This is a glossary of common shoulder terms that I use in my practice and clinical letters to assist my patients and referring clinicians. Hopefully this glossary can assist patients and other clinicians to better understand much of the confusing medical terminology. It does not cover every single word, but hopefully the majority of those I use in my practice. If there are any terms / words you feel are missing, please let me know and I will add them - [email protected] .
Thanks, Lennard Funk
Acromioclavicular joint (AC Joint or ACJ) – The joint that connects the distal end of the clavicle to the acromion, which is part of the scapula, or shoulder blade. https://www.shoulderdoc.co.uk/section/18
Acromion – the most superior and lateral part of the scapula; the supraspinatus tendon (one of the rotator cuff muscles) passes underneath the acromion before attaching to the humerus. In some cases, a malshaped acromion may lead to shoulder impingement. https://www.shoulderdoc.co.uk/article/1177
Active exercise – exercise in which the participant uses the muscles of the affected limb to create the limb motion.
Adduction - bringing the arm towards or across the body Anterior - in front
Apprehension - a clinical sign of instability. The feeling that your shoulder may slip out of joint when moved into certain positions. Tested with apprehension tests - https://www.shoulderdoc.co.uk/article/754
Arthritis – degeneration of a joint. When a joint becomes arthritic there is a loss of articular cartilage and degenerative changes to the bone. https://www.shoulderdoc.co.uk/section/24
Arthroplasty – joint replacement, the creation of an artificial joint, or the surgical restoration of the integrity and functional power of a joint. In shoulder arthroplasty, the arthritic articular surfaces are replaced by metal and polyethylene components. https://www.shoulderdoc.co.uk/section/24
Arthroscopy – also known as 'keyhole surgery'. It is the use of small and long telescopic instruments to allow surgery to be performed through small skin incisions (skin portals). https://www.shoulderdoc.co.uk/section/894
Avascular necrosis – death of bone and cartilage tissue due to impaired or disrupted blood supply (as that caused by traumatic injury or disease) and marked by severe pain in the affected region and by weakened bone that may flatten and collapse. Also called osteonecrosis.
Axillary nerve - a nerve that supplies the deltoid muscle. If injured it causes wasting of the muscle, weakness raising the arm and reduced sensation over the outside of the shoulder (badge patch area). https://www.shoulderdoc.co.uk/article/1181
Beighton score - a clinical scoring system to assess generalised joint laxity / mobility. A score over 6/9 indicates hypermobility. https://www.shoulderdoc.co.uk/article/645
Belly Press Test - a clinical examination test for subscapularis muscle weakness - https://www.shoulderdoc.co.uk/news/view/981
Biceps tendon – the biceps is a muscle at the front of the upper arm that bends the elbow and turns the forearm outward (supination). It has two tendons in the shoulder, known as the long head and short head tendons. There is one tendon at the elbow. https://www.shoulderdoc.co.uk/article/1180
Brachial neuritis – an acute syndrome of unknown cause marked by pain in the shoulder girdle, flaccid weakness of the muscles innervated by the brachial plexus, and mild sensory loss in the affected upper extremity.
Brachial neuritis is usually of limited duration with spontaneous recovery. Also called Parsonage-Turner syndrome or Neuralgic Amyotrophy. https://www.shoulderdoc.co.uk/article/364
Brachial plexus – a network of nerves formed by cervical and thoracic spinal nerves and supplying the arm and parts of the shoulder. https://www.shoulderdoc.co.uk/article/1181
Bursitis - inflammation of a bursa (a fluid filled sac that reduces friction and allows movement between tendons and bone). The largest bursa in the shoulder is the subacromial bursa
Capsule - the lining of the joint, usually the glenohumeral joint. See https://www.shoulderdoc.co.uk/article/480
Capsulitis - inflammation of the capsule. Commonly the early stages of adhesive capsulitis (frozen shoulder). https://www.shoulderdoc.co.uk/article/55
Clavicle – Also called collarbone, connects the sternum to the shoulder. Commonly fractures with high energy falls. See https://www.shoulderdoc.co.uk/article/636
Copeland Impingement Test - a test for subacromial impingement - https://www.shoulderdoc.co.uk/section/9
Coracoid – a bony process projecting from the scapula toward the sternum. Several ligaments attach to the coracoid, as do the tendons of the coracobrachialis muscle and the short head of the biceps. See https://www.shoulderdoc.co.uk/article/1177
Coraco-clavicular ligaments - two strong ligaments linking the coracoid to the clavicle. The two ligaments are the trapezoid and conoid ligaments. They are strong stabilisers of the AC joint and rupture in AC joint dislocations - https://www.shoulderdoc.co.uk/section/21
Core stability - the process of holding the shoulder and pelvic girdles (that is, the centre part, or core of the body) stable in order to support the movement forces from the arms and legs, which in turn will also increase the ability to balance. https://www.shoulderdoc.co.uk/news/view/1004
Coronal (plane) - the transverse plane of the body from left to right, that divides the body from front to back. Perpendicular to the sagittal plane.
Cuff tear arthropathy – a type of arthrosis of the shoulder joint with a unique bony wear pattern. After years of having a massive rotator cuff tear, superior migration of the humeral head is often seen, along with superior wear of the glenoid bone.
Deltoid muscle – the large round muscle on the outside of your shoulder, giving it the broad shape. It is supplied by the axillary nerve and can be injured with shoulder dislocations or as a surgical complication. If injured it causes wasting of the muscle, weakness raising the arm and reduced sensation over the outside of the shoulder (badge patch area). https://www.shoulderdoc.co.uk/section/902
Dermotomes - areas of the skin supplied by a specific spinal nerve root Dislocation – displacement of a body part, especially the temporary displacement of a bone from its normal position within a joint.
Drop Arm Test - a clinical examination test for significant weakness of arm elevation, usually a large / massive supraspinatus rotator cuff tear. The patient is unable to hold the arm elevated against gravity and just drops - https://www.shoulderdoc.co.uk/section/497
EMG test - EMG (Electromyogram) is a test for nerves and muscle function. It is usually done by a Neurophysiologist and involves small tiny needles and skin electrodes which stimulate the nerves and muscles to assess how well they are working. It is done as part of Nerve Conduction Studies (NCS) examination.
Empty Can Test - a clinical examination test for the supraspinatus tendon, where pain on resistance suggests possible supraspinatus tendon pathology. Very similar to the Jobe's Supraspinatus test - https://www.shoulderdoc.co.uk/article/748
External - outer side / outside something External rotation – rotating away from the body. An action performed by the infraspinatus muscle of the rotator cuff.
Fracture – a break, rupture, or crack, of a bone.
Frozen shoulder - a painful and stiff shoulder, often of unknown cause - https://www.shoulderdoc.co.uk/section/16
GIRD - Glenohumeral Internal Rotation Deficit - a clinical test showing a restriction of passive internal rotation with the arm in 90 degrees of abduction. It is often seen in overhead athletes with chronic shoulder pain as part of an Internal Impingement, but also in patients with Frozen Shoulder and Rotator Cuff Disorders. GIRD is often attributed to a tightness of the posterior Glenohumeral joint capsular ligaments, but other elements can contribute to it, such as the bone shapes and positions (scapula malposition, humeral torsion and version alignment)
Glenohumeral joint – the main shoulder joint. A ball and socket joint, where the ball is larger than the socket and therefore reliant on the muscles and ligaments to provide stability, https://www.shoulderdoc.co.uk/article/1177
Glenoid – the articular depression of the scapula entering into the formation of the shoulder joint. https://www.shoulderdoc.co.uk/article/1177
Hemiarthroplasty – arthroplasty in which one joint surface is replaced with artificial material, usually metal. In shoulder hemiarthroplasty, the proximal humerus is usually replaced, rather than the glenoid. https://www.shoulderdoc.co.uk/section/24
Heterotopic ossification – the pathologic formation of bony tissue in a location where bone does not normally form, e.g. within muscle. Humeral head – the smooth, round articular surface of the proximal humerus bone. https://www.shoulderdoc.co.uk/article/1177
Hornblowers Test - A clinical examination test for the Infraspinatus and Teres Minor muscles at the back of the shoulder - a positive test shows significant weakness of these muscles - https://www.shoulderdoc.co.uk/article/614
Humerus – the bone of the arm, articulating with the scapula above and the radius and ulna below. https://www.shoulderdoc.co.uk/article/1177
Hypermobility - joints are more flexible than most people. It is not an abnormality in itself, but can predispose to joint problems, such as instability and pain. It is measured using the Beighton score.
Impingement – often a short term for 'subacromial impingement', where the rotator cuff and humerus catch / impinge under the acromion. It has many direct and indirect causes. https://www.shoulderdoc.co.uk/section/9
Inferior - below
Infraspinatus muscle – an intrinsic (scapulohumeral) muscle of the shoulder joint. The tendon of this muscle contributes to the formation of the rotator cuff; origin, infraspinous fossa of scapula; insertion, middle facet of greater tubercle of humerus; action, extends arm and rotates it laterally; its tonic contraction helps to hold the head of the humerus in the shallow glenoid fossa; nerve supply, suprascapular (from fifth to sixth cervical spinal nerves).
Internal rotation – rotating towards the body. An action performed by the subscapularis muscle of the rotator cuff.
Interscalene block – a procedure that is used to provide pain relief for shoulder surgery. An anesthetic (e.g. bupivcaine) is injected near the nerves as they exit from the neck region. This often leads to better pain control with less need for narcotic pain medications - https://www.shoulderdoc.co.uk/article/941
Jobe's Relocation Test - a clinical examination test for anterior shoulder apprehension, where the examinaer puts light pressure on the front of the shoulder in the position of apprehension (ABER) and the apprehension decreases.
Jobe's Supraspinatus test - a clinical examination test for the supraspinatus tendon, where pain on resistance suggests possible supraspinatus tendon pathology. Very similar to the Empty Can Test - https://www.shoulderdoc.co.uk/spr/Exam_shoulder.pdf
Kibler corkscrew test - a clinical examination test for core stability. Patient stands and squats on one leg. https://www.shoulderdoc.co.uk/section/497
Kibler's Grind Test - for labral tears - the examiner circumducts the shoulder producing a clunk or grind or catching feeling. Similar to the McMurray test for meniscal tears of the knee.
Labrum – a rim or cup of cartilage that contributes to shoulder stability by deepening and increasing the glenoid surface area, and by providing attachments for the shoulder capsule and various ligaments and tendons. https://www.shoulderdoc.co.uk/article/1399
Lateral - on the outside, away from the centre of the body.
Ligament - a band of tough, flexible fibrous tissue that joins to bones and holds a joint together. The glenohumeral joint ligaments provide stability to the joint. If injured they can cause instability of the joint. They can also become inflamed in frozen shoulder, leading to stiffness. https://www.shoulderdoc.co.uk/article/1179
Medial - closer to / towards the centre of the body MRI scan - a scan used to show the soft tissues (muscles, tendons, ligaments). The cells get 'activated' and then relax by large, spinning magnets. It does not involve any radiation. Claustrophobic patients can request an Open MRI scan (if available). More info - https://www.shoulderdoc.co.uk/article/44
Multidirectional instability (MDI) – shoulder instability in patients who have generalized looseness of the supporting ligaments that surround the shoulder’s glenohumeral joint. The laxity can be a congenital condition (present from birth) or a condition that has developed over time, often from repetitive activities that stretch the shoulder capsule such as overhead sports (volleyball, gymnastics, swimming, or throwing).
Multi-disciplinary Team (MDT) - a team of medical professionals with differing, but complementary expertise and training working together to make decisions and provide comprehensive treatment for a patient. It utilises the skills, knowledge and best practice from multiple disciplines to optimnise the patient's management, satisfaction and outcome.
Nerve Conduction Studies (NCS) - a medical diagnostic test to assess the motor and sensory nerves of the body. It is done when there is a concern that a particular nerve or group of nerves are not working properly from disease or injury. When muscles are tested also it is known as an EMG.
Osteoarthritis – arthritis that occurs with aging or as a sequela of trauma characterized by degenerative and sometimes hypertrophic changes in the bone and cartilage of a joint and a progressive wearing down of apposing joint surfaces with consequent distortion of joint position. Also called degenerative arthritis, degenerative joint disease, hypertrophic arthritis, post-traumatic arthritis. https://www.shoulderdoc.co.uk/section/24
Osteolysis - a stress response of the bone, where it resorbs as a result of repetitive stresses. The most common is the lateral clavicle at the AC joint - https://www.shoulderdoc.co.uk/article/1280 Osteonecrosis – necrosis of bone tissue due to impaired or disrupted blood supply (as that caused by traumatic injury or disease) and marked by severe pain in the affected region and by weakened bone that may flatten and collapse. Also called avascular necrosis.
Paralabral cysts - swellings that arise around the socket of the shoulder joint (glenoid). They are pockets of joint fluid that develop outside of the joint under tears of the labrum. These are also known as ganglia (or a ganglion). https://www.shoulderdoc.co.uk/article/1496
Passive exercise – exercise that emphasizes maintaining range of motion rather than strengthening. During a passive shoulder exercise, for example, the surgical shoulder and arm remain loose while the unaffected arm provides the power to take the shoulder through a range of motion. See also active exercise.
Pathological - abnormal and caused by a disease or injury
Posterior - behind or at the back
Prosthesis (pl. prostheses) – an artificial device used to replace a missing body part. A shoulder prosthesis is usually made of metal and plastic.
Reverse shoulder prosthesis – an artificial shoulder joint made from metal and plastic that is used to replace a natural shoulder joint that is worn out, painful, and/or no longer functions properly. With a reverse shoulder prosthesis, the ball (humeral head) and socket (glenoid cup) are switched or “reversed.” There may be advantages to using a reverse shoulder prosthesis in patients with an irreparable, massive rotator cuff tear or significant glenoid bone loss. Compare to standard shoulder prosthesis. - https://www.shoulderdoc.co.uk/article/631
Revision surgery – surgery that is performed after a previous, initial surgery; a revision surgery may be performed for many reasons, e.g. to correct alignment, replace worn out components, etc. - https://www.shoulderdoc.co.uk/article/1583
Rheumatoid arthritis – a usually chronic disease that is considered an autoimmune disease and is characterized especially by pain, stiffness, inflammation, swelling, and sometimes destruction of joints.
Rotator cuff – a supporting and strengthening structure of the shoulder joint that is made up of part of its capsule blended with tendons of the subscapularis, infraspinatus, supraspinatus, and teres minor muscles as they pass to the capsule or across it to insert on the humerus. Also called the musculotendinous cuff. - https://www.shoulderdoc.co.uk/section/22
Rotator interval - the area between the subscapularis tendon and supraspinatus tendon at he front of the glenohumeral joint. It contains the long head of biceps tendon and the superior glenohumeral ligament. It is the primary area of inflammation in frozen shoulder (capsulitis)
Sagittal (plane) - the longitudinal plane from front to back that divides the body in to two halves from left to right. Perpendicular to the Coronal plane.
Scapula – The large, flat, triangular bone forming the back part of the shoulder. Also called shoulder blade.
Scapula Retraction Test (SRT) - A clinical examination test of the scapula. The test is performed through stabilization of the scapula in a retracted position, in conjunction with standard manual supraspinatus muscle strength testing with the empty can test, with the arm in the plane of the scapula. A positive test correlates with scapular dyskinesis, demonstrating an improvement in supraspinatus strength as compared with the empty can test without scapular stabilization. - https://pubmed.ncbi.nlm.nih.gov/22661566/
Scapular winging – a rare condition sometimes caused by nerve injury or another disorder affecting the shoulder; “winging” refers to abnormal protrusion of a part of the scapula. - https://www.shoulderdoc.co.uk/article/577
Scarf test - a clinical examination test for AC joint pain. The arm is passively pushed across the chest (adduction). https://www.shoulderdoc.co.uk/article/614
Septic arthritis – acute inflammation of synovial membranes, with purulent effusion into a joint, due to bacterial infection; the usual route of infection is hemic to the synovial tissue, causing destruction of the articular cartilage, and may become chronic, with sinus formation, osteomyelitis, deformity, and disability. Also called suppurative arthritis.
SLAP tear – a tear of the superior labrum of the shoulder. SLAP is an acronym for Superior Labrum Anterior Posterior. If the arm is forcefully bent inward at the shoulder, the humerus acts as a lever and tears the long head of the biceps tendon and labrum cartilage from the glenoid cavity in a front-to-back (anterior-posterior) direction. - https://www.shoulderdoc.co.uk/article/51
Speed's Test - a clinical examination test for a painful long head of biceps tendon - https://www.shoulderdoc.co.uk/article/767
Shoulder replacement / prosthesis / arthroplasty – an artificial shoulder joint made from metal and plastic that is used to replace a natural shoulder joint that is worn out, painful, and/or no longer functions properly. With a standard shoulder prosthesis, the ball (humeral head) and socket (glenoid cup) are fabricated in a manner that imitates the shoulder’s normal anatomy. Compare to reverse shoulder prosthesis.
Subacromial Bursa - a fluid filled sac between the acromion and the rotator cuff. It allows frictionless movement between the acromion and rotator cuff tendons. It can become inflamed and swollen in any disease process or injury affecting the rotator cuff or subacromial area. This is known as a bursitis
Subacromial impingement - where the rotator cuff and humerus catch / impinge under the acromion. It has many direct and indirect causes. https://www.shoulderdoc.co.uk/section/9
Subscapularis muscle – one of four rotator cuff muscles. The subscapularis is located on the undersurface of the scapula and connects to an area on the proximal humerus bone called the lesser tubercle. It is responsible for internal rotation of the arm at the shoulder.
Sulcus - a clinical sign of laxity of the shoulder joint. A ‘dip’ is seen as the joint is distracted. https://www.shoulderdoc.co.uk/article/752
Superior - above or at the top
Supraspinatus muscle – one of four rotator cuff muscles. The supraspinatus sits on the superior, posterior scapula in an area known as the supraspinatus fossa, and it connects to the proximal humerus bone at the greater tubercle. It contributes to stabilization of glenohumeral joint. The supraspinatus is the most often injured rotator cuff muscle.
Suture anchor – a small screw made of metal or synthetic material that is buried into the bone during some shoulder surgeries. Sutures or stitches run through an eyelet in the screw, and these are used to repair soft tissues and hold them to the bone. - https://www.shoulderdoc.co.uk/article/538
Synovial osteochondromatosis (SOC) – a benign condition characterized by synovial membrane proliferation and metaplasia. The entity also is termed synovial chondromatosis. The synovial lining of a joint, bursa, or tendon sheath undergoes nodular proliferation, and fragments may break off from the synovial surface into the joint. In this location and nourished by synovial fluid, the fragments may grow, calcify, or ossify. The intra-articular fragment may vary in size from a few millimeters to a few centimeters.
Tear - defined as a ripping action of a structure. However, it is often reported on MRI and ultrasound scans where a defect or abnormality is seen in the tendon or labrum. This is confusing to patients and incorrect use of the word in reports, where the mechanism is not known. Often worn, degenerate tendons from age, and useage are reported as tears. A scan report of a tear, does not mean it needs to be repaired. This needs to be taken in context with the clinical findings by your treating clinician.
Tenodesis – the surgical anchoring of a tendon, as to a bone.
Teres minor muscle – one of four rotator cuff muscles, it originates from the lateral border of the scapula and inserts into the proximal humerus at the greater tubercle. It contributes to the shoulder’s external rotation strength.
Total joint arthroplasty – arthroplasty in which both joint surfaces are replaced with artificial materials, usually metal and high-density plastic.
Whipple Scapula Test - A clinical examination test for scapula muscle weakness. Elevation against resistance is improved on scapula correction similar to Scapula Retraction Test (SRT)
Winging - where the shoulder balde (scapula) protrudes on movement. It is the result of many possible nerve or muscle causes. - - https://www.shoulderdoc.co.uk/article/577
Wrightington Posterior Instability Test (WPIT) - clinical examination test suggestive of posterior glenohumeral joint instability and posterior labral tears. https://www.shoulderdoc.co.uk/news/view/1655