surgery.
– Common shoulder injuries and repair part 2 : rotator cuff injuries, separated shoulder, frozen shoulder.
– Common knee injuries and repair part 1: knee joint anatomy, meniscus tear and repair.
– Common knee injuries and repair part 2 : Knee sprains, ACL injuries, ACL reconstruction.
– Common ankle injuries : Ankle joint anatomy, ankle sprains and fractures.
– Ankle fusion surgery.
– Femoral acetabular impingement (FAI of hip).
– Bone remodeling.
– Shoulder arthritis and surgical repairs.
– Reverse total shoulder replacement.
– Temporomandibular joint (TMJ) disorders.
– Piriformis syndrome
– Sciatica

Temporomandibular joint (TMJ) disorders – disc displacement.

Temporomandibular joint (TMJ) anatomy and function

Below is a narrated animation about TMJ anatomy, disc displacement and natural adaptation. Click here to license this video and/or other related videos on Alila Medical Media website.

The temporomandibular joint (TMJ) is the joint between the lower jawbone – the mandible – and the temporal bone of the skull (Fig. 1). The TMJ is responsible for jaw movement and is the most used joint in the body.

The TMJ is essentially the articulation between the condyle of the mandible and the mandibular fossa – a socket in the temporal bone. The unique feature of the TMJ is the articular disc – a flexible and elastic cartilage that divides the joint into two parts: a upper joint and a lower joint.
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Fig. 1 : Anatomy of the TMJ with jaw closed and open. Click on image to see a larger version on Alila Medical Media website where the image is also available for licensing.

The disc serves as a cushion between the two bone surfaces. The disc lacks nerve endings and blood vessels in its center and therefore is insensitive to pain. Anteriorly it attaches to lateral pterygoid muscle – a muscle of mastication (chewing). Posteriorly it continues as retrodiscal tissue fully supplied with blood vessels and nerves. This is commonly the source of pain in disorders with anterior disc displacement (see below).

The jawbone (mandible) is the only bone that moves when the mouth opens. The first 20 mm (three quarters of an inch) opening involves only a rotational movement of the condyle within the socket. For the mouth to open wider, the condyle and the disc have to move out of the socket, forward and down the articular eminence, a convex bone surface located anteriorly to the socket (see Fig.1 and video below). This movement is called translation.

Click here to see an animation of normal TMJ function on Alila Medical Media website where the video is also available for licensing.

TMJ disorders

The most common disorder of the TMJ is disc displacement, and in most of the cases, the disc is dislocated anteriorly (Fig. 2, middle and lower panels). As the disc moves forwards, the retrodiscal tissue is pulled in between the two bones. This can be very painful as this tissue is fully vascular and innervated, unlike the disc. The movements made by chewing or even talking cause a chronic bruise to the tissue resulting in inflammation and pain.

Fig. 2 : Anterior disc displacement, “clicking” and “locking” symptoms, see text for details. Click on image to see a larger version on Alila Medical Media website where the image is also available for licensing.

The forward dislocated disc is an obstacle for the condyle movement when the mouth is opening. In order to fully open the jaw, the condyle has to jump over the back end of the disc and onto its center. This produces a clicking or popping sound. Upon closing, the condyle slides back out of the disc hence another “click” or “pop”. This condition is called disc displacement with reduction. In later stage of disc dislocation, the condyle stays behind the disc all the time, unable to get back onto the disc. The clicking sound disappeared but mouth opening is limited. This is usually the most symptomatic stage – the jaw is said to be “locked” as it is unable to open wide. At this stage the condition is called disc displacement without reduction.

Click here to see an animation of TMJ disc displacement on Alila Medical Media website where the video is also available for licensing.

Fortunately, in most of the cases, the condition resolves by itself after some time. This is thanks to a process called natural adaptation of the retrodiscal tissue, which after a while becomes scar tissue and can functionally replace the disc. In fact, it becomes so similar to the disc that it is called a pseudodisc.

Reverse Total Shoulder Replacement

The videos on this page can be downloaded upon purchase of a license on Alila medical Media website. Click here!

Reverse Total Shoulder Replacement or Delta Shoulder Replacement is a modification of total shoulder replacement procedure. The conventional procedure has a metal ball on the humerus (replacing the natural humeral head) and a plastic component on the glenoid. The reverse procedure has the reverse positions of the prostheses : the metal ball is now fixed on the glenoid socket and the plastic cup is fixed in place of the humeral head (Fig. 1). This configuration is indicated for people with rotator cuff arthropathy.

Fig. 1: Configuration of conventional versus reverse total shoulder replacement. Note the location of the metal head and plastic component in each case. Click on image to see a larger version on Alila Medical Media website where the image is also available for licensing.

Why a conventional total shoulder will not work with rotator cuff arthropathy?

Rotator cuff arthropathy or cuff tear arthropathy (CTA) is shoulder arthritis in a setting of rotator cuff tears. Rotator cuff muscles hold the ball and the socket together and prevent the humeral head from moving out of the socket when the deltoid muscle raises the arm. In people with torn rotator cuff, the head of the humerus moves upwards out of the socket resulting in shoulder instability. Conventional total shoulder preserving the natural configuration of the shoulder joint will encounter the same problem (Fig. 2, left panel).

Fig. 2: Conventional versus reverse total shoulder replacement with torn rotator cuff. The upward force displaces the humeral head in conventional configuration but stabilizes the joint in reverse configuration. Click on image to see a larger version on Alila Medical Media website where the image is also available for licensing.

Why a reverse total shoulder would work?

In reverse total shoulder procedure, the arthritic humeral head is replaced with a plastic cup and the metal ball is fixed onto the glenoid surface. With this configuration, the contraction of the deltoid will move the arm up and compress the socket to the ball at the same time (Fig. 2, right panel). The ball and the socket will fit more snugly together providing stability.

> See all Orthopedic topics

Shoulder arthritis

The videos on this page can be downloaded upon purchase of a license on Alila Medical Media website. Click here!

Shoulder arthritis refers to loss of cartilage on the surface of the ball (humeral head) and the socket (glenoid) of the shoulder glenohumeral joint. The two bones rub against each other and produce pain, stiffness and difficulty moving an arm.

Types and Causes of Shoulder arthritis

Osteoarthritis (OA) – also called degenerative joint disease (DJD), is the “wear and tear” condition of the joint commonly due to old age. OA is characterized by loss of cartilage, bone spurs (osteophytes) and no major inflammation (Fig. 1).

Fig. 1: Osteoarthritis of the main shoulder joint. Click on image to see a larger version on Alila Medical Media website where the image is also available for licensing.

Rheumatoid arthritis (RA) – Inflammation of the synovium – the membrane that encloses the joint and contains lubricant fluid. Inflammation brings in the cells of the immune system whose inflammatory chemicals damage and destroy the joint. It’s not clear how RA starts but genetic predisposition together with infection of the joint are likely to be among the causes.

Rotator cuff arthropathy or cuff tear arthropathy (CTA) – Shoulder arthritis as a result and in a setting of rotator cuff tears. Rotator cuff muscles hold the ball and the socket together and prevent the humeral head from moving out of the socket when the person raises an arm. In people with torn rotator cuff, the head of the humerus moves upwards and rub onto the acromion. This causes damages to the covering cartilage and eventually arthritis. Combination of cuff tear and arthritis is a devastating condition that seriously compromises function of the shoulder.

Post-traumatic arthritis – arthritis that develops after physical injury to the joint.

Chondrolysis – sudden loss of cartilage that happens occasionally after a shoulder surgery, commonly seen in association with infusion of local anesthetics into the joint for pain management.

Treatments

Non-surgical treatments include shoulder exercises and anti-inflammatory medications.

Surgical treatments include a variety of procedures :

1. Total shoulder replacement surgery : the arthritic humeral head is replaced with a metal ball on a stem that fits inside the humerus, the socket is replaced with a plastic component made of high density polyethylene.

Fig. 2: Total shoulder replacement procedure. Click on image to see a larger version on Alila Medical Media website where the image is also available for licensing.

2. Ream and Run Arthroplasty – a modification of total shoulder procedure above. The metal ball replaces the humeral head but the socket is simply shaped, smoothed to fit the ball and left to heal. No plastic component used. With time, the body grows a cartilage layer on top of the socket. This procedure is recommended for younger and more active individuals.

3. Reverse total shoulder or Delta total shoulder replacement – This is indicated for people with rotator cuff arthropathy (see types of shoulder arthritis above). This procedure reverses the positions of the prostheses : the metal ball is now fixed on the socket and the plastic component is fixed in place of the humeral head. This topic is covered in the next article about reverse total shoulder replacement.
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Femoral acetabular impingement (FAI)

What is femoral acetabular impingement (FAI)?

Femoral acetabular impingement (FAI) is a condition of hip joint where the bones are abnormally shaped, they pinch each other on the covering cartilages when the joint is in motion and cause damages.

The hip joint is a ball-and-socket joint (Fig. 1). The femoral head (the ball) fits into the acetabulum (the socket). The femoral head is covered with articular cartilage, the acetabulum has a ring of cartilage around its rim called the labrum. In FAI, there are abnormal bone growths (spurs) on the ball or the socket or both (Fig. 2). The ball can no longer move smoothly inside the socket. They rub onto each other and pinch on the covering cartilages causing damages.

Fig. 1 : Anatomy of the hip joint. Click on image to see a larger version on Alila Medical Media website where the image is also available for licensing.

Types of FAI

Pincer – Bone spurs on the acetabulum, commonly on the upper edge (Fig. 2 ). This situation is also described as over-coverage of the socket over the ball.

Cam – Bones spurs on the femoral head and neck making the neck less prominent and the head not completely round.

Combined – both cam and pincer are present, this is a very common situation.

Fig. 2 : Types of FAI. Bones spurs are colored in red. Click on image to see a larger version on Alila Medical Media website where the image is also available for licensing.

What damages can it make?

Impingement results in cartilage breakdown on the femoral head and labral tears on the rim of the acetabulum. FAI is also the cause of premature hip osteoarthritis in young adults.

Causes and risk factors

The bone spurs are the result of abnormal bone growth during childhood development. The reasons why this happens are unclear.

FAI is more common in young athletes, dancers who practice a larger range of motions of the hip, and in active individuals.

Symptoms

Some of the symptoms may include:

– Pain at the groin area or inner hip is more common although the pain may be felt at the side of the hip.

– Pain after sitting for a long period of time.

– Stabbing pain when sitting down or standing up.

Treatment

Treatments range from lifestyle changes, physical therapies to surgeries.

Lifestyle changes usually involve being less active. Physical therapy helps to increase hip strength but stretching should be avoided.

Arthroscopic surgeries are commonly performed to remove damaged tissues, repair the labrum and stimulate cartilage growth by microfractures. Removal of abnormal bony structures are also recommended to prevent future damages to the joint.

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Bone remodeling

Bone remodeling (bone metabolism) is the process of removal of old bone tissue and formation of a new one.

Functions of bone remodeling

– Renewal of bone tissue to prevent accumulation of old bone with multiple micro-damages.

– Repair of small injuries : In response to small fractures, the damaged tissue is removed and new bone matrix is formed to replace it.

– Adjustment of bone architecture to meet changing mechanical needs: new bone matrix is deposited where needed, old bone tissue is removed elsewhere.

– Role in maintenance of calcium homeostasis of blood plasma.

Bone remodeling process

Bone remodeling involves the removal of bone tissue by osteoclasts followed by the formation of new bone matrix deposited and mineralized by osteoblasts (Fig. 1).

Fig. 1: Bone remodeling cycle: resorption, reversal and formation. See text for details. Click on image to see a larger version on Alila Medical Media website where the image is also available for licensing.

Bone resorption : removal of old bone tissue by osteoclasts. Osteoclasts are bone-dissolving cells. They derive from hematopoietic stem cells and are product of fusion of several cell precursors. Because of this, osteoclasts are unusually large and multinuclear. Osteoclast resembles an octopus crawling on the bone surface due to the presence of a ruffled border – multiple infoldings of plasma membrane – served to increase its surface area. They also have a foamy appearance as they contain lots of lysosomes.

Reversal: Mononuclear cells (monocytes, macrophages) clean up the debris on bone surface.

New bone formation : Recruitment of pre-osteoblasts to the surface, these mature to become osteoblasts. Osteoblasts are bone – forming cells. They synthesize the organic matter of bone matrix (osteoid). Osteoid mineralized and becomes new bone.

Osteocytes are former osteoblasts that have been trapped in the bone matrix they deposited. They can no longer synthesize bone matrix and instead serve as mechanical sensors. When they detect a strain in a bone, they communicate with the osteoblasts on the bone surface. These latter would deposit bone matrix where needed in response.

Bone modeling versus Bone remodeling

Bone modeling is the process in which bones change their overall shape to adapt to physiological and mechanical changes. In bone modeling, the two sub-processes of bone resorption and bone formation are less coordinated, i.e. bone resorption may happen without subsequent new bone formation and vice versa: new bone formation may happen without old bone being removed. Bone modeling is more frequent in growing children while bone remodeling is more frequent in adults.

Disorders of bone metabolism

Bone resorption and formation must be in balance to maintain healthy bone metabolism. When bone resorption overtakes new bone formation, bone loss – osteoporosis – may result (Fig. 2). Osteoporosis (or porous bone) is very common in older adults, especially in post-menopause women. This condition usually affects all the bones in the body.

Fig. 2: Bone loss in osteoporosis (right panel) compared to normal bone tissue (left). Click on image to see a larger version on Alila Medical Media website where the image is also available for licensing.

Another disorder of bone remodeling is Paget’s disease of bone (osteitis deformans). This condition is characterized by larger and denser but weaker bones. Paget’s disease typically is localized to just a few bones. The pelvis, lower spine and long bones of the legs are the most commonly affected.

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Ankle Fusion Surgery

The videos on this page can be downloaded upon purchase of a license on Alila Medical Media website. Click here!

Ankle fusion surgery is a reconstructive surgical procedure where a damaged ankle joint is converted into an immobile mass of bone. It’s a highly successful procedure commonly suggested for repair of severely injured joint.

During the procedure the end of the fibula is cut to gain access to the joint (transfibular procedure), damaged bones and cartilage are then removed and screws (and possibly plates) are used to fix the tibia and talus together. With time bone grows fusing the joint into one solid mass of bone. Sometimes, bone graft may be added to facilitate bone growth, this is usually taken from some other bones of the same person. Screws will remain inside the body after surgery.

Click here to see an animation of ankle fusion surgery on Alila Medical Media website where the video is also available for licensing.

Fig. 1 : Steps of surgical procedure for ankle fusion: 1. damaged joint; 2. fibula modified; 3. damaged bones and cartilage removed; 4. screws used to fix the tibia and talus together. Click on image to see a larger version on Alila Medical Media website where the image is also available for licensing.

After the surgery, the up and down range of motion is mostly restricted, but lateral motions remain unchanged. Compared to ankle joint replacement and other ankle procedures, ankle fusion has higher success rate with less pain and less complication risk.

> Ankle joint anatomy and common injuries

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Common ankle injuries

Ankle anatomy

The ankle includes three bones : the tibia (shinbone), the fibula and the talus (Fig. 1). Articulations between these bones make up the ankle joint.

Fig.1: Anatomy of the ankle joint. Click on image to see a larger version on Alila Medical Media website where the image is also available for licensing.

The ankle is stabilized by the following ligaments (Fig. 2):
– tibiofibular ligaments connect the tibia to the fibula, one in front (anterior tibiofibular) and one in the back (posterior tibiofibular);
– lateral collateral ligaments connect the fibula to the talus (two of them: again one in front and one in the back) and to the calcaneus (the heel bone); and
– on the medial side, a multipart deltoid ligament connects the tibia to the talus and other bones of foot (the calcaneus and navicular).

Fig.2 : Ligaments of ankle. Click on image to see a larger version on Alila Medical Media website where the image is also available for licensing.

Common ankle injuries include ankle sprains and ankle fractures.

Ankle sprain

Ankle sprain refers to injury to any of the ligaments of the ankle joint. This happens when the ankle is rolled or twisted beyond the normal range of motion and the ligaments are overstretched and torn. Commonly, the ankle moves suddenly outward while the foot turns inward resulting in overstretching of the ligaments on the outside of the foot (lateral ligaments). This type of sprain is called inversion (Fig. 3). On the other hand, when the ankle moves inwards and the foot turns outwards it’s the ligaments on the inside (medial) that are hurt. This type of sprain is called eversion and is much less common.

Fig.3 :Types of ankle sprain, illustrated for the right foot, anterior view. Click on image to see a larger version on Alila Medical Media website where the image is also available for licensing.

Ankle sprains are common sport injuries. They can range from mild to severe depending on how bad is the damage and how many ligaments are involved (Fig. 4)

Fig.4 :Grades of ankle sprain. Click on image to see a larger version on Alila Medical Media website where the image is also available for licensing.

In most cases sprains can be treated with rest, ice pack, compression with a bandage and elevation (raising your foot up) to reduce swelling. Severe injuries may require surgery.

Ankle fracture

Broken bones of the ankle, a common sport injury. Commonly due to a direct blow to the ankle or a fall. Pott’s fracture (Fig. 5) represents a typical situation when the ankle receives a blow from the outside resulting in broken fibula at the point of impact. The talus moves outward shearing off a piece of the tibia. Medial ligaments are also injured in this case.

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Fig. 5: Pott’s fracture. Click on image to see a larger version on Alila Medical Media website where the image is also available for licensing.

Imaging techniques such as x-ray or CT-scan are used to determine the severity of fractures. If the broken bones are still in their normal position they will be immobilized (with a cast for example) to facilitate healing. Bones that are fallen out of place will require surgery. During surgery the bones are positioned back to their normal place, screws and metal plates are then used to keep the fragments together.

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Common knee injuries and surgical repair, part 2

Knee sprains

Knee sprains refer to injuries in any of the ligaments of the knee. The most commonly injured are medial collateral ligament (MCL) running along the inner side of the knee, lateral collateral ligament (LCL) running along the outer side of the knee and anterior cruciate ligament (ACL) that connects the femur and tibia inside the joint (Fig. 1). For more about knee joint anatomy click here.

Fig. 1: Common types of knee sprain. Click on image to see a larger version on Alila Medical Media website where the image is also available for licensing.

Commonly, injury happens after a direct blow to the knee. When the knee is hit from outside it moves inwards and the ligament on the inside (the MCL) is overstretched and injured. Inversely, when the blow comes from the inside of the knee it’s the outside ligament (the LCL) that is hurt. ACL injuries, on the other hand, are caused by twisting movement of the knee and are most common among athletes in sports that involve sudden rotation movement of lower leg.

Fig. 2: Completely torn ACL. Click on image to see a larger version on Alila Medical Media website where the image is also available for licensing.

Mild sprains (stretched ligament but no tear or small tears) can be treated with rest, knee exercises and physical therapy. Complete tears require surgical repair or reconstruction.

ACL reconstruction surgery

Below is a narrated animation of ACL reconstruction surgery. Click here to license this video and/or other orthopedic videos on Alila Medical Media website.

This procedure is used to replace a severely damaged or completely torn anterior cruciate ligament (ACL) with a graft. The graft is a piece of healthy ligament taken from the same person or a donor. Graft from the same person is called autograft and usually works best. The procedure is detailed in Fig. 3. Autograft is commonly taken from the patellar ligament (one that connects the kneecap to the tibia), but hamstring tendon may also be used. See the figure legends for details of procedure, step 1 is done through open surgery, the rest are done through an arthroscope.

Fig. 3: Steps of arthroscopic knee surgery for reconstruction of anterior cruciate ligament injury: 1. Graft taken from kneecap and patellar ligament; 2. Torn ACL shown; 3. Damaged ACL removed and a channel is drilled through tibia and femur; 4. graft inserted and secured with screws; 5. graft in place. Click on image to see a larger version on Alila Medical Media website where the image is also available for licensing.

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Common knee injuries and surgical repair, part 1

Knee anatomy

The knee has three bones : the femur (the thigh bone), the tibia (the shinbone) and the patella (the kneecap). The femur and the tibia form a hinge joint. The joint is enclosed by the joint capsule at the back and on the sides, and is covered by the patella and patellar ligament in front. The knee joint is stabilized mainly by the tendons of quadriceps femoris muscle in front and semimembranosus muscle (one of the hamstrings) on the back. Strengthening these two muscles therefore helps to reduce the risk of knee injuries.

Fig.1 : Midsagittal section of the knee joint. Click on image to see a larger version on Alila Medical Media website where the image is also available for licensing.

Apart from the regular articular cartilage that cover the end surfaces of the three bones there are two additional pads of cartilage that are unique to the knee joint : medial meniscus and lateral meniscus (Fig. 2 and Fig. 3). The menisci act as shock absorbers to cushion the joint.

Two pairs of ligaments help to stabilize the knee : collateral ligaments run along two sides of the knee (Fig. 2), and cruciate ligaments which connect the femur and tibia in the center of the joint and cross each other in the from of an X (hence the names) : anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) (Fig. 2 and Fig. 3).

Fig. 2 : Front view of the right knee (the kneecap is removed in this picture to show structures behind). Click on image to see a larger version on Alila Medical Media website where the image is also available for licensing.

Fig. 3 : The right knee viewed from top (femur removed to show structures underneath). Click on image to see a larger version on Alila Medical Media website where the image is also available for licensing.

Meniscus tear and repair

Commonly referred to as torn cartilage, torn meniscus is a common sport injury. Mild injuries maybe treated with rest, ice, compression and elevation (the RICE approach). Larger tears may require surgery. The goal of surgery is to remove the damaged tissue which is the source of irritation, pain and possibly inflammation, and attempt to induce healing. Treatments vary depending on the location of the tear. If the tear is located on the outer border of the meniscus (the red zone, see Fig. 3) where there is a good blood supply, the damaged loose tissue will be removed and sutures will be used to tight the cartilage together to facilitate self healing. If the tear is located on the inner part (the white zone, see Fig. 3) where the blood supply is poor and hence healing is unlikely, the damaged part is simply removed (partial meniscectomy) (Fig. 4).

Minimal invasive arthroscopic surgery is commonly used for meniscus repair. In case of large tears, open surgery may be required.

Click here to see an animation of arthroscopic meniscus repair on Alila Medical Media website where the video is also available for licensing.

Fig. 4 : Treatment of meniscus tear depends on its location. Click on image to see a larger version on Alila Medical Media website where the image is also available for licensing.

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Common shoulder injuries and surgical repair (part 2)

Rotator cuff injuries

Fig. 1 shows a group of four muscles that cover the shoulder joint. These muscles originate on the scapula and insert on the humerus: the supraspinatus, infraspinatus, subscapularis and teres minor. The tendons of theses muscles form the rotator cuff (tendons connect muscles to bones). The most common injury to the rotator cuff is the impingement of one or more of these tendons. This may happen as a result of a trauma or sport related injury but more commonly as a result of aging. The tendons may rub against the acromion (a bony extension of the scapula that hangs over the cuff) every time the person raises an arm and become irritated, inflamed and ultimately torn.

Fig. 1: Rotator cuff muscles of the right shoulder. Click on image to see a larger version on Alila Medical Media website where the image is also available for licensing.

Below is a narrated animation of arthroscopic rotator cuff repair. Click here to license this video and/or other orthopedic videos on Alila Medical Media website.

Impingement usually develops over a period of time. Treatment includes rest, shoulder exercise, physical therapy and surgery. In most cases surgical treatment is done through an arthroscope but open surgery may be needed for larger tears. During surgery the damaged tissue is removed, source of irritation (commonly bone spurs on the acromion) is identified and removed. If there is no tear, the treatment may stop here and the surgical procedure is called shoulder debridement. In case of tear sutures will be used to tight the tendon back down to the bone (Fig.2).

Fig 2. Rotator cuff injury (1) and repair: small holes are drilled (2) into the bone of the humerus to hold small suture anchors with threads (3). The threads are attached to the tendon (4) and pulled tightly to hold the tendon to the bone (5). Click on image to see a larger version on Alila Medical Media website where the image is also available for licensing.

Separated shoulder

Separated shoulder is a condition affecting the “second” joint of the shoulder : the AC joint (acromioclavicular joint) between the acromion (an extension of the scapula) and the clavicle. This condition is commonly due to a direct blow to the shoulder as in a fall or sport injury. Fig. 3 shows the ligaments involved in stabilization of AC joint, injury to any of these ligament results in separated shoulder. Injuries are graded according to the extend of tears and number of ligaments involved. Grade I injury (partial tear in one of the ligament) may be treated with simple rest and ice, small tears heal themselves over time. Grade III injury where the clavicle is completely detached from the scapula requires surgery where a screw will be inserted to fix the clavicle to the coracoid process of the scapula.

Fig.3 : Shoulder separation grading. Click on image to see a larger version on Alila Medical Media website where the image is also available for licensing.

Frozen shoulder (adhesive capsulitis)

The shoulder, like all synovial joint, has a capsule around it. The capsule encloses the two end surfaces of the bones involved in the joint and a joint cavity containing a lubricant called synovial fluid. In people with frozen shoulder condition this capsule is thicken and inflamed (Fig. 4) causing pain when they try to move an arm. The pain increases with time and the range of motion decreases, the shoulder becomes stiff or “frozen”.

Fig. 4: Frozen shoulder. Click on image to see a larger version on Alila Medical Media website where the image is also available for licensing.

The causes of frozen shoulder are not fully established. People with diabetes and some other diseases show increased risk for frozen shoulder. It can also be resulted from a long-term immobilization of the shoulder (for example after a shoulder surgery). Treatments include pain management and physical therapy although in some cases surgery may be necessary. A procedure called arthroscopic capsular release is usually performed to cut through the tight area of the capsule.

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Medical Information Illustrated

Medical and health topics fully illustrated with pictures and videos for easy understanding.

Category Archives: Orthopedics (muscles, joints, bones)

Temporomandibular joint (TMJ) disorders – disc displacement.

Temporomandibular joint (TMJ) anatomy and function

TMJ disorders

Reverse Total Shoulder Replacement

Why a conventional total shoulder will not work with rotator cuff arthropathy?

Why a reverse total shoulder would work?

Shoulder arthritis

Types and Causes of Shoulder arthritis

Treatments

Femoral acetabular impingement (FAI)

What is femoral acetabular impingement (FAI)?

Types of FAI

What damages can it make?

Causes and risk factors

Symptoms

Treatment

Bone remodeling

Functions of bone remodeling

Bone remodeling process

Bone modeling versus Bone remodeling

Disorders of bone metabolism

> See all Orthopedic topics

Ankle Fusion Surgery

Common ankle injuries

Ankle anatomy

Ankle sprain

Ankle fracture

Common knee injuries and surgical repair, part 2

Knee sprains

ACL reconstruction surgery

Common knee injuries and surgical repair, part 1

Knee anatomy

Meniscus tear and repair

Common shoulder injuries and surgical repair (part 2)

Rotator cuff injuries

Separated shoulder

Frozen shoulder (adhesive capsulitis)