A third of all elderly people over the age of sixty complain of 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 great disruption in everyday life and drastically reduces working capacity. In more severe cases, shoulder osteoarthritis leads to disability. It is important to identify the disease in the early stages. Today, there are treatment methods that suppress the progression of the disease when therapy is started 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 arthrosis is classified as a group of pathologies of a non-infectious nature. First, the cartilaginous tissue covering the joint surfaces is destroyed.
Cartilage loses 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, bony growths are formed on the joint surfaces.
The pathology manifests itself with pain and crunching in the affected shoulder area. In the later stages of the disease, the range of motion of the shoulder joint is sharply reduced. Inflammation in it with this nature of the process is 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 due to 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 develops against the background of previous diseases. It occurs at any age. The main causes of the disease are considered:
- Developmental anomalies. The pathology is often found in patients with underdevelopment of the humeral head or glenoid cavity, as well as the presence of other upper limb defects.
- Injuries. Traumatic arthrosis often develops after intra-articular fractures. Sometimes the cause of the pathology is shoulder dislocation, most often habitual. Occasionally, severe bruising provokes the development of pathology.
- Inflammation. Osteoarthritis 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 occur 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 osteoarthritis:
- Genetic predisposition. Close relatives of many patients also suffer from osteoarthritis. They also present 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 a high and constant load on the upper limbs (loaders, miners and others).
- Illnesses. Osteoarthritis often develops in patients suffering from autoimmune joint diseases. Some endocrine diseases, metabolic disorders and connective tissue failure, characterized by excessive joint mobility, also contribute to cartilage degenerative processes.
The incidence of degenerative joint lesions in patients increases markedly with age. Frequent hypothermia also negatively affects the joints.
Symptoms
At the beginning 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 time. They become more intense after physical activity. The pain intensifies in a certain position of the body. 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 the position of the body. 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 during the night. The characteristics of pain syndrome in osteoarthritis of the joint are as follows:
- along with the appearance of aching pain over time, acute pain occurs during physical activity;
- unpleasant sensations are registered only in the joint area, they radiate to the elbow area and then can spread over 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 feels morning stiffness in the shoulder. The range of active motion in the joint decreases. After physical activity, in addition to hypothermia, a slight swelling of the soft tissues in the shoulder area is noted.
As joint damage progresses, an increase in the range of motion limitations is observed. The patient develops a contracture (stiffness), which significantly impairs the functioning of the limb. If the arthrosis is on the right side, the patient cannot take care of himself.
Development phases
With this disease, there are three stages of the pathological process in the joint. They reflect the severity of 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. The absence of gross structural changes in the thickness of the cartilaginous tissue is noted. The composition of the intraarticular fluid changes. Cartilage nutrition is disrupted. Does not tolerate stress well, which leads to periodic pain.
- Second. In this phase, the thinning of the cartilaginous tissue occurs. Its structure is changing. The surface becomes rough. Cysts are formed 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 outgrowths. The discomfort becomes constant.
- Third. A pronounced degree of thinning of the cartilaginous layer and breakdown of its structure is noted. Extensive areas of cartilage destruction are identified. There is significant deformation of the articular platform. Limitation of range of motion is revealed. Weakness of the ligaments is observed, as well as decreased size and flaccidity of the periarticular muscles.
This approach to the classification of injuries 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 contact the doctor. He needs to see a therapist. The specialist will make an initial diagnosis. After determining the cause of the joint damage, he will refer the patient to a rheumatologist, endocrinologist, surgeon or orthopedic traumatologist.
Doctors make the diagnosis in the presence of typical clinical manifestations and radiographic signs of osteoarthritis. During the initial examination, the tissues of the joint are palpated to determine the extent 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 osteoarthritis, the following studies are recommended:
- X-ray. In the joint, the presence of dystrophic changes in the cartilaginous layer is detected. Characteristic bony growths are identified along the edge of the joint cavity. At a later stage, they find that the joint space is reduced. 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. Signs of rarefaction and the presence of cyst-like formations are visible in the thickness of the bone.
- CT scan. This study in the early stages of the disease offers the opportunity to evaluate the condition of the bones and cartilage using layer-by-layer images.
- Magnetic resonance imaging. The method evaluates the state 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.
- Ultrasound. Changes in the joint are detected using ultrasound. The method is safe for the body, since there is no 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. Areas of softening in the thickness of the cartilage are determined. It reveals the presence of deep cracks that penetrate deep into the subchondral (subchondral) plate of the bone. Deep cartilage ulcerations, 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 arthrosis is carried out by orthopedic traumatologists or rheumatologists. In the phase of restoration of motor functions, rehabilitation specialists actively participate in the treatment process.
To relieve pain and restore functionality in the case of arthrosis of the limb, it is important to receive timely medical care and follow all the doctor's prescriptions. 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, 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.
Pharmacological 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 drugs are prescribed:
- Preparations for general anesthesia. Nonsteroidal drugs are prescribed to patients for a short course during a flare-up. With prolonged uncontrolled use, they irritate the gastric mucosa and slow down the recovery process in the joint.
- Local remedies. Gels and ointments containing nonsteroidal anti-inflammatory compounds are used when symptoms increase. Drugs containing hormones with local action are less commonly used. They relieve inflammation and swelling.
- Means for intraarticular injections. For persistent, severe pain that cannot be eliminated by other means, glucocorticoid drugs are injected into the joint. Blocks can be carried out no more than four times a year.
In the first and second phases, 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 osteoarthritis. 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 significant destruction of the joint occurs with limited mobility and loss of working capacity, endoprosthetic surgery is performed. Before deciding whether to perform an operation, age, level of physical activity and general health are taken into consideration.
The installation of modern ceramic, plastic and metal endoprostheses completely restores the functioning of the joint. The devices have a guaranteed lifespan of over fifteen years.
Non-pharmacological treatment
Physiotherapeutic techniques are actively used in the phase of mitigating exacerbation in the treatment of joint arthrosis. Their constant use gives good results if included in a complex therapeutic program. For arthrosis the following physiotherapeutic methods are used:
- Amplipulse. The treatment method acts locally on the joint using alternating electric current. Relieves pain and has a vasodilatory effect. The procedure improves tissue nutrition.
- UHF. The joint is exposed to very high frequency waves. The method reduces pain, relieves inflammation and swelling.
- Magnetotherapy. The 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 drugs into the affected joint, ensured 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 arthrosis. 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 performed using electrodes that transmit a current with certain parameters.
Therapeutic massage is carried out after the exacerbation has been relieved. Restores blood flow and increases the elasticity of the ligaments. Muscle spasm in the joint decreases. Range of motion increases. Physical therapy is useful for osteoarthritis.
The gymnastics complex is performed when the pain subsides. When carrying out mechanotherapy, special simulators are used for rehabilitation. Active-passive movements are performed 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 osteoarthritis. The laser beam has a beneficial effect on the affected joint tissue. Devices that produce low intensity infrared laser rays are used for the therapy. Laser therapy is prescribed to accelerate cellular metabolism.
All physicochemical reactions are stimulated in the tissues. The functions of the cartilage cells are activated. Laser treatment provides an analgesic effect. Blood flow improves and swelling is eliminated. Local immunity is improved. The reserve capillaries expand. Laser therapy has an anti-inflammatory effect.
To receive the procedures, it is not necessary to constantly visit a medical facility. Treatment of shoulder arthrosis at home is carried out using portable laser therapy devices. With their regular use, the pain decreases. Shoulder joint function improves with laser treatment of osteoarthritis at home.
Prognosis and prevention
Shoulder osteoarthritis cannot be completely cured. But it is possible to slow down the progression of joint pathological changes. With regular treatment, the ability to work is maintained. It is important to follow your doctor's recommendations.
It is necessary to prevent hand injuries. It is important to avoid excessive impact on the shoulder joint when carrying out professional tasks and during sports. It is necessary to timely treat diseases that contribute to the development of arthrosis.