A third of all older people over 60 years of age report pain in the shoulder joint. In most cases, the cause of pain in this area is the development of osteoarthritis. The disease also affects young people whose profession is associated with constant heavy physical activity - miner, construction worker, loader, etc.
The disease causes great inconvenience in everyday life and greatly reduces the ability to work. In severe cases, shoulder osteoarthritis leads to disability. It is important to detect the disease in its early stages. There are now treatment methods that suppress the progression of the disease if therapy is started promptly.
What is pathology?
Osteoarthritis of the shoulder joint is a chronic disease in which degenerative processes destroy and thin out 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 joint surfaces is destroyed.
Cartilage loses its strength and elasticity. It gradually becomes thinner and flatter. Due to changes in the cartilage layer, it loses its shock-absorbing properties. Its ability to reduce shock loads that occur when the arm is flexed or extended decreases.
Osteoarthritis also affects all structures such as the joint capsule, its shell, the bone surfaces adjacent to the cartilage layer, ligaments and adjacent muscles. This is accompanied by pathological changes in other soft tissues near the joint. As a result of the disease, bone growths form on the joint 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 severely limited. In this type of process, inflammation is either absent or only mild. The pathology has a chronic, gradually progressive course.
causes
The cascade of pathological changes in osteoarthritis is triggered by the natural aging of the tissue. Cartilage damage caused by strong mechanical stress can contribute to the onset of cartilage destruction. This is also facilitated by various pathological processes.
Primary shoulder osteoarthritis is usually diagnosed in older people. Secondary joint damage occurs against the background of previous illnesses. It happens at any age. The main causes of the disease are:
- Developmental abnormalities. Pathologies often occur in patients with underdevelopment of the humeral head or glenoid cavity, as well as other defects of the upper extremity.
- Injuries. Traumatic osteoarthritis often occurs 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.
- inflammation. Osteoarthritis often occurs when a patient suffers from glenohumeral periarthritis for a long period of time. This is also facilitated by previously suffered non-specific purulent arthritis as well as specific joint damage caused by tuberculosis, syphilis and other diseases.
There are a group of risk factors that contribute to the occurrence of such a polyetiological disease. The following phenomena increase the likelihood of developing osteoarthritis:
- Genetic predisposition. Close relatives of many patients also suffer from osteoarthritis. They also have lesions with other locations. Typically, knees, ankles and other joints are affected.
- Overload. It often occurs in athletes who play volleyball, tennis, basketball, or throw sports equipment. This condition also occurs in people whose profession is characterized by a constant high load on the upper limbs (loaders, miners and others).
- Diseases. Osteoarthritis often develops in patients suffering from autoimmune joint diseases. Some endocrine diseases, metabolic disorders and connective tissue insufficiency, characterized by excessive joint mobility, also contribute to degenerative processes in the cartilage.
The frequency of degenerative joint lesions in patients increases sharply with increasing age. Frequent hypothermia also has a negative effect on the joints.
Symptoms
At the beginning of the disease, patients with osteoarthritis experience discomfort and moderate pain in the shoulder area. The pain depends on the weather. They become more intense after physical activity. The pain increases in a certain posture. The pain disappears after rest or changing position.
When the patient moves his hand, a grinding sensation occurs. There are no external changes to the joint, no swelling. Over time the pain gets worse. It constantly bothers the patient, regardless of posture. The pain has a pulling or aching character.
Pain in the shoulder joint becomes a habit and persists. Painful sensations occur both during exercise and at rest. They can disturb the patient at night. The characteristic features of the pain syndrome in arthrosis of the joint are as follows:
- along with the appearance of aching pain over time, stabbing pains appear during physical activity;
- unpleasant sensations are registered only in the joint area, they radiate to the elbow area and can then spread over the entire surface of the arm;
- The pain can spread across the back and neck on the affected side.
After a short time, the patient complains of morning stiffness in his shoulder. The amount of active movement in the joint decreases. After physical activity, as well as hypothermia, a slight swelling of the soft tissues in the shoulder area is noted.
As joint damage progresses, an increase in movement restrictions can be observed. The patient develops a contracture (stiffness) that significantly impairs the function of the limb. If there is osteoarthritis on the right side, the patient cannot take care of himself.
Stages of development
In this disease there are three stages of the pathological process in the joint. They reflect the severity of the damage to the joint structures and the presence of certain symptoms of damage to the shoulder joint. Experts distinguish the following stages of the pathological process:
- First. It is found that there are no gross structural changes in the thickness of the cartilage tissue. The composition of the intra-articular fluid changes. The nutrition of the cartilage is disturbed. He does not tolerate stress well, which leads to periodic pain.
- Second. At this stage there is a thinning of the cartilage tissue. Its structure changes. The surface becomes rough. Cysts form in the thickness of the cartilage layer and foci of calcification appear. The bone areas adjacent to the joint are moderately deformed. The edges of the articular platform are covered with bony growths. The discomfort becomes constant.
- Third. A pronounced thinning of the cartilage layer and disruption of its structure are noted. Extensive areas of cartilage destruction are identified. Significant deformation of the articular platform is noted. A restriction in the range of movement becomes visible. This leads to weakness of the ligaments and a reduction and relaxation of the periarticular muscles.
This approach to classifying lesions of the shoulder joint allows doctors to select appropriate treatment tactics, taking into account the severity of the pathological process.
diagnosis
The appearance of symptoms of arthrosis forces the patient to go to the doctor. He needs to see a therapist. The specialist carries out an initial diagnosis. After determining the cause of joint damage, he refers 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 osteoarthritis. During the initial examination, the tissue of the joint is palpated to determine the extent of the pain.
The possibility of performing active and passive movements in the affected area is being investigated. The doctor notices a deformation of the joint or an increase in its volume. To confirm the presence of osteoarthritis, the following tests are recommended:
- Radiography. In the joint, the presence of dystrophic changes in the cartilage layer is noted. Characteristic bone growths can be seen at the edge of the joint cavity. They later notice that the joint space is narrowed. A change in the shape and structure of the bone adjacent to the cartilage is noted. The shape of the joint space becomes wedge-shaped. In the thickness of the bone, signs of thinning and the presence of cyst-like formations are visible.
- CT scan. This study at the initial stage of the disease provides an opportunity to assess the condition of bones and cartilage using layer-by-layer images.
- Magnetic resonance imaging. The method assesses 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.
- Ultrasonic. Ultrasound is used to detect changes in the joint. The method is harmless to the body because no harmful radiation is produced.
- 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. Softening zones in the cartilage thickness are determined. It shows the presence of deep cracks that penetrate deep into the subchondral (subchondral) bone plate. Deep ulcers of the cartilage, erosions and superficial cracks are noted.
Diagnosis of arthrosis of the shoulder joint in the later stages does not pose 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 of osteoarthritis is carried out by orthopedic traumatologists or rheumatologists. In the phase of restoring motor functions, rehabilitation specialists take an active part in the treatment process.
To relieve pain and restore function in extremity osteoarthritis, it is important to seek prompt medical attention and follow all medical instructions. 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 requires a measured load under the supervision of specialists, as complete inactivity has a negative effect on the affected limb. Treatment options include conservative therapies and surgical procedures. The choice of methods depends on the prevalence of certain symptoms and the stage of the disease.
Drug therapy
An important goal in treating osteoarthritis is pain relief. To eliminate discomfort and reduce the severity of inflammation, the following drugs are prescribed:
- Preparations for general anesthesia. During an exacerbation, patients are prescribed non-steroidal drugs for a short period of time. With prolonged uncontrolled use, they irritate the gastric mucosa and slow down the recovery process in the joint.
- Local remedies. If symptoms worsen, gels and ointments containing non-steroidal anti-inflammatory agents are used. Hormone-containing medications with local effects are used less frequently. They relieve inflammation and swelling.
- 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 a maximum of 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.
In addition, vasodilators are used for shoulder osteoarthritis. They increase blood circulation and relieve capillary spasms. To relax the muscles in the shoulder area, muscle relaxants are prescribed if cramps are detected.
Surgical methods
In the third stage of arthrosis, when there is significant destruction of the joint with limited mobility and loss of ability to work, endoprosthetic surgery is performed. When deciding whether to perform a procedure, age, physical activity and general health are taken into account.
Through the use of modern endoprostheses made of ceramic, plastic and metal, joint function is completely restored. The devices have a guaranteed lifespan of more than fifteen years.
Non-drug treatment
Physiotherapeutic techniques are actively used in the treatment of joint arthrosis in the phase of subsiding exacerbation. Your course use leads to good results when included in a complex therapy program. The following physiotherapeutic methods are used for osteoarthritis:
- Amplipulse. The treatment method works locally on the joint using alternating electrical current. It relieves pain and has a vasodilating effect. The procedure improves tissue nutrition.
- UHF. The joint is exposed to ultra-high frequency waves. The method relieves pain, relieves inflammation and swelling.
- Magnetic field therapy. The joint structures are influenced by a pulsed magnetic field. It improves blood circulation. The cartilage is saturated with nutrients. The magnet removes decay products from the cells. It suppresses autoimmune reactions.
- Electrophoresis. This technique promotes the penetration of drugs into the affected joint, which is ensured by the action of electric current on the tissues. During treatment, blood flow to the joint structures increases. The procedure reduces inflammation and swelling. Unpleasant sensations in the hand are relieved. Muscle spasms are eliminated.
- Balneotherapy. Medicinal baths with radon, saline and other beneficial solutions are actively used for shoulder arthrosis. Blood circulation improves, which improves nutrition and accelerates cell regeneration. Inflammation is relieved.
- Electrical stimulation. In this treatment method, nerve trunks and muscles are electrically stimulated using electrodes that transmit a current with specific parameters.
Therapeutic massage is performed after the exacerbation is relieved. It restores blood circulation and increases the elasticity of the ligaments. Muscle spasms in the joint decrease. The range of motion increases. Exercise therapy is useful for osteoarthritis.
The gymnastics complex is performed when the pain subsides. In 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 for treating shoulder osteoarthritis. The laser beam has a positive effect on the affected joint tissue. Devices that generate low-intensity infrared laser beams are used for therapy. Laser therapy is prescribed to accelerate cell metabolism.
All physico-chemical reactions are stimulated in the tissue. The functions of the cartilage cells are activated. Laser treatment has a pain-relieving effect. Blood circulation improves and swelling is eliminated. Local immunity is strengthened. Reserve capillaries expand. Laser therapy has an anti-inflammatory effect.
To receive procedures, you do not need to constantly visit a medical facility. Treatment of shoulder osteoarthritis at home is carried out using portable laser therapy devices. With regular use the pain decreases. The function of the shoulder joint improves with laser treatment of osteoarthritis at home.
Prognosis and prevention
Shoulder arthritis cannot be completely cured. However, it is possible to slow the progression of pathological joint changes. With regular treatment, the ability to work is maintained. It is important to follow the doctor's recommendations.
It is necessary to prevent hand injuries. When carrying out professional activities and during sports, it is important to avoid excessive strain on the shoulder joint. Illnesses that contribute to the development of osteoarthritis must be treated immediately.