Arthrosis of the shoulder joint

A third of all older people over sixty years of age report pain in the shoulder joint. The cause of pain in this area in most cases is the development of arthrosis. The disease also affects young people whose profession involves constant heavy physical activity - miner, builder, loader, etc.

The disease causes great inconvenience in everyday life and sharply reduces ability to work. In severe cases, shoulder arthrosis leads to disability. It is important to identify the disease in the initial stages. There are now treatment methods that suppress the progression of the disease when therapy is started in a timely manner.

What is pathology

Arthrosis 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 group of pathologies that are non-infectious in nature. First, the cartilage tissue covering the articular surfaces is destroyed.

Cartilage loses its strength and elasticity. It gradually thins and flattens. Due to changes in the cartilage layer, it loses its shock-absorbing qualities. Its ability to reduce shock loads that occur during flexion or extension of the arm deteriorates.

Osteoarthritis also affects all structures, such as the joint capsule, its shell, bone surfaces adjacent to the cartilaginous 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 articular surfaces.

The pathology is manifested by pain and crunching in the area of the affected shoulder. In the later stages of the disease, the range of motion in the shoulder joint is sharply reduced. Inflammation in it with this nature of the process is either absent or weakly expressed. The pathology has a chronic, gradually progressive course.

Causes

The cascade of pathological changes in osteoarthritis is triggered by the natural aging of tissues. Damage to cartilage as a result of strong mechanical stress can contribute to the onset 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 the presence of other defects of the upper limb.
2. Injuries. Traumatic arthrosis often develops after intra-articular fractures. Sometimes the cause of the pathology is a shoulder dislocation, most often a habitual one. Occasionally, severe bruises provoke the development of pathology.
3. Inflammation. Arthrosis often occurs when a patient suffers from glenohumeral periarthritis for a long time. This is also facilitated by previously suffered nonspecific purulent arthritis, as well as specific joint lesions that arise due to tuberculosis, syphilis and other diseases.

There is a group of risk factors that contribute 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 lesions with other localizations. Typically the knee, ankle and other joints are affected.
• Overvoltage. It often occurs in athletes involved in volleyball, tennis, basketball, and throwing sports equipment. This condition also occurs in people if their profession is characterized by constant high load on the upper limbs (loaders, miners and others).
• Diseases. Osteoarthritis often develops in patients who suffer from autoimmune joint diseases. Some endocrine diseases, metabolic disorders, and connective tissue insufficiency, which is characterized by excessive joint mobility, also contribute to degenerative processes in cartilage.

The incidence of degenerative articular lesions in patients increases sharply with age. Frequent hypothermia also negatively affects joints.

Symptoms

At the onset of the disease, patients with arthrosis experience a feeling of discomfort and moderate pain in the shoulder area. There is a dependence of pain 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 has a pulling or aching character.

Pain in the shoulder joint becomes habitual and constant. Painful sensations appear both during exercise and at rest. They can disturb the patient at night. The characteristic features of pain syndrome in osteoarthritis of the joint are the following:

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

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

As joint damage progresses, an increase in the range of movement restrictions is observed. The patient develops contracture (stiffness), which significantly impairs the functioning of the limb. If osteoarthritis is on the right side, the patient cannot care for 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 the articular 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 is noted. The composition of the intra-articular fluid changes. The nutrition of the cartilage is disrupted. He does not tolerate stress well, which leads to periodic pain.
2. Second. At this stage, thinning of the cartilage tissue occurs. Its structure is changing. The surface becomes rough. Cysts form in the thickness of the cartilaginous layer, and foci of calcification appear. The areas of bone adjacent to the joint are moderately deformed. The edges of the articular platform are covered with bone growths. The discomfort becomes constant.
3. Third. A pronounced degree of thinning of the cartilaginous layer and disruption of its structure are noted. Extensive areas of cartilage destruction are identified. A significant deformation of the articular platform is found. Limitation of range of motion is revealed. There is weakness of the ligaments, as well as a decrease in size and flabbiness of the periarticular muscles.

This approach to classifying lesions of the shoulder joint allows doctors to select appropriate treatment tactics that take into account the severity of the pathological process.

Diagnostics

The appearance of symptoms of arthrosis forces the patient to go to the doctor. He needs to see a therapist. The specialist will conduct an initial diagnosis. After determining the cause of the joint damage, he will refer the patient to a rheumatologist, endocrinologist, surgeon or orthopedist-traumatologist.

Doctors make the diagnosis in the presence of typical clinical manifestations and X-ray signs of arthrosis. During the initial examination, the tissues of the joint are felt to determine the degree of pain.

The possibility of performing active and passive movements in the affected area is being studied. The doctor detects deformation of the joint or its increase in volume. To confirm the presence of arthrosis, the following studies are recommended:

1. Radiography. The presence of dystrophic changes in the cartilaginous layer is detected in the joint. Characteristic bone growths are identified along the edge of the articular cavity. At a later stage, they find that the joint space is narrowed. A change in the shape and structure of the bone adjacent to the cartilage is determined. The shape of the joint space becomes wedge-shaped. In the thickness of the bone, signs of rarefaction and the presence of cyst-like formations are visible.
2. CT scan. This study at the initial stages of the disease provides an opportunity to assess the condition of bone 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. ). Layer-by-layer clear images help determine the extent of damage to articular and periarticular structures.
4. Ultrasonography. 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 clearly sees the areas of damage. Zones of softening in the thickness of the cartilage are determined. It reveals the presence of deep cracks penetrating deep into the subchondral (subchondral) plate of the bone. Deep ulceration of the cartilage, erosion and superficial cracks are detected.

Making a diagnosis of arthrosis of the shoulder joint in the later stages does not present any difficulties for doctors. When assessing the nature of joint damage, it is necessary to take into account the possible secondary origin of joint pathology against the background of other diseases.

Treatment

Treatment for osteoarthritis is carried out by orthopedic traumatologists or rheumatologists. At the stage of restoration of motor functions, rehabilitation specialists actively participate in the treatment process.

To relieve pain and restore function in case of arthrosis of the limb, it is important to receive prompt medical care and follow all doctor’s orders. It is necessary to limit the load on the joint and avoid sudden movements of the hand. It is important to avoid lifting or carrying heavy objects for long periods of time.

The joint needs a dosed load under the supervision of specialists, since complete inactivity has a negative impact on the affected limb. Treatment options include conservative therapy and surgical interventions. The choice of methods depends on the prevalence of certain symptoms and the stage of the disease.

Drug therapy

An important goal in the treatment of arthrosis is the elimination of pain. To eliminate discomfort and reduce the severity of inflammation, the following medications are prescribed:

1. Preparations for general anesthesia. Non-steroidal drugs are prescribed to patients for a short course during an exacerbation. With prolonged uncontrolled use, they irritate the gastric mucosa and slow down the recovery process in the joint.
2. Local remedies. Gels and ointments containing non-steroidal anti-inflammatory compounds are used when symptoms increase. Hormone-containing drugs with local action are less commonly used. They relieve inflammation and swelling.
3. Means for intra-articular injections. For persistent and severe pain that cannot be eliminated by other means, glucocorticoid drugs are injected into the joint. Blockades can be carried out no more than four times a 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 therapy becomes noticeable only after three months of continuous use of the drug.

Additionally, vasodilators are used for shoulder 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

At the third stage of arthrosis, when there is significant destruction of the joint with limited mobility and loss of ability to work, endoprosthetics surgery is performed. Before deciding whether to perform an intervention, age, level of physical activity, and general health are taken into account.

Installation of modern endoprostheses made of ceramic, plastic and metal completely restores the functioning of the joint. The devices have a guaranteed service life of more than fifteen years.

Non-drug treatment

Physiotherapeutic techniques are actively used in the phase of subsiding exacerbation in the treatment of joint osteoarthritis. Their course use gives good results when included in a complex therapy program. For arthrosis, the following physiotherapeutic methods are used:

1. Amplipulse. The treatment method locally affects the joint using alternating electric current. It relieves pain and has a vasodilator 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. The joint structures are affected by a pulsed magnetic field. It improves blood flow. The cartilage is saturated with nutrients. The magnet removes decay products from the cells. It suppresses autoimmune reactions.
4. Electrophoresis. This technique promotes the penetration of drugs into the affected joint, which is ensured by the effect of electric current on the tissue. During treatment, blood flow in the joint structures increases. The procedure reduces inflammation and swelling. Unpleasant sensations in the hand are relieved. Muscle spasm is eliminated.
5. Balneotherapy. Therapeutic baths with radon, saline and other beneficial solutions are actively used for shoulder arthrosis. Blood flow improves, which enhances nutrition and accelerates cell recovery. Inflammation is relieved.
6. Electrical stimulation. With this method of treatment, electrical stimulation of nerve trunks and muscles is performed using electrodes, which transmit a current that has certain parameters.

Therapeutic massage is carried out after the exacerbation is relieved. It restores blood flow and increases the elasticity of ligaments. Muscle spasm in the joint decreases. The range of movements increases. For arthrosis, exercise therapy is useful.

The gymnastics complex is performed when the pain calms down. When conducting mechanotherapy, special simulators are used for rehabilitation. Active-passive movements are carried out on them. They restore the function of the affected joint.

How to treat at home?

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

All physicochemical reactions are stimulated in tissues. The functions of cartilage cells are activated. Laser treatment provides an analgesic effect. Blood flow improves and swelling is eliminated. Local immunity is enhanced. Reserve capillaries expand. Laser therapy has an anti-inflammatory effect.

To receive procedures, you do not have to constantly visit a medical facility. Treatment of shoulder arthrosis at home is carried out using portable laser therapy devices. With their regular use, pain decreases. The function of the shoulder joint improves with laser treatment of arthrosis at home.

Prognosis and prevention

Shoulder arthrosis cannot be completely cured. But it is possible to slow down the progression of pathological joint changes. With regular treatment, ability to work is maintained. It is important to follow the doctor's recommendations.

It is necessary to prevent injury to the hand. It is important to avoid excessive impact on the shoulder joint when performing professional duties, as well as during sports. It is necessary to promptly treat diseases that contribute to the development of arthrosis.