Osteoarthritis of the shoulder

Shoulder pain may occur gradually and significantly reduce the patient's quality of life. To find out why your shoulder hurts, you need to visit a doctor and undergo a complete examination. The most common cause of such pain is osteoarthritis of the shoulder.

The disease requires long-term adequate treatment, which can be prescribed only by an experienced specialist.

What is it?

Osteoarthritis of the shoulder is a long-term, constantly progressive metabolic-dystrophic disease, which leads to the gradual destruction of the articular cartilage, the protective growth of the bone tissue with the deformity of the joint and the loss of its function.

A wide range of arm movements is ensured by the synchronous interaction of the shoulder complex joints:

• humeroscapular or simply humeral;
• acromioclavicular - between the clavicle and the acromial extension of the scapula;
• sternoclavicular - between the sternum and the collarbone.

The shoulder joint is very mobile, which is ensured by the convex head of the humerus and the relatively flat articular fossa of the shoulder blade. The joint is strengthened by the tendons of the muscles of the upper extremity, above it is the coracoid-acromial ligament. Not too reliable reinforcement allows the joint to move in different directions, but at the same time increases the risk of injury.

The code for shoulder arthrosis according to the International Classification of Diseases 10th revision (ICD-10) is M19 (other types of arthrosis). Treatment of shoulder osteoarthritis should begin as soon as possible. But even advanced stages of the disease can be successfully treated.

Causes of shoulder osteoarthritis

The main causes of osteoarthritis of the shoulder:

• consequences of acute injuries - dislocations, subluxations, intra-articular fractures, bruises;
• permanent long-term microtrauma related to the profession or sports load;
• transmitted acute and chronic infectious-inflammatory and autoimmune processes in the shoulder joint - acute purulent arthritis, chronic rheumatoid, psoriatic and other arthritis;
• on the background of chronic inflammatory process in the periarticular tissues - humeroscapular periarthritis, which leads to impaired blood circulation and nutrition of cartilage tissues;
• metabolic (exchange) joint disorders - gouty arthritis;
• hormonal disorders;
• congenital malformations (dysplasia) - for example, the articular surfaces of the shoulder joints.

Under the influence of any of these reasons (sometimes several at once) there is a disturbance in the composition and volume of the joint fluid that feeds the cartilaginous tissue of the joint. Cartilage gradually reduces in volume, cracks, loses its cushioning properties. This leads to bone injury, its growth along the edges of the joint surfaces, joint deformity and reduced function. Inflammation of the synovial membrane - synovitis - occasionally occurs in the joint cavity. Because of synovitis, osteoarthritis is called osteoarthritis or osteoarthritis - depending on which process prevails (inflammatory or metabolic-dystrophic). As a result of inflammation and necrosis of the bone, small pieces of tissue are separated from it - sequesters or articular mice.

In danger:

• for microtraumas - blacksmiths, miners, tennis players, weightlifters, discus throwers;
• for acute injuries - gymnasts, athletes, circus artists;
• persons with a burdened heritage;
• persons suffering from any chronic joint disease.

Symptoms of osteoarthritis of the shoulder

The disease begins gradually, gradually. The rate of progression depends on the cause, the general condition of the patient and his inheritance.

The first signs

The initial symptoms of arthrosis of the shoulder joint may not be noticed, especially if they occur in the background of some existing shoulder disease. They are smaller, they appear periodically, mostly after exercise, pain, discomfort during movement in the joint. Pain in the left joint can be confused with pain in the heart. They pass quickly, but it is worth paying attention to them.

If such symptoms recur, it is better to consult a doctor immediately, because any disease is easier to treat in the early stages.

Open symptoms

The pain intensifies, it does not disappear immediately after the effort. Night pains appear, as well as pains associated with the change of weather. The movements in the hand become painful, accompanied by characteristic crunching. In the morning or when you stay in a certain position for a long time, stiffness of movement appears, in order to remove it, you need to move. Pain syndrome can be localized not only in the shoulder area, but also radiate to the arm, neck and upper back.

Occasionally, the joint swells, a slight reddening of the skin appears over it, the pain intensifies, it becomes permanent. Body temperature may rise slightly. This is a sign of synovitis - aseptic (no infection) inflammation of the synovial membrane. If there are foci of infection in the body (carious teeth, ENT diseases, etc. ), then it can enter the joint through blood and lymph vessels, causing a purulent inflammatory process. In this case, high fever, headache may occur, the general condition may be severely disturbed.

The combination of degenerative-dystrophic and inflammatory processes in the joint gradually leads to permanent loss of limb function and constant pain.

But even such patients can be helped, you just need to go to the clinic.

Dangerous symptoms

There are a number of symptoms of osteoarthritis of the shoulder joint, which signal that you need to seek medical help urgently. This:

• occurrence of edema and redness of tissues in the joints, fever;
• aching pain in the joint, accompanied by a change in its shape;
• joint pain radiating to the arm, neck or back;
• the former range of motion in the arm is impossible, even just lifting causes severe pain.

These symptoms indicate that your body needs help. Only a doctor can give that.

What is the danger of osteoarthritis of the shoulder

In the absence of medical care, brachial arthrosis is dangerous with stable progression with the development of permanent pain syndrome, reduced limb function and various, sometimes life-threatening complications.

Degrees of arthrosis of the shoulder joint

There are three degrees of arthrosis of the shoulder joint:

• Osteoarthritis of the shoulder joint 1 degree- initial phase. All symptoms occur mildly and mostly after exercise. X-rays sometimes show a slight narrowing of the joint space, but more often it is not. Small injuries in cartilage tissue at this stage can be detected only with the help of magnetic resonance imaging (MRI).
• Osteoarthritis of the shoulder joint 2 degrees- progressive phase. The shoulder hurts constantly, the pain intensifies with hand movements, down (in the elbow, forearm, fist) or in the neck, back, below the shoulder blade. There are difficulties with the functioning of the extremities, signs of synovitis occasionally develop. On the X-ray, the joint space is significantly narrowed, bone growths (osteophytes) are visible along the edges of the joint surfaces, bone tissue is compacted (osteosclerosis).
• Osteoarthritis of the shoulder joint 3 degrees- advanced stage. The pain in the joint is strong, constant, with a pronounced crunch when moving the arm. The range of motion is limited, sometimes the arm is completely immobile due to pain. The joint is deformed, which sometimes leads to pinching of nerves and blood vessels. On the X-ray: the joint space is almost invisible, significant bone growths with joint deformity, pronounced sclerosis and necrosis of bone tissue, joint mice.

Possible complications

Every localization and form of arthrosis has serious complications, so treatment should not be delayed.

If you do not treat the disease or treat it yourself with folk remedies, there is a risk of developing complications such as:

• significant deformity and limited mobility of joints;
• dislocations, subluxations, and intraarticular fractures with minor injuries or sudden movements;
• tendon ruptures surrounding the joint muscles and ligaments - atrophy and easily rupture;
• aseptic necrosis of the head of the humerus with complete destruction of the articulation and loss of its function;
• purulent-septic complications when the infection enters the joint cavity from other foci.

What to do with the worsening

Exacerbations of the pathological process are usually associated with increased load on the extremities or with the development of inflammation - synovitis. In this case the joint hurts more, there is a slight swelling, the body temperature rises. In such cases, you should adhere to the following self-help algorithm:

• call a doctor at home;
• take one of the painkillers;
• apply anesthetic ointment to the skin in the area of the affected joint;
• tie a sore hand with a handkerchief - it will reduce the load;
• take an elevated position - sit with a pillow under your back - this will reduce tissue swelling.

Types of shoulder arthrosis

According to different criteria, the disease is divided into special types.

Due to illness

According to this criterion, primary and secondary osteoarthritis are distinguished. Primary osteoarthritis of the shoulder is mainly due to changes in age and develops after 50 years. But sometimes the disease starts at a young age, but the cause of its occurrence cannot be determined. In this case, they are talking about primary idiopathic arthrosis of the shoulder. An important role in its development is played by hereditary predisposition: the presence of a similar disease in one of the close relatives.

Secondary arthrosis of the shoulder joint occurs after injuries and previous illnesses, but there is an important burden of heredity: in one person even a minor injury or acute arthritis can lead to arthrosis, while in another, significant damage ends without consequences.

According to the characteristics of the flow

Assign deforming arthrosis of the shoulder, which is characterized by rapid progression of bone deformities. The characteristic of this type of disease is a change in the shape of the joint and frequent injuries to nearby blood vessels and nerves. Compression of blood vessels leads to circulatory disorders and rapid progression of degenerative-dystrophic disorders, and compression of nerves leads to impaired sensitivity of the extremities and severe pain along peripheral nerves.

Origin

Post-traumatic osteoarthritis of the shoulder - the symptoms and treatment of this disease have their own characteristics associated with a traumatic lesion of certain joint structures. Metabolic-dystrophic changes occur after intra-articular fractures, dislocations, subluxations, ruptures of ligaments, tendons and simply bruises. Injuries result from hitting the wrist or falling to the side with adduction of the arm. Rupture of the articular capsule with dislocation usually occurs when falling on the abducted arm.

Often, after a minor injury, a person does not notice the first signs of osteoarthritis for a long time and seeks medical help in the second stage of the disease. Significant injuries require long-term rehabilitation treatment, and osteoarthritis usually begins to be treated at an early stage.

Osteoarthritis of the shoulder after inflammatory diseases - the symptoms and course of such pathology depend on the underlying disease. In psoriatic arthritis, the shoulder joint is often affected, while osteoarthritis develops in one joint, develops slowly but is difficult to treat. In rheumatoid arthritis, both shoulders are affected, arthrosis develops in waves with frequent changes in metabolic-dystrophic and inflammatory processes.

Distribution

Only one left or right joint can be affected and then there is talk of monoarthrosis. Simultaneous defeat of two (left and right) shoulder-scapular joints is called oligoarthrosis.

Osteoarthritis of other joints of the shoulder complex

Acromioclavicular arthrosis - most often of post-traumatic origin. It develops against the background of lifting weights with the hands above the horizontal. Follow the pain when raising the arm. With the increase of osteophytes on the joint surfaces, impingement syndrome can occur - involvement of the tendons and muscles of the shoulder between the head of the humerus and the acromion of the scapula during rotation and abduction of the shoulder. This accelerates the progression of osteoarthritis and the decline of hand function.

Diagnosis

Without a correct diagnosis, it is impossible to cure this disease. A complete examination is possible only in the clinic. At the initial consultation, the doctor asks the patient, examines him, prescribes additional research methods and specialist consultations:

• Laboratory tests of blood and joint fluids reveal inflammatory, autoimmune and degenerative-dystrophic processes.
• instrumental:
  1. radiography of the shoulder joint - changes in bone tissue are detected;
  2. computed tomography (CT) - changes in cartilage and bone tissue in the early stages;
  3. magnetic resonance imaging (MRI) - changes in the soft joint and periarticular tissues;
  4. diagnostic arthroscopy - is performed if it is necessary to clarify the nature of the pathological process.

Treatment of osteoarthritis of the shoulder joint

After the final diagnosis is made, a complex conservative treatment of shoulder arthrosis is prescribed. If conservative therapy is ineffective, surgical treatment is prescribed.

Conservative therapy

Includes pharmacological and nonpharmacological methods.

Treatment

The goals of drug treatment are to eliminate pain and suppress the progression of osteoarthritis. To alleviate the patient's condition, appoint:

1. Drugs from the groupnon-steroidal anti-inflammatory drugs (NSAIDs). Medicines are given intramuscularly, orally or rectally; at the same time, NSAIDs are prescribed externally in the form of ointments, gels or creams.
2. Drugs from the groupmuscle relaxants- relax the muscles surrounding the joint; the spastic state of these muscles increases the pain;
3. Blockage of painwith local anesthetics.The drug solution is injected into the joint cavity or periarticular tissues - a rapid analgesic effect.

The course of pathogenetic (influence on the mechanisms of the disease) therapy in the treatment of osteoarthritis of the shoulder includes:

1. Chondroprotectors- drugs that contain biologically active substances that regenerate cartilage tissue. They are prescribed orally in the form of tablets and powder, in the form of intramuscular and intraarticular injections, and also externally in the form of ointments and creams.
2. Angioprotectors- Means that improve blood microcirculation. Administer in tablets for oral administration and intravenous drip solutions.
3. Hyaluronic acid preparations- are introduced into the joint cavity to improve the cushioning properties and prevent the destruction of bone tissue.

Vitamin-mineral complexes to improve metabolic processes in joint and periarticular tissues.

Drug-free treatment

The basis of non-medical methods of treating osteoarthritis of the shoulder is a healthy active lifestyle and proper nutrition. It is very important to get rid of bad habits such as smoking and alcohol abuse - they contribute to circulatory disorders and are toxic to joint tissues.

Nutrition, diet

There is no special diet to treat osteoarthritis of the shoulder, but proper nutrition is very important in this disease. It is recommended to include in the daily diet: sea fish, seafood, lean poultry, dairy products, cottage cheese, cheese, cereals (oatmeal, buckwheat), vegetables, fruits.

Excluded from the diet are: easily digestible carbohydrates (sweets, muffins, sweet carbonated drinks), fatty red meat, foods that irritate the tissues that cause swelling - salt (excessive amount), hot and spicy spices.

It is recommended to give preference to cooked, stewed and cooked dishes.

Orthopedic treatment for limb load distribution

To prevent shoulder injuries, it is recommended to occasionally wear an elastic protective holder in the form of a short sleeve that attaches to the opposite arm. The device improves blood circulation, removes swelling. But constant wearing is not recommended, because it leads to a rapid reduction in the range of motion in the shoulder.

Many experts include taping in the complex treatment of osteoarthritis of the shoulder - fixing the tissue with adhesive elastic bands. This eliminates pain, improves blood circulation and joint function.

Physiotherapy

Exercise therapy - daily performance of a set of exercises - is the main method of rehabilitation for shoulder arthrosis. Gymnastic complexes are prescribed by a doctor, mastered under the supervision of an exercise therapy instructor. Once the patient begins to perform the entire set of exercises properly, this can be done at home.

Physiotherapy

Physiotherapy is included in complex therapy at any stage of the disease. These are electro- and phonophoresis with the use of painkillers, laser and magnetotherapy - stimulation of regenerative processes in joint tissues, shock wave therapy (SWT) - exposure to sound, which has a pronounced chondroprotective effect.

Folk remedies

Folk remedies will be of great benefit only if prescribed by a doctor. Here are some of them:

• Decoction of viburnum branches for oral use.Pour a glass of crushed raw materials with 500 ml of water before going to bed, let it boil, keep on low heat for 5 minutes, insist all night, then strain and drink 100 ml 3 times a day. It's an anesthetic.
• An old recipe for an anesthetic ointment from the wild rosemary plant.Take Vaseline or butter and dry chopped grass. In an enamel bowl, alternately fold the greasy base and grass to the very top in layers, close the bowl with a lid, coat the cracks with dough and put in the oven (preferably in the oven) on low heat for 2 hours, remove from oven, strain through double gauze, store in refrigerator andrub into the skin over the affected joint 2-3 times a day.

Surgical operations

In addition to the ineffectiveness of conservative therapy for shoulder osteoarthritis, the following surgical interventions are performed:

• Arthroscopic surgeryallowing the removal of various defects in the joint cavity. They are performed mainly on young people with post-traumatic osteoarthritis. Arthroscopy allows you to tighten and attach the biceps tendon to the bone (tenodesis - this will eliminate the looseness of the joint), remove bone growths - osteophytes (debridement), renew the joint cavity by transplantation, etc.
• Endoprosthetics- replacement of a destroyed joint that has lost its function with an artificial one.

Approach to disease treatment in clinics

Clinical experts have developed their own approach to treating shoulder osteoarthritis. First of all, each patient is carefully examined with the latest diagnostic equipment (including magnetic resonance imaging). Then he is completely relieved of pain by using medical and non-medical methods. At the same time, individual complex therapy is selected for him, including:

• state-of-the-art drug and non-medical methods, including plasmolifting;
• traditional oriental methods of treatment and restoration of joint function and the whole organism as a whole; these are acupuncture, moxibustion, auriculotherapy, taping, etc.

This approach quickly relieves a person of pain and suppresses the progression of the disease. And regular preventive courses allow patients to forget about the disease and lead a normal life. Numerous patient reviews speak of how effective this treatment is.

A combination of proven techniques of the East and innovative methods of Western medicine.

General clinical guidelines

For people suffering from osteoarthritis of the shoulder, it is recommended:

• lead a healthy, active lifestyle, alternating physical activity and rest;
• eat properly regularly;
• get rid of all bad habits;
• perform therapeutic exercises regularly, avoiding sudden movements;
• sleep at night on your back or on your healthy side, placing a small pillow under your sore arm;
• give up heavy physical exertion, avoid injuries, prolonged stress and colds;
• during exacerbation (development of synovitis), avoid any thermal procedures;
• adhere to all recommendations of the attending physician.

Prevention

It is especially important for people with severe heredity to adhere to certain rules for the prevention of shoulder arthrosis. They should not engage in weightlifting, tennis, traumatic sports, work as hammers, blacksmiths, miners. Everyone who wants to have healthy joints should lead an active lifestyle and eat regularly.

Frequently asked questions about the disease

1. What is the pain of osteoarthritis of the shoulder?

   The pain is painful, intensified by movement and lifting weights.

2. Why is the disease dangerous?

   Formation of a permanent pain syndrome and loss of limb function.

3. Which doctor treats deforming shoulder osteoarthritis?

   Post-traumatic - orthopedist-traumatologist, on the background of inflammatory diseases - rheumatologist.

4. Is there a blockage in shoulder osteoarthritis?

   For severe pain, yes.

5. How effective are physiotherapy methods for this disease?

   Effective as part of a complex treatment.

6. Is it possible to completely cure deforming shoulder arthrosis?

   No, but a doctor can suppress its progression and save the patient from pain.

Osteoarthritis of the shoulder should be treated for a long time, systematically and strictly under the supervision of a doctor. Attempts to cope with this disease on their own are fraught with complications and disabilities. But a qualified specialist can stop the process at any stage of the disease, save the patient from pain and significantly improve his quality of life.