Arthrosis of the shoulder joint

A third of the elderly over the age of sixty report pain in the shoulder joint. In most cases, the cause of pain in this area is the development of arthrosis. The disease also affects young people whose profession involves constant heavy physical activity - miners, builders, loaders, etc.

The disease causes great discomfort in everyday life and sharply reduces the ability to work. In severe cases, the shoulder joint leads to disability. It is important to identify the disease at an early stage. Today, there are treatment methods that suppress the progression of the disease if therapy is started in time.

What is pathology

Osteoarthritis of the shoulder joint is a chronic disease in which degenerative processes destroy and thin the cartilage. Osteoarthritis of the shoulder is classified as a non-infectious pathology. First, the cartilage tissue covering the joint surfaces is destroyed.

Cartilage loses its strength and flexibility. It gradually thins and flattens. Due to changes in the cartilage layer, it loses its shock-absorbing properties. The ability to reduce shock loads during arm flexion or extension is impaired.

Osteoarthritis also affects all structures, such as the joint capsule, its shell, bone surfaces adjacent to the cartilage layer, ligaments and adjacent muscles. This is accompanied by pathological changes in other soft tissues located near the joint. As a result of the disease, bone growths form on the joint surfaces.

The pathology manifests itself in pain and crunching in the area of the affected shoulder. In the later stages of the disease, the range of motion of the shoulder joint decreases sharply. This kind of inflammation of the process is either absent or weakly expressed. The pathology has a chronic, gradually progressive course.

Cause

The cascade of pathological changes in osteoarthritis is triggered by the natural aging of tissues. Cartilage damage caused by strong mechanical stress can contribute to the initiation of cartilage destruction. This is also facilitated by various pathological processes.

Primary shoulder arthrosis is usually diagnosed in older people. Secondary joint damage develops against the background of previous diseases. It occurs at any age. The main causes of the disease are considered:

1. Developmental anomalies. Pathology is often found in patients with underdevelopment of the humeral head or glenoid cavity, as well as other defects of the upper limb.
2. Injuries. Traumatic arthrosis often develops after intra-articular fractures. Sometimes the cause of pathology is dislocation of the shoulder, most often it is usual. Sometimes severe bruises provoke the development of pathology.
3. Inflammation. Arthrosis often occurs when the patient suffers from glenohumeral periarthritis for a long time. This is facilitated by previously suffered non-specific purulent arthritis, as well as specific joint changes that occur as a result of tuberculosis, syphilis and other diseases.

There is a risk factor that contributes to the appearance of such a polyetiological disease. The following phenomena increase the likelihood of developing arthrosis:

• Genetic predisposition. Close relatives of many patients also suffer from arthrosis. They also have other localization changes. Knees, ankles and other joints are usually affected.
• Overvoltage. It often occurs in volleyball, tennis, basketball and throwing athletes. This condition also occurs in people if their profession is characterized by a constant high load on the upper limbs (loaders, miners and others).
• Diseases. Osteoarthritis often develops in patients who suffer from autoimmune joint diseases. Certain endocrine diseases, metabolic disorders and connective tissue insufficiency, characterized by excessive mobility of the joints, also contribute to the degenerative processes of the cartilage.

The incidence of degenerative joint changes in patients increases sharply with advancing age. Frequent hypothermia negatively affects the joints.

Symptoms

At the beginning of the disease, patients with arthrosis experience discomfort and moderate pain in the shoulder area. The pain depends on the weather. They become more intense after physical activity. The pain intensifies in a certain body position. After resting or changing position, the pain disappears.

When the patient moves his hand, a crunching sensation occurs. There are no external changes in the joint, no swelling. Over time, the pain becomes more intense. It constantly bothers the patient, regardless of body position. The pain is pulling or aching.

Pain in the shoulder joint becomes habitual and constant. Painful sensations occur during exercise and at rest. They can disturb the patient at night. The characteristics of the pain syndrome in joint osteoarthritis are as follows:

• along with the appearance of aching pain, sharp pain during physical activity;
• discomfort occurs only in the joint area, radiates to the elbow area, and can then spread to the entire surface of the arm;
• the pain may spread to the back and neck on the affected side.

After a short time, the patient is bothered by morning stiffness of the shoulder. The range of active movements in the joint decreases. After physical activity and hypothermia, a slight swelling of the soft tissues in the shoulder area can be observed.

As the joint damage progresses, an increase in the range of movement restrictions can be observed. The patient develops a contracture (stiffness), which significantly impairs the function of the limb. If the osteoarthritis is on the right side, the patient cannot take care of himself.

Stages of development

With this disease, there are three stages of the pathological process in the joint. They reflect the severity of damage to joint structures and the presence of certain symptoms of damage to the shoulder joint. Experts distinguish the following stages of the pathological process:

1. First. The absence of gross structural changes in the thickness of the cartilage tissue can be observed. The composition of the intra-articular fluid changes. Cartilage nutrition is interrupted. He does not tolerate stress well, which leads to periodic pain.
2. Second. At this stage, thinning of the cartilage tissue occurs. Its structure changes. The surface will be rough. Cysts form in the thickness of the cartilaginous layer, and foci of calcification appear. Bone areas adjacent to the joint are moderately deformed. The edges of the joint platform are covered by bony outgrowths. The discomfort becomes constant.
3. Third. A pronounced thinning of the cartilaginous layer and disruption of its structure can be observed. Extensive areas of cartilage destruction are identified. A significant deformation of the articular platform is found. The limitation of the range of motion is revealed. Weakness of the ligaments and reduction in size and flaccidity of the periarticular muscles are observed.

This approach to the classification of changes in the shoulder joint allows doctors to choose an appropriate treatment tactic that takes into account the severity of the pathological process.

Diagnostics

The appearance of symptoms of arthrosis forces the patient to consult a doctor. You need to see a therapist. The specialist performs the initial diagnosis. After determining the cause of joint damage, a rheumatologist, endocrinologist, surgeon or orthopedic traumatologist refers the patient to a specialist.

Doctors make the diagnosis based on the presence of typical clinical manifestations of arthrosis and X-rays. During the initial examination, the tissues of the joint are palpated to determine the degree of pain.

The possibility of performing active and passive movements in the affected area is examined. The doctor notices the deformation of the joint or an increase in its volume. The following tests are recommended to confirm the presence of arthrosis:

1. Radiography. The presence of dystrophic changes in the cartilage layer can be detected in the joint. A characteristic bone growth is identified along the edge of the joint cavity. At a later stage, they find that the joint space has narrowed. They determine the change in the shape and structure of the bone next to the cartilage. The shape of the joint gap becomes wedge-shaped. Signs of rarefaction and the presence of cyst-like formations can be seen in the thickness of the bone.
2. CT scan. In the initial stages of the disease, this test provides an opportunity to assess the state of the bones and cartilage using layer-by-layer images.
3. Magnetic resonance imaging. The method evaluates the condition of soft tissue formations (cartilage, ligaments, joint capsule, etc. ). Clear layer-by-layer images help determine the extent of damage to joint and periarticular structures.
4. Ultrasound. Changes in the joint are detected using ultrasound. The method is safe for the body, as there is no harmful radiation.
5. Arthroscopy. It is performed using an endoscope. A manipulator with a camera is inserted into the joint. The doctor can clearly see the damaged areas. We determine the softening zones in the thickness of the cartilage. It reveals the presence of deep cracks penetrating deep into the subchondral (subchondral) plate of the bone. Deep ulceration of the cartilage, erosion and surface cracks can be seen.

The diagnosis of arthrosis of the shoulder joint in the later stages is not difficult for doctors. When evaluating the nature of joint damage, the possible secondary origin of joint pathology against the background of other diseases should be taken into account.

Treatment

Osteoarthritis is treated by an orthopedic traumatologist or rheumatologist. In the phase of restoration of motor functions, rehabilitation specialists are actively involved in the treatment process.

To relieve pain and restore function in limb arthrosis, it is important to receive immediate medical attention and follow all the doctor's instructions. The load on the joint should be limited and sudden movements of the hand should be avoided. It is important to avoid lifting or carrying heavy objects for long periods of time.

The joint needs dosed loading under the supervision of a specialist, as complete inactivity has a negative effect on the affected limb. Treatment options include conservative therapy and surgical interventions. The choice of methods depends on the frequency of certain symptoms and the stage of the disease.

Drug therapy

An important goal of treating arthrosis is to eliminate pain. To eliminate discomfort and reduce the severity of inflammation, the following drugs are prescribed:

1. Preparations for general anesthesia. Patients are prescribed non-steroidal drugs for a short course during an exacerbation. In case of long-term uncontrolled use, they irritate the mucous membrane of the stomach and slow down the healing process in the joint.
2. Local remedies. In case of exacerbation of symptoms, gels and ointments containing non-steroidal anti-inflammatory compounds are used. Locally acting hormone-containing drugs are used less often. They reduce inflammation and swelling.
3. Devices for intra-articular injections. In case of persistent and severe pain that cannot be eliminated by other means, glucocorticoid drugs are injected into the joint. Blockades can be implemented a maximum of four times per year.

In the first and second stages, chondroprotectors are prescribed to restore and strengthen the joint. These products contain chondroitin sulfate, hyaluronic acid and glucosamine. They are used in long courses of six months or more. The effect of the therapy becomes noticeable only after three months of continuous drug use.

In addition, vasodilators are used in shoulder joint arthrosis. They increase blood flow and relieve capillary spasms. Muscle relaxants are prescribed to relax the muscles in the shoulder area when spasms are detected.

Surgical methods

In the third stage of arthrosis, when there is significant damage to the restricted joint and loss of working capacity, endoprosthetic surgery is performed. Age, level of physical activity and general health should be taken into account before deciding whether to perform the intervention.

The installation of modern endoprostheses made of ceramic, plastic and metal completely restores the function of the joint. The guaranteed lifetime of the devices is more than fifteen years.

It is not a drug treatment

Physiotherapy techniques are actively used in the treatment of joint osteoarthritis in the phase of reduction of exacerbation. Their course use gives good results if they are included in a complex therapy program. In case of arthrosis, the following physiotherapy methods are used:

1. Amplipulse. The treatment method affects the joint locally with an alternating electric current. It relieves pain and has a vasodilating effect. The procedure improves tissue nutrition.
2. UHF. The joint is exposed to ultra high frequency waves. The method reduces pain, relieves inflammation and swelling.
3. Magnetotherapy. Joint structures are affected by a pulsating magnetic field. Improves blood flow. Cartilage is saturated with nutrients. The magnet removes decay products from the cells. Suppresses autoimmune reactions.
4. Electrophoresis. This technique facilitates the penetration of drugs into the affected joint, which is ensured by the effect of electric current on the tissue. During the treatment, the blood flow in the joint structures increases. The procedure reduces inflammation and swelling. Unpleasant sensations in the hand are alleviated. The muscle spasm stops.
5. Balneotherapy. Therapeutic baths with radon, saline and other beneficial solutions are actively used in shoulder arthrosis. Blood flow improves, which improves nutrition and accelerates cell regeneration. The inflammation subsides.
6. Electrical stimulation. With this treatment method, electrical stimulation of the nerve trunks and muscles is carried out using electrodes that transmit current with certain parameters.

The therapeutic massage is performed after the exacerbation subsides. It restores blood flow and increases the flexibility of ligaments. The muscle spasm in the joint is reduced. Range of motion increases. In case of arthrosis, exercise therapy is useful.

The gymnastics complex is performed when the pain subsides. During mechanotherapy, special simulators are used for rehabilitation. Active-passive movements are performed on them. They restore the function of the affected joint.

How do we treat it at home?

Laser therapy is an effective method in the treatment of shoulder arthritis. The laser beam has a beneficial effect on the affected joint tissues. Devices that produce low-intensity infrared laser beams are used for therapy. Laser therapy is prescribed to speed up cell metabolism.

All physico-chemical reactions in the tissues are stimulated. The functions of cartilage cells are activated. Laser treatment provides pain relief. Blood flow improves and swelling goes away. Local immunity increases. Reserve capillaries dilate. Laser therapy has an anti-inflammatory effect.

You do not need to visit a medical facility continuously to receive the procedures. Shoulder joint arthrosis is treated at home with portable laser therapy devices. With their regular use, the pain decreases. The function of the shoulder joint improves with home laser treatment of arthrosis.

Prognosis and prevention

Shoulder joint arthrosis cannot be completely cured. But the progression of pathological joint changes can be slowed down. The ability to work is maintained with regular treatment. It is important to follow your doctor's recommendations.

Injury to the hand must be prevented. It is important to avoid excessive impact on the shoulder joint during professional tasks and during sports. Diseases contributing to the development of arthrosis require urgent treatment.