One third of all seniors over the age of sixty 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 intense and constant physical activity - miner, builder, loader, etc.
The disease causes major disruptions in everyday life and drastically reduces work capacity. In severe cases, shoulder osteoarthritis leads to disability. It is important to identify the disease in the early stages. There are now treatment methods that suppress disease progression when therapy is initiated in a timely manner.
What is pathology
Osteoarthritis of the shoulder joint is a chronic disease in which degenerative processes destroy and thin the cartilage. Shoulder osteoarthritis is classified as a group of pathologies of a non-infectious nature. First, the cartilaginous tissue covering the articular surfaces is destroyed.
Cartilage loses strength and elasticity. Gradually thins and flattens. Due to changes in the cartilaginous 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 close to the joint. As a result of the disease, bone growths form on the articular surfaces.
The pathology is manifested by pain and crushing in the affected shoulder region. In the later stages of the disease, the range of motion of the shoulder joint is drastically reduced. Inflammation in it with this nature of the process is absent or weakly expressed. The pathology has a chronic and 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 initiation of cartilage destruction. This is also facilitated by various pathological processes.
Primary shoulder osteoarthritis is usually diagnosed in elderly people. Secondary joint damage develops against the background of previous diseases. It occurs at any age. The main causes of the disease are considered:
- Developmental anomalies. Pathology is often found in patients with underdevelopment of the humeral head or glenoid cavity, as well as in the presence of other defects of the upper limb.
- Injuries. Traumatic arthrosis often develops after intra-articular fractures. Sometimes the cause of the pathology is a shoulder dislocation, most often habitual. Occasionally, severe bruising provokes the development of pathology.
- Inflammation. Osteoarthritis usually occurs when a patient suffers from glenohumeral periarthritis for a long period. 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 onset of this polyetiological disease. The following phenomena increase the likelihood of developing arthrosis:
- Genetic predisposition. Close relatives of many patients also suffer from osteoarthritis. They also present lesions in other locations. Typically the knee, ankle and other joints are affected.
- Overvoltage. It frequently occurs in athletes involved in volleyball, tennis, basketball, and throwing sports equipment. This condition also occurs in people whose profession is characterized by high and constant loads on the upper limbs (porters, miners and others).
- Illnesses. 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 cartilage degenerative processes.
The incidence of degenerative joint injuries in patients increases markedly with age. Frequent hypothermia also negatively affects joints.
Symptoms
At the beginning of the disease, patients with osteoarthritis experience a feeling of discomfort and moderate pain in the shoulder region. There is a dependence of pain on the weather. They become more intense after physical activity. The pain intensifies in a certain position of the body. After resting or changing positions, the pain disappears.
When the patient moves his hand, a grinding sensation occurs. There are no external changes to the joint, nor 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 during exercise and at rest. They can disturb the patient at night. The characteristics of pain syndrome in joint osteoarthritis are as follows:
- along with the appearance of severe pain over time, sharp pain occurs during physical activity;
- unpleasant sensations are registered only in the joint region, radiate to the elbow region, and can then spread over the entire surface of the arm;
- the pain may spread to the back and neck on the affected side.
After a short period of time, the patient becomes bothered by morning stiffness in the shoulder. The range of active movements in the joint decreases. After physical activity, in addition to hypothermia, slight swelling of soft tissues in the shoulder area is detected.
As the joint injury 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 the osteoarthritis is on the right side, the patient will not be able to take care of themselves.
Development stages
With this disease, there are three phases 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:
- First. The absence of gross structural changes in the thickness of the cartilaginous tissue is observed. The composition of the intra-articular fluid changes. Cartilage nutrition is disturbed. He does not tolerate stress well, which leads to periodic pain.
- Second. At this stage, the cartilaginous tissue thins. Its structure is changing. The surface becomes rough. Cysts form in the thickness of the cartilaginous layer and foci of calcification appear. The bony areas adjacent to the joint are moderately deformed. The edges of the joint platform are covered with bony protrusions. The discomfort becomes constant.
- Third. A pronounced degree of thinning of the cartilaginous layer and rupture of its structure is observed. Extensive areas of cartilage destruction are identified. Significant deformation of the joint platform is found. Limitation of range of motion is revealed. There is weakness of the ligaments, as well as a decrease in the size and flaccidity of the periarticular muscles.
This approach to classifying shoulder joint injuries allows doctors to select appropriate treatment tactics that take into account the severity of the pathological process.
Diagnosis
The appearance of osteoarthritis symptoms forces the patient to see a doctor. He needs to see a therapist. The specialist will make an initial diagnosis. After determining the cause of 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 radiographic 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 increase in volume. To confirm the presence of osteoarthritis, the following studies are recommended:
- Radiography. The presence of dystrophic changes in the cartilaginous layer is detected in the joint. Characteristic bony growths are identified along the edge of the joint 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.
- Computed tomography. This study in the early stages of the disease provides an opportunity to assess the condition of bones and cartilage through layer-by-layer imaging.
- Magnetic resonance imaging. The method assesses the state of soft tissue formations (cartilage, ligaments, joint capsule, etc. ). Clear layer-by-layer images help determine the extent of damage to articular and periarticular structures.
- Ultrasound. Changes in the joint are detected by ultrasound. The method is safe for the body, as it does not contain harmful radiation.
- Arthroscopy. It is performed using an endoscope. A manipulator with a camera is inserted into the joint. The doctor clearly sees the damaged areas. Zones of softening are determined in the thickness of the cartilage. It reveals the presence of deep fissures that penetrate deep into the subchondral (subchondral) plate of the bone. Deep cartilage ulcerations, erosion and superficial fissures are detected.
Making the 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
The treatment of osteoarthritis is carried out by orthopedic traumatologists or rheumatologists. At the stage of restoring motor functions, rehabilitation specialists actively participate in the treatment process.
To relieve pain and restore function in the event of limb osteoarthritis, it is important to receive immediate 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 dosed load under the supervision of specialists, as total 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 treating osteoarthritis is the elimination of pain. To eliminate discomfort and reduce the severity of inflammation, the following medications are prescribed:
- Preparations for general anesthesia. Nonsteroidal medications are prescribed to patients for a short period during an exacerbation. With prolonged and uncontrolled use, they irritate the gastric mucosa and delay the joint recovery process.
- Local remedies. Gels and ointments containing nonsteroidal anti-inflammatory compounds are used when symptoms increase. Medicines containing hormones with local action are less commonly used. They relieve inflammation and swelling.
- Means for intra-articular injections. For persistent, severe pain that cannot be eliminated by other means, glucocorticoid medications are injected into the joint. Lockouts cannot be carried out 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 the therapy only becomes noticeable after three months of continuous use of the medication.
Additionally, vasodilators are used for shoulder osteoarthritis. They increase blood flow and relieve capillary spasms. Muscle relaxants are prescribed to relax the muscles in the shoulder region when spasms are detected.
Surgical methods
In the third stage of arthrosis, when there is significant destruction of the joint with limited mobility and loss of working capacity, endoprosthetic surgery is performed. Before deciding to carry out an intervention, age, level of physical activity and general health status are taken into account.
The installation of modern ceramic, plastic and metal endoprostheses completely restores the functioning of the joint. The devices have a guaranteed useful life of more than fifteen years.
Non-drug treatment
Physiotherapeutic techniques are actively used in the phase of decreasing exacerbation in the treatment of joint osteoarthritis. Course use gives good results when included in a complex therapy program. For arthrosis, the following physiotherapeutic methods are used:
- Amplipulso. The treatment method locally affects the joint using alternating electrical current. Relieves pain and has a vasodilatory effect. The procedure improves tissue nutrition.
- UHF. The joint is exposed to ultra-high frequency waves. The method reduces pain, relieves inflammation and swelling.
- Magnetotherapy. Joint structures are affected by a pulsed magnetic field. Improves blood flow. Cartilage is saturated with nutrients. The magnet removes decay products from the cells. Suppresses autoimmune reactions.
- Electrophoresis. This technique promotes the penetration of medications into the affected joint, which is guaranteed by the effect of the 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.
- Balneotherapy. Therapeutic baths with radon, saline and other beneficial solutions are actively used for shoulder osteoarthritis. Blood flow improves, which improves nutrition and accelerates cell recovery. Inflammation is relieved.
- Electrical stimulation. With this method of treatment, electrical stimulation of nerve trunks and muscles is carried out using electrodes, which transmit a current that has certain parameters.
Therapeutic massage is performed after the exacerbation has been relieved. 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 subsides. When carrying out mechanotherapy, special simulators are used for rehabilitation. Active-passive movements are performed in them. They restore function to the affected joint.
How to treat at home?
Laser therapy is considered an effective method for treating shoulder osteoarthritis. 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 cellular metabolism.
All physicochemical reactions are stimulated in the tissues. The functions of cartilage cells are activated. Laser treatment provides an analgesic effect. Blood flow improves and swelling is eliminated. Local immunity is increased. Reserve capillaries expand. Laser therapy has an anti-inflammatory effect.
To receive procedures, you do not need to constantly visit a medical center. The treatment of shoulder arthrosis at home is carried out using portable laser therapy devices. With regular use, the pain decreases. Shoulder joint function improves with laser osteoarthritis treatment at home.
Prognosis and prevention
Shoulder osteoarthritis cannot be completely cured. But it is possible to slow down the progression of pathological changes in the joints. With regular treatment, working capacity is maintained. It is important to follow your doctor's recommendations.
It is necessary to avoid hand injuries. It is important to avoid excessive impacts on the shoulder joint when carrying out professional duties, as well as during sports. It is necessary to promptly treat diseases that contribute to the development of arthrosis.