Osteoarthritis of the shoulder

Osteoarthritis of the shoulderChronicIt is a disease in which articular cartilage tissue is destroyed and thinned, pathological changes occur in the soft tissues, and bone growths occur in the joint area. It manifests itself in pain and tingling in the affected area. In the later stages, the range is reduced. The pathology is chronic and progresses gradually. The diagnosis is made taking into account the clinical picture and radiological signs. Treatment is generally conservative: physiotherapy, anti-inflammatory drugs, chondroprotectors, exercise therapy. When the joint is destroyed, arthroplasty is performed.

General Information

Osteoarthritis of the shoulder joint is a chronic disease in which cartilage and other tissues in the joint are gradually destroyed as a result of degenerative-dystrophic processes. Osteoarthritis usually affects people 45 years of age and older, but in some cases (after injury, inflammation) the disease can develop at a young age. The pathology is equally observed in women and men, more often in athletes and people engaged in heavy physical labor.

Reasons

The starting point of osteoarthritis changes in the shoulder joint can be both the normal aging process of tissues, as well as damage or disruption of cartilage structure as a result of mechanical effects and various pathological processes. Primary osteoarthritis is generally found in the elderly, and secondary (developed against the background of other diseases) can occur at any age. The main reasons are considered:

• Developmental defects. Pathology can be detected by the absence of the development of the head, shoulder capomelia and other anomalies of the humerus or glenoid cavity.
• Traumatic injury.Osteoarthritis of traumatic etiology most often occurs after intra-articular fractures. A possible cause of the disease may be a common shoulder dislocation. Less severe bruises act as a provocative injury.
• Inflammatory processes.The disease can be diagnosed with long-term shoulder-scapular periarthritis, previously nonspecific purulent arthritis and specific arthritis of the joint (with tuberculosis, syphilis and some other diseases).

Risk factors

Osteoarthritis is a polyetiological disease. There is a wide group of factors that increase the likelihood of this pathology:

• Hereditary predisposition.Many patients have close relatives suffering from osteoarthritis, including other localizations (gonarthrosis, coxarthrosis, arthrosis of the ankle joint).
• Excessive tension of the joint.It can occur in volleyball players, tennis players, basketball players, throwers of sports equipment, as well as people whose professions carry a constant high load (hammers, loaders).
• Other pathologies.Arthrosis is more common in patients suffering from autoimmune (rheumatoid arthritis), some endocrine diseases and metabolic diseases, systemic connective tissue deficiency, and excessive joint mobility.

The probability of developing the disease increases sharply with age. Often hypothermia and unfavorable environmental conditions have a certain negative impact.

Pathogenesis

The main reason for the development of osteoarthritis of the shoulder joint is a change in the structure of the articular cartilage. Cartilage loses its smoothness and elasticity, making it difficult for joint surfaces to slide during movement. Microtrauma occurs, which worsens the condition of cartilage tissue. Small pieces of cartilage break off from the surface to form free-stretching joint bodies, which damage the inner surface of the joint.

Over time, the capsule and synovium thicken, showing areas of fibrous degeneration. Due to thinning and loss of elasticity, cartilage stops providing the necessary shock absorption, thus increasing the load on the main bone. The bone is deformed and grows along the edges. The normal configuration of the joint is violated, there are restrictions on movement.

Classification

In traumatology and orthopedics, a three-stage systematization is generally used, which reflects the severity of pathological changes and the symptoms of osteoarthritis of the shoulder joint. This approach allows you to choose the optimal medical tactics, taking into account the severity of the process. The following stages are distinguished:

• First- No rough changes in cartilage tissue. The composition of synovial fluid is changed, cartilage nutrition is impaired. Cartilage does not tolerate stress, so joint pain (arthralgia) occurs from time to time.
• The second- cartilage tissue begins to thin, changes its structure, loses surface smoothness, cysts and calcification areas appear in the depths of cartilage. The main bone is slightly deformed, and bone growths are visible along the edges of the joint platform. The pain is permanent.
• Third- some thinning and disruption of cartilage structure with large areas of fracture. The joint platform is deformed. Restriction of movement, weakness of the garden apparatus and atrophy of the periarticular muscles were found.

Symptoms

In the early stages, patients with osteoarthritis are concerned about tension and discomfort or minor pain in the shoulder joint during certain body positions. Crunching may occur during movement. The joint is not changed from the outside, there is no edema. Then the intensity of the pain increases, arthralgia becomes a habit, it becomes persistent, it appears not only during exercise, but also at rest, including at night. Distinctive features of pain syndrome:

• Many patients report that the pain syndrome is weather dependent.
• In addition to excruciating pain, there is a sharp pain during physical exertion over time.
• The pain can only occur in the shoulder joint, spread to the elbow joint, or spread along the arm. Possible back and neck pain on the affected side.

After a while, patients begin to notice a noticeable morning stiffness in the joint. The area of movement is reduced. Slight swelling of the soft tissues is possible after exercise or hypothermia. With the development of osteoarthritis, movements become increasingly limited, contractures develop, and joint function is severely impaired.

Diagnostics

The diagnosis is made by an orthopedic surgeon taking into account the characteristic clinical and radiological signs of the shoulder joint. If you suspect secondary osteoarthritis, consult a surgeon, endocrinologist. At first the joint is not changed, then it is sometimes deformed or enlarged. Pain is determined during palpation. Restriction of movement can be detected. The following is recommended to confirm osteoarthritis:

• X-ray of the shoulder joint.Dystrophic changes and extraneous bone growths (osteophytes) are found, followed by narrowing of the joint space, deformity, and changes in the structure of the main bone. The joint cavity may take the form of a wedge, osteosclerotic changes and cystic formations appear in the bone.
• Tomographic examination.In suspicious cases, especially in the early stages of the disease, CT of the shoulder joint is performed to obtain additional information about the condition of the bone and cartilage. If it is necessary to assess the condition of soft tissues, magnetic resonance imaging is performed.

Differential diagnosis

The differential diagnosis of osteoarthritis is made with gout, psoriatic, rheumatoid and reactive arthritis, as well as pyrophosphate arthropathy. A blood test with arthritis shows signs of inflammation; changes on radiography are not very clear, there are no osteophytes, no signs of deformation of the joint surfaces.

In psoriatic arthritis, in addition to joint manifestations, skin rashes are also common. Positive rheumatoid factor is prescribed in rheumatoid arthritis. With pyrophosphate arthropathy and gouty arthritis, a biochemical blood test detects relevant changes (increased levels of uric acid salts, etc. ).

Treatment of shoulder arthrosis

Patients are under the supervision of an orthopedic surgeon. It is necessary to limit the load on the arm, except for sudden movements, lifting and carrying weights for a long time. At the same time, we must not forget that inactivity also has a negative effect on the diseased joint. To keep your muscles in good condition and restore your shoulder joint, you should regularly perform a set of sports therapy recommended by your doctor.

Conservative treatment

One of the most urgent tasks in osteoarthritis is the fight against pain. To relieve pain and reduce inflammation, the following are prescribed:

• General action drugs.NSAIDs are prescribed in tablet form during exacerbations. Uncontrolled use can irritate the stomach wall, adversely affect the condition of the liver and metabolism in cartilage tissue, so it should be taken only with a doctor's prescription.
• Local treatment.NSAIDs are commonly used in the form of gels and ointments. If symptoms appear or worsen, self-management is possible. Less common, local hormonal drugs should be used according to the doctor's recommendations.
• Hormones for intraarticular application.In case of severe pain syndrome, which can not be eliminated by other methods, intarticular administration of drugs (triamcinolone, hydrocortisone, etc. ) is carried out. Blockages are carried out no more than 4 times a year.

In stages 1 and 2 of osteoarthritis, drugs from the group of chondroprotectors - hyaluronic acid, chondroitin sulfate and glucosamine - are used to restore and strengthen cartilage. The course of treatment is long (from 6 months to a year or more), the effect is noticeable after 3 or more months.

Physiotherapy treatment

Massage, physiotherapy exercises and physiotherapy methods are actively used with arthrosis of the shoulder joint. During remission, patients are referred to spa treatment. Apply:

• mud treatment and paraffin;
• medicinal baths;
• magnetotherapy and infrared laser therapy;
• ultrasound.

Surgery

In stage 3 of the disease, significant cartilage destruction, limited mobility, and disability are replaced. The application for surgery is made taking into account the patient's age, level of activity, the presence of severe chronic diseases. The use of modern ceramic, plastic and metal endoprostheses allows you to fully restore the function of the joint. The service life of prostheses is 15 years or more.

Forecast

Arthrosis is a long-term, progressive disease. It cannot be completely cured, but it is possible to significantly slow down the development of pathological changes in the joint, maintain work capacity and high quality of life. To achieve maximum effect, the patient must seriously deal with the desire to follow the doctor's recommendations during illness and remission.

Prophylaxis

Preventive measures include reducing home injuries, maintaining safety in the workplace, and eliminating excessive loads on the shoulder joint while performing professional duties and playing sports. Pathologies that can lead to the development of arthritis changes need timely diagnosis and treatment.