A third of people over the age of sixty report pain in the shoulder joint. In most cases, the cause of pain in this area is the development of arthrosis. The disease also affects young people whose profession involves constant heavy physical activity - miners, builders, loaders, etc. Sh.
The disease causes great discomfort in everyday life and drastically reduces work capacity. In severe cases, arthrosis of the shoulder causes disability. It is important to identify the disease at the initial stage. Currently, there are treatment methods that suppress the progression of the disease when therapy is started on time.
What is pathology?
Shoulder joint arthrosis is a chronic disease in which degenerative processes destroy and thin the cartilage. Shoulder osteoarthritis is classified as a group of non-infectious pathologies. First, the cartilaginous tissue that covers the joint surfaces is destroyed.
Cartilage loses its strength and elasticity. It gradually thins and flattens. Due to changes in the cartilage layer, it loses its shock absorption properties. Its ability to reduce shock loads generated during arm flexion or extension is impaired.
Osteoarthritis also affects all structures such as the joint capsule, its membrane, bone surfaces surrounding the cartilage layer, ligaments and surrounding muscles. This is accompanied by pathological changes in other soft tissues near the joint. As a result of the disease, bone formations are formed on the joint surfaces.
The pathology is manifested by pain and cramping in the area of the affected shoulder. In the later stages of the disease, the range of motion of the shoulder joint is sharply reduced. With this nature of the process taking place in it, inflammation either does not exist or is weakly expressed. Pathology has a chronic, gradually progressive course.
Reasons
The cascade of pathological changes in osteoarthritis is caused by the natural aging of tissues. Cartilage damage as a result of strong mechanical stress can contribute to the initiation of cartilage destruction. Various pathological processes also contribute to this.
Primary arthrosis of the shoulder is usually diagnosed in the elderly. Secondary damage to the joint develops against the background of previous diseases. It happens 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 in the presence of other defects of the upper limb.
- injuries. Traumatic arthrosis often develops after intra-articular fractures. Sometimes the cause of pathology is dislocation of the shoulder, most often the usual one. Sometimes heavy bruises lead to the development of pathology.
- inflammation. Arthrosis often occurs when the patient suffers from glenohumeral periarthritis for a long time. This is also facilitated by previously developed non-specific 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 occurrence of such a polyetiological disease. The following phenomena increase the likelihood of developing arthrosis:
- Genetic predisposition. Close relatives of many patients also suffer from arthrosis. They also have lesions with other localization. Knee, ankle and other joints are usually affected.
- excessive voltage. This is often seen in athletes who participate in volleyball, tennis, basketball, and throwing sports equipment. This condition also occurs in people, if their profession is characterized by a constant high load on the upper limbs (loaders, miners, etc. ).
- Diseases. 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 the degenerative processes of cartilage.
The frequency of degenerative joint injuries in patients increases dramatically with age. Frequent hypothermia also has a negative effect on the joints.
symptoms
At the beginning of the disease, patients with arthrosis have a feeling of discomfort and moderate pain in the shoulder area. There is a dependence of pain on the weather. They become more intense after physical exertion. The pain intensifies in a certain position of the body. After resting or changing the position, the pain disappears.
When the patient moves the hand, a cramping sensation appears. There are no external changes in the joint, no swelling. Over time, the pain becomes more intense. It constantly disturbs the patient, regardless of the position of the body. Pain has a pulling or aching character.
Pain in the shoulder joint becomes common and constant. Painful sensations appear both during exercise and during rest. They can disturb the patient at night. The characteristic signs of pain syndrome in osteoarthritis of the joint are as follows:
- With the appearance of painful pain over time, sharp pain appears during physical exertion;
- Unpleasant sensations are recorded only in the joint area, it radiates to the elbow area and then can spread to 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 complains of morning stiffness in the shoulder. The range of active movements in the joint decreases. After physical activity and hypothermia, a slight swelling of soft tissues in the shoulder area was revealed.
As the joint damage progresses, there is an increase in the range of motion limitations. The patient develops contracture (stiffness), which significantly hinders the functioning of the limb. If the osteoarthritis is on the right side, the patient cannot take care of himself.
Stages of development
In 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 shoulder joint damage. Experts distinguish the following stages of the pathological process:
- Პirveli. The absence of gross structural changes in the thickness of cartilage tissue is noted. The composition of the intra-articular fluid changes. Cartilage nutrition is disturbed. He does not tolerate stress well, which causes periodic pain.
- second. At this stage, cartilage tissue is thinned. Its structure changes. The surface becomes rough. Cysts form in the thickness of the cartilage layer and foci of calcification appear. The bone areas surrounding the joint are moderately deformed. The edges of the articular platform are covered with bony formations. Discomfort becomes constant.
- the third. A pronounced degree of thinning of the cartilage layer and disruption of its structure is noted. Wide areas of cartilage destruction have been identified. A significant deformation of the articular platform was found. Limitation of range of motion is evident. There is weakness of ligaments, as well as a decrease in the size and size of periarticular muscles.
This approach to classifying shoulder joint injuries allows doctors to choose appropriate treatment tactics that take into account the severity of the pathological process.
diagnosis
Manifesting symptoms of arthrosis forces the patient to consult a doctor. He needs to see a therapist. A specialist will conduct an initial diagnosis. After determining the cause of joint damage, the patient is referred to a rheumatologist, endocrinologist, surgeon or orthopedic traumatologist.
Doctors make a diagnosis in the presence of typical clinical manifestations and radiological signs of arthrosis. During the initial examination, joint tissues are felt to determine the degree of pain.
The possibility of active and passive movements in the affected area is studied. The doctor finds deformation of the joint or an increase in volume. To confirm the presence of arthrosis, the following studies are recommended:
- Radiography. The presence of dystrophic changes in the cartilage layer is detected in the joint. Characteristic bone formations are identified at the edge of the joint cavity. At a later stage, they find that the joint space is narrowing. The change in the shape and structure of the bone surrounding the cartilage is determined. The shape of the joint space becomes wedge-shaped. Signs of rarefaction and the presence of cyst-like formations are noticeable in the thickness of the bone.
- CT scan. This study provides an opportunity to assess the state of bone and cartilage in the initial stages of the disease using layer-by-layer images.
- Magnetic resonance imaging. The method evaluates the condition of soft tissue formations (cartilage, ligaments, joint capsule, etc. ). Layer-by-layer clear images help us determine the degree of damage to the articular and peri-articular structures.
- Ultrasonography. Changes in the joint are detected using ultrasound. The method is safe for the body because 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 injury sites. Softening zones 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. Cartilage deep ulceration, erosion and superficial cracks are revealed.
Diagnosing 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 occurrence of joint pathology against the background of other diseases.
treatment
Osteoarthritis is treated by orthopedic traumatologists or rheumatologists. Rehabilitation specialists actively participate in the treatment process at the stage of restoring motor functions.
In order to relieve pain and restore function in arthrosis of the limb, it is important to provide urgent medical care and follow all the doctor's instructions. It is necessary to limit the load on the joint and avoid sudden hand movements. It is important to avoid lifting or carrying heavy objects for long periods of time.
The joint needs dosed loading under the supervision of specialists, since complete inactivity has a negative effect on the affected limb. Treatment options include conservative therapy and surgery. The choice of methods depends on the prevalence of certain symptoms and the stage of the disease.
drug therapy
An important goal of arthrosis treatment is to eliminate pain. To eliminate discomfort and reduce the severity of inflammation, the following medications are prescribed:
- Drugs for general anesthesia. Non-steroidal drugs are prescribed to patients in a short course during exacerbations. With long-term uncontrolled use, they irritate the gastric mucosa and slow down the recovery process in the joint.
- local remedies. When symptoms increase, gels and ointments containing non-steroidal anti-inflammatory compounds are used. Drugs containing local hormone are used less often. They relieve inflammation and swelling.
- Means for intra-articular injections. In case of persistent and severe pain, which cannot be eliminated by other means, glucocorticoid drugs are injected into the joint. The blockade can be implemented no 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 therapy becomes noticeable only after three months of continuous use of the drug.
In addition, vasodilators are used in shoulder arthrosis. They increase blood flow and relieve capillary spasms. Muscle relaxants are prescribed to relax the muscles in the shoulder when spasm occurs.
Surgical methods
At the third stage of arthrosis, when there is significant destruction of the joint with limited mobility and loss of working capacity, endoprosthesis is performed. Age, physical activity level and general health are taken into consideration before deciding whether to have an intervention.
Installation of modern endoprostheses made of ceramics, plastic and metal fully restores joint functionality. The devices have a guaranteed service life of more than fifteen years.
Non-drug treatment
Physiotherapy techniques are actively used for the treatment of joint osteoarthritis in the phase of reduction of exacerbations. Using their course gives good results when included in a complex therapy program. The following physiotherapeutic methods are used for arthrosis:
- Amplipulse. The treatment method affects the joint locally using alternating electric current. It relieves pain and has a vasodilator 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 pulsed magnetic field. It improves blood flow. Cartilage is saturated with nutrients. The magnet removes decay products from the cells. It suppresses autoimmune reactions.
- electrophoresis. This technique facilitates the penetration of drugs into the affected joint, which is provided by the effect of electric current on the tissue. During the treatment, the blood circulation in the joint structures increases. The procedure reduces inflammation and swelling. Unpleasant sensations are released in the hands. Muscle spasm is eliminated.
- Balneotherapy. Treatment baths with radon, physiological solution and other useful solutions are actively used in case of arthrosis of the shoulder. Blood circulation improves, which enhances nutrition and accelerates cell recovery. Inflammation is relieved.
- Electrical stimulation. In this method of treatment, electrical stimulation of nerve trunks and muscles is carried out using electrodes that transmit a current that has certain parameters.
Therapeutic massage is performed after the aggravation is removed. It restores blood flow and increases the elasticity of ligaments. Muscle spasm in the joint is reduced. The range of motion increases. Exercise therapy is useful in arthrosis.
The gymnastics complex is performed when the pain subsides. During 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 for treating shoulder arthrosis. The laser beam has a positive effect on the damaged joint tissue. Devices that produce low-intensity infrared laser rays are used for therapy. Laser therapy is prescribed to accelerate cell metabolism.
All physico-chemical reactions are stimulated in tissues. Cartilage cell functions are activated. Laser treatment provides a pain-relieving effect. Blood circulation improves and swelling is eliminated. Local immunity is strengthened. Reserve capillaries dilate. Laser therapy has an anti-inflammatory effect.
You don't need to visit a medical facility all the time to get the procedures. Shoulder arthrosis is treated at home using portable laser therapy devices. With their regular use, pain is reduced. Shoulder joint function improves with home laser treatment for arthrosis.
Prognosis and prevention
Shoulder arthrosis cannot be completely cured. But it is possible to slow down the progression of pathological changes in the joints. Working capacity is maintained with regular treatment. It is important to follow the doctor's recommendations.
It is necessary to prevent hand injury. It is important to avoid excessive impact on the shoulder joint during professional duties as well as during sports. Timely treatment of diseases that contribute to the development of arthrosis is necessary.