Shoulder arthrosis

Shoulder arthrosisChronica disease in which articular cartilage tissue is destroyed and thinned, abnormal changes occur in soft tissues, and bone growths develop in the area of the joint. It manifests itself in pain and crackling in the affected area. In later stages, the range of motion decreases. The pathology is chronic and progressive. The diagnosis is made based on the clinical picture and radiological symptoms. Treatment is usually conservative: physiotherapy, anti-inflammatory drugs, chondroprotectors, exercise. When the joint is destroyed, arthroplasty is performed.

general information

Shoulder joint arthrosis is a chronic disease in which the cartilage and other tissues of the joint are gradually destroyed as a result of degenerative-dystrophic processes. Arthrosis usually affects people aged 45 and older, but in some cases (after injury, inflammation) the disease can develop at a younger age. Pathology is just as common in women and men, more common in athletes and people doing heavy physical work.

The reasons

Changes in shoulder joint arthrosis can be the starting point for both the normal aging process of tissues and damage or disruption of cartilage structure as a result of mechanical effects and various pathological processes. Primary arthrosis is usually seen in the elderly, secondary (formed underlying other diseases) can occur at any age. We consider the main reasons:

• Developmental defects. Pathology can be detected by immaturity of the head of the humerus or glenoid cavity, capomelia of the shoulder, and other disorders of the upper limb.
• Traumatic injury.Arthrosis of traumatic etiology most commonly occurs after intra-articular fractures. A possible cause of the disease may be shoulder displacement, especially normal. Less commonly, severe bruises act as a provocative injury.
• Inflammatory processes.The disease can be diagnosed with long-term shoulder periarthritis, previously nonspecific purulent arthritis, and specific arthritis of the joint (tuberculosis, syphilis, and some other diseases).

Risk factors

Arthrosis is a polyethiological disease. A wide range of factors increase the likelihood of this pathology:

• Hereditary tendency.Many patients have close relatives who also suffer from arthrosis, including other localizations (gonarthrosis, coxarthrosis, ankle arthrosis).
• Joint overload.This can happen to volleyball players, tennis players, basketball players, throwers of sports equipment, as well as people whose profession puts a constant heavy load on their hands (hammer, loader).
• Other pathologies.Arthrosis is more common in patients with autoimmune (rheumatoid arthritis), some endocrine diseases and metabolic disorders, systemic connective tissue failure, and excessive joint mobility.

The likelihood of developing the disease increases dramatically with age. Frequent hypothermia and adverse environmental conditions have some negative effects.

Pathogenesis

The main cause of arthrosis of the shoulder joint is a change in the structure of the articular cartilage. The cartilage loses its smoothness and elasticity, making it difficult for the joint surfaces to slip during movement. Microtrauma occurs, leading to further deterioration of cartilage tissue. Tiny pieces of cartilage rupture from the surface, forming free-lying joint bodies that also injure the inner surface of the joint.

Over time, the capsule and synovium thicken, showing fibrous degeneration areas. Due to the thinning and decrease in elasticity, the cartilage eliminates the required shock-absorbing ability, thus increasing the load on the underlying bone. The bone deforms and grows along the edge. The normal configuration of the joint is interrupted, there are limits to movement.

Classification

In traumatology and orthopedics, a three-stage systematization is commonly used, reflecting the severity of abnormalities in the shoulder joint and the symptoms of arthrosis. This approach allows the selection of optimal medical tactics, taking into account the severity of the process. The following sections are distinguished:

• The first- there are no rough changes in the cartilage tissue. The composition of the synovial fluid changes and the cartilage food is damaged. Cartilage does not tolerate stress, so joint pain (arthralgia) occurs from time to time.
• The second- the cartilage tissue begins to thin, its structure changes, the surface loses its smoothness, cysts and areas of calcification appear deep in the cartilage. The bone beneath it is slightly deformed, with bone growths appearing along the edge of the joint platform. The pains become permanent.
• Third- significant thinning and rupture of the cartilage structure with extensive areas of destruction. The joint platform is deformed. Limitation of range of motion, weakness of the ligament device, and atrophy of the periarticular muscles.

Symptoms

In the early stages, patients with arthrosis are concerned about discomfort or minor pain in the shoulder joint during exertion and certain postures. Cracking may occur during movement. The joint does not change externally, there is no edema. Then the intensity of the pain increases, the arthralgias become normal, permanent, appearing not only during exercise, but also at rest, at night. Distinctive features of pain syndrome:

• Many patients note that pain syndrome depends on weather conditions.
• In addition to painful pain, over time, sharp pain occurs during exercise.
• The pain can only occur in the shoulder joint, radiate to the elbow joint, or spread throughout the arm. Possible back and neck pain on the affected side.

After a while, patients begin to notice noticeable morning stiffness in the joint. The range of motion decreases. Mild swelling of the soft tissues is possible after exercise or hypothermia. As arthrosis progresses, movements become more restricted, contractures develop, and limb function is severely impaired.

Diagnostics

Diagnosis is made by an orthopedic surgeon, taking into account the characteristic clinical and radiological signs of shoulder joint arthrosis. If secondary arthrosis is suspected, consult a surgeon or endocrinologist. At first, the joint does not change, later it sometimes deforms or enlarges. Pain is determined by touch. Movement restriction is detected. To confirm arthrosis, the following are recommended:

• Radiography of the shoulder joint.Dystrophic changes and marginal bone growths (osteophytes) are found, in later stages they determine the narrowing of the joint space, deformation and changes in the structure of the underlying bone. The joint gap may take a wedge-shaped shape, showing osteosclerotic changes and cystic formations in the bone.
• Tomographic research.In cases of doubt, especially in the early stages of the disease, CT of the shoulder joint is performed to obtain additional data on the condition of the bone and cartilage. If it is necessary to assess the condition of the soft tissues, magnetic resonance imaging is performed.

Differential diagnosis

Differential diagnosis of arthrosis is made with gout, psoriasis, rheumatoid and reactive arthritis, and pyrophosphate arthropathy. In case of arthritis, the blood test shows signs of inflammation; changes in radiographs are not very pronounced, osteophytes are absent, and there are no signs of deformation of joint surfaces.

In rheumatoid arthritis, rashes are often found along with joint manifestations. In rheumatoid arthritis, a positive rheumatoid factor is determined. In the case of pyrophosphate arthropathy and gouty arthritis, a biochemical blood test reveals appropriate changes (increased levels of uric acid salts, etc. ).

Treatment of shoulder arthrosis

Patients are under the supervision of an orthopedic surgeon. The load on the arm must be limited, except for sudden movements, lifting and prolonged weight loading. However, it should be borne in mind that inactivity also has a negative effect on the patient’s joint. To maintain the normal condition of your muscles and to restore your shoulder joint, you should perform the exercise complex recommended by your doctor on a regular basis.

Conservative treatment

One of the most urgent tasks in arthrosis is to fight pain. In order to eliminate pain and reduce inflammation, the following are prescribed:

• Medicines with general effects.NSAIDs are prescribed in tablets for aggravation. If used uncontrolled, they can irritate the stomach wall, adversely affect the condition of the liver and metabolism in the cartilage tissue, so they should only be taken as directed by your doctor.
• Local remedies.NSAIDs are commonly used in the form of gels and ointments. Self-administration is possible if symptoms occur or worsen. Less commonly, topical hormone preparations are indicated and should be used according to the doctor’s recommendations.
• Hormones for intra-articular administration.In case of severe pain syndrome that cannot be eliminated by other methods, drugs are administered intra-articularly (triamcinolone, hydrocortisone, etc. ). Blockades are carried out up to four times a year.

Drugs containing drugs from the group of chondroprotectors - hyaluronic acid, chondroitin sulfate and glucosamine - are used in stages 1 and 2 of arthrosis to restore and strengthen cartilage. Cures are long (6 months to a year or more), the effect becomes noticeable after 3 or more months.

Physiotherapy treatment

Massage, physiotherapy exercises and physiotherapy techniques can be actively applied with shoulder arthrosis. During remission, patients are referred for treatment. Apply:

• mud therapy and paraffin;
• spas;
• magnetotherapy and infrared laser therapy;
• ultrasound.

Surgery

In stage 3 of the disease, joint replacement is performed with significant destruction of cartilage, restriction of mobility and disability. The referral for the operation is given taking into account the patient's age, level of activity, and the presence of serious chronic diseases. Modern ceramic, plastic and metal endoprostheses allow complete restoration of joint function. Prostheses have a lifespan of at least 15 years.

Forecast

Arthrosis is a long-term, progressive disease. It cannot be completely cured, but at the same time we can significantly slow down the development of pathological changes in the joint, we can maintain the ability to work and the high quality of life. To achieve maximum effect, the patient should seriously consider their illness and willingness to follow the doctor’s recommendations, even during remission.

Prophylaxis

Preventive measures include reducing household injuries, taking into account workplace safety, and eliminating excessive strain on the shoulder joint while performing professional tasks and exercising. It is timely to diagnose and treat pathologies that can provoke the development of joint changes.