shoulder arthrosis

shoulder arthrosisit's chronic<1_img_leftxx>a disease in which articular cartilage tissue is destroyed and thinned, pathological changes occur in the soft tissue, and bone growths form in the area of the joint. It manifests as pain and crushing in the affected area. In later stages, range of motion decreases. 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, chondroprotective drugs, exercise therapy. When the joint is destroyed, arthroplasty is performed.

General information

Arthrosis of the shoulder joint is a chronic disease in which, as a result of degenerative dystrophic processes, cartilage and other tissues in the joint are gradually destroyed. Osteoarthritis usually affects people 45 years and older, but in some cases (after injury, inflammation), the disease can develop at a younger age. The pathology occurs with equal frequency in women and men, more frequently seen in athletes and in people involved in heavy physical work.

The reasons

The starting point for changes in arthrosis of the shoulder joint may be the normal process of tissue aging and damage or rupture of the cartilage structure as a result of mechanical influences and various pathological processes. Primary arthrosis is usually detected in the elderly, secondary arthrosis (developed in the context of other diseases) can occur at any age. The main reasons are considered:

• Development defects.The pathology can be detected with underdevelopment of the humeral head or glenoid cavity, shoulder capomelia, and other upper limb anomalies.
• Traumatic injury.Arthrosis of traumatic etiology occurs more frequently after intra-articular fractures. A possible cause of the disease can be a dislocation of the shoulder, especially the usual one. Less often, severe bruises act as a provocative lesion.
• Inflammatory processes.The disease can be diagnosed with long-standing shoulder-scapular periarthritis, previously suffered from nonspecific purulent arthritis and joint-specific arthritis (with tuberculosis, syphilis, and some other diseases).

Risk factors

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

• Hereditary predisposition.Many patients have close relatives who also suffer from arthrosis, including those from other locations (gonarthrosis, coxarthrosis, arthrosis of the ankle joint).
• Excessive joint tension.It can occur in volleyball players, tennis players, basketball players, sports equipment throwers, as well as in people whose profession involves a constant high load on their hands (hammers, clips).
• Other pathologies.Arthrosis is most often detected in patients suffering from autoimmune diseases (rheumatoid arthritis), some endocrine diseases and metabolic disorders, systemic connective tissue insufficiency, and excessive joint mobility.

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

Pathogenesis

The main reason for the development of arthrosis of the shoulder joint is a change in the structure of the articular cartilage. Cartilage loses its smoothness and elasticity, the sliding of joint surfaces during movement becomes difficult. Microtrauma occurs, which leads to further deterioration in the condition of the cartilage tissue. Small pieces of cartilage detach from the surface, forming loose joint bodies, which also damage the inner surface of the joint.

Over time, the capsule and synovium become thicker, areas of fibrous degeneration appearing in them. Due to thinning and decreased elasticity, the cartilage no longer provides the necessary shock absorption, so the load on the underlying bone increases. The bone deforms and grows along the edges. The normal configuration of the joint is interrupted, there are limitations of movement.

Classification

In traumatology and orthopedics, a three-stage systematization is generally used, reflecting the severity of pathological changes and symptoms of arthrosis 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 differentiated:

• The first- there are no gross changes in the cartilage tissue. The composition of synovial fluid is altered, cartilage nutrition is impaired. Cartilage does not tolerate stress, so joint pain (arthralgia) occurs from time to time.
• The second- the cartilage tissue starts to thin, its structure changes, the surface loses its smoothness, cysts and areas of calcification appear at the bottom of the cartilage. The underlying bone is slightly deformed, bony growths appear along the edges of the articular platform. The pain becomes permanent.
• Third- marked thinning and rupture of the cartilage structure with extensive areas of destruction. The articulated platform is deformed. Revealed limitation of range of motion, weakness of the ligament apparatus, and atrophy of periarticular muscles.

Symptoms

In the early stages, patients with osteoarthritis are concerned with discomfort or mild pain in the shoulder joint during exertion and certain body positions. Crushing may occur during movement. The joint is not altered externally, there is no edema. Then the intensity of pain increases, arthralgias become habitual, constant, appearing not only during exercise, but also at rest, even at night. Distinctive features of the pain syndrome:

• Many patients observe the pain syndrome's dependence on weather conditions.
• Along with the sharp pain, over time, there is a sharp pain during physical exertion.
• Pain may only occur in the shoulder joint, radiate to the elbow joint, or spread through the arm. Possible back and neck pain on affected side.

After a while, patients begin to notice noticeable morning stiffness in the joint. Range of motion decreases. After exercise or hypothermia, there may be slight swelling of the soft tissue. As the arthrosis progresses, movement is increasingly limited, contractures develop and limb function is seriously impaired.

Diagnosis

The diagnosis is made by an orthopedic surgeon taking into account the clinical and radiological signs characteristic of arthrosis of the shoulder joint. If you suspect secondary arthrosis, consult a surgeon, endocrinologist. At first, the joint is not altered, then sometimes it becomes deformed or enlarged. On palpation, the pain is determined. Motion restriction can be detected. To confirm the arthrosis, the following is recommended:

• Radiography of the shoulder joint.Dystrophic alterations and marginal bone growths (osteophytes) are found, in the later phases the narrowing of the joint space, deformations and alterations in the structure of the underlying bone are determined. The joint gap can take on a wedge shape, osteosclerotic changes and cystic formations are visible in the bone.
• Tomographic research.In doubtful cases, 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 tissue, MRI is performed.

Differential diagnosis

The differential diagnosis of arthrosis is made with gouty, psoriatic, rheumatoid and reactive arthritis, as well as with pyrophosphatic arthropathy. In arthritis, a blood test shows signs of inflammation; changes on radiographs are not very pronounced, osteophytes are absent, and there are no signs of deformation of the joint surfaces.

In psoriatic arthritis, together with joint manifestations, skin rashes are often found. In rheumatoid arthritis, a positive rheumatoid factor is determined. In pyrophosphate arthropathy and gouty arthritis, the biochemical blood test reveals the corresponding changes (increased level of uric acid salts, etc. ).

Shoulder arthrosis treatment

Patients are under the supervision of an orthopedic surgeon. It is necessary to limit the load on the arm, excluding sudden movements, lifting and prolonged carrying of weights. At the same time, it should be borne in mind that inaction also negatively affects the diseased joint. To keep the muscles in a normal state, as well as to restore the shoulder joint, it is necessary to regularly perform the exercise therapy complex recommended by the physician.

Conservative treatment

One of the most urgent tasks in osteoarthritis is combating pain. To eliminate pain and reduce inflammation, the following is prescribed:

• Medicines of general action.NSAIDs are prescribed in tablets during an exacerbation. With uncontrolled use, they can irritate the stomach wall, have a negative effect on the state of the liver and on the metabolism of the cartilage tissue, therefore, they are only taken as directed by the doctor.
• Local remedies.NSAIDs are commonly used in the form of gels and ointments. Self-administration is possible if symptoms appear or intensify. Less commonly, topical hormonal preparations are indicated, which should be applied according to medical recommendations.
• Hormones for intra-articular administration.In case of severe pain syndrome, which cannot be eliminated by other methods, intra-articular administration of drugs (triamcinolone, hydrocortisone, etc. ) is performed. Locks are performed a maximum of 4 times a year.

To restore and strengthen cartilage in stages 1 and 2 of arthrosis, agents from the chondroprotective group are used - medications containing hyaluronic acid, chondroitin sulfate and glucosamine. Treatment courses are long (from 6 months to a year or more), the effect becomes noticeable after 3 or more months.

physiotherapeutic treatment

In arthrosis of the shoulder joint, massage, physiotherapy exercises and physiotherapy techniques are actively used. During the remission period, patients are referred for spa treatment. To apply:

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

Surgery

In stage 3 of the disease, with significant cartilage destruction, limited mobility and disability, joint replacement is performed. The referral for the operation is made taking into account the patient's age, the level of activity, the presence of severe chronic diseases. The use of modern ceramic, plastic and metal endoprostheses allows full restoration of joint function. The service life of prostheses is 15 years or more.

Prediction

Arthrosis is a long-lasting, gradually progressive disease. It cannot be completely cured, however, it is possible to significantly delay the development of pathological changes in the joint, to preserve work capacity and a high quality of life. To achieve the maximum effect, the patient must take their illness seriously and their willingness to follow the doctor's recommendations, even during the period of remission.

Prophylaxis

Preventive measures include reducing domestic injuries, observing safety at work, eliminating excessive loads on the shoulder joint while performing professional tasks and practicing sports. It is necessary to timely diagnose and treat the pathologies that can lead to the development of arthritic alterations.