Osteoarthritis of the shoulder joint is a dystrophic lesion of the cartilage plate covering the articular surfaces of the joint, with subsequent involvement of the underlying bone.
About the disease
With this disease, not only cartilage layers and subchondral bones are affected. The pathological process gradually includes the articular capsule and the ligamentous apparatus, the synovium, the musculotendinous compartment, as well as the subacromial region.
Osteoarthritis of the shoulder joint at a certain stage can lead to the development of osteoarthritis. This condition is characterized by the following symptoms: chronic pain, reduced range of motion in the joint, intra-articular cracking during rotation. Most often, people over 40 undergo this transformation.
The main symptoms of arthrosis of the shoulder joint are pain and limited mobility of the arm. To verify the diagnosis, imaging methods are informative - ultrasound and X-ray scanning, computed tomography and magnetic resonance.
In accordance with clinical recommendations, the treatment of the disease in the initial stages is carried out using conservative methods, and in the later stages, when there is significant damage to the cartilage layer and the patient's self-care is impaired, joint replacement is indicated.
Types of arthrosis of the shoulder joint
According to the classification, the following types of arthrosis of the shoulder joint are distinguished:
- primary arthrosis, in the development of which genetics plays a big role, even the most complete examination does not allow us to identify the most important cause of the disease;
- secondary arthrosis, which is a consequence of the action of unfavorable factors in the joint (trauma, endocrine diseases, damaged joint anatomy).
Doctors judge the degree of progression of the pathological process by the degree of the disease. The more aggressive the process, the faster the destruction of the articular cartilage and the involvement of the underlying bone. From the morphological point of view, there are 6 degrees of arthrosis of the shoulder joint:
- first degree - the cartilage matrix swells and disintegrates, but the integrity of the surface area of the cartilage has not yet been compromised;
- second degree - the cells of the cartilage tissue located in the deep layers are affected, the surface plate of the cartilage is damaged;
- third degree - vertical cracks appear in the cartilage plate;
- fourth degree - the surface area of the cartilaginous plate is gradually exfoliated, erosive defects are formed and cystic cavities appear in the underlying bone;
- fifth degree - at this stage the underlying bone is exposed;
- sixth grade - the subchondral area thickens significantly, the cysts become more pronounced and marginal bone growth appears.
Symptoms of arthrosis of the shoulder joints
The main clinical signs of shoulder arthrosis are pain, joint stiffness up to complete loss of mobility, and joint deformity.
Distinctive features of pain with deforming arthrosis are:
- the onset of flexion, extension, or rotation;
- increase during physical activity;
- nocturnal character due to stagnation of venous blood in the intraosseous channels;
- the presence of blockages - sudden blockage in the joint due to the separation of separate osteochondral fragments entering between the articular surfaces;
- weather dependence - the pain intensifies when the weather changes (in humid and cold climates, the pain becomes more intense).
Arthrosis is a chronic pathology. In the initial stage of the disease, pain appears periodically (at the time of worsening of the disease). The rate of progression of the pathology is determined by the time of initiation of treatment and the suitability of lifestyle modification. Shoulder pain becomes chronic if it continues for 6 months or more. The change from acute to chronic pain indicates the progression of the pathological process.
Causes of arthrosis of the shoulder joint
The causes of arthrosis of the shoulder joint are classified into 2 groups:
- modifiable - correction is possible;
- unmodifiable - it is not possible to influence their action.
Non-modifiable factors that can increase the risk of developing arthrosis changes in the shoulder joint include:
- gender - up to the age of 50, women are less susceptible to the disease than men; after about 50 years, the prevalence of pathology among representatives of both sexes becomes approximately the same;
- the age of the person - the older the patient is, the higher the risks (and from the age of about 30 in the cartilage tissue, the degeneration process continues faster than the regeneration process, which creates the prerequisites for the development of the disease);
- congenital anomalies of the structure of the shoulder - excessive increased mobility (hypermobility), dysplasia of connective tissue (normally, articular cartilage is represented by type 2 collagen fibers, with dysplasia, replacement with less stable types of collagen occurs), instabilityof articulation;
- genetic features - hereditary predominance of type 2 collagen, interleukin-1 and interleukin-2 gene polymorphism.
Modifiable risk factors for deforming arthrosis of the right or left shoulder joint are:
- traumatic joint damage;
- excessive physical activity (strength sports and martial arts, including barbell bench press);
- obesity - for shoulder arthrosis, the important factor is not the increase in mechanical load, but the metabolic changes that occur in the connective tissue, incl. a state of chronic inflammation that accompanies obesity;
- weakness of the muscular girdle of the shoulder joint, especially in those people who perform precise activities with their hands (jewelers, dentists, secretaries, writers);
- lack of vitamin D, which is actively involved in maintaining the health of the musculoskeletal system;
- a diet low in vitamin C, which is an important link in the body's calcium-phosphorus metabolism;
- hormonal imbalance - thyroid disease, diabetes, etc. ;
- smoking - both active and passive.
In shoulder arthrosis, the main targets of the pathological process are articular cartilage, subchondral bone and synovium. In the affected cartilage, the synthesis of proteoglycans decreases, fragmentation and cracking of the plate is observed, exposing the underlying bone. The increase in the non-physiological load on the bone leads to its compression, the appearance of cysts and osteophytes (marginal growth).
Diagnosing
Examination of a patient with pain in the shoulder joint should begin with an x-ray. It is important to scan in several projections to examine the joint in detail. Images can be obtained in direct projection, in the position of internal and external rotation. To evaluate the soft tissue formations of the joint, especially in the early stage of arthrosis, the ultrasound scan of the joint is more informative. If the diagnosis remains unclear, magnetic resonance imaging/computed tomography of the joint is recommended. In the next phase, the preservation of joint functions is evaluated.
Expert opinion
All morphological formations of the joint are involved in the pathological process. The main symptom of osteoarthritis is pain in the joint area, caused not only by synovitis, but also by bone damage (osteitis, periostitis), affecting periarticular soft tissues (tendinitis, tenosynovitis, myalgia, enthesopathies, stretching of the joint capsule). , degeneration of the meniscus and involvement of the neurosensory system (for example, irritation of nerve trunks by large osteophytes). Therefore, the sooner treatment begins, incl. lifestyle modification, the more effective will be the control over the occurrence of pain.
Treatment
In the initial stage of the pathological process, the treatment of arthrosis of the shoulder joint is carried out using conservative methods, and with severe degeneration of the articular cartilage, surgical intervention (endoprosthetics) is indicated.
Conservative treatment
During the period of worsening of the process, the first priority is to relieve the pain. Non-steroidal anti-inflammatory drugs are most often used for pain relief. They can be applied topically (in the form of creams and ointments), injected into the joint cavity or used systemically (tablets, intramuscular injections). In some patients, the pain may be so severe that a short course of corticosteroid drugs may be used to relieve it.
Intra-articular injection of hyaluronic acid or plasma, incl. enriched with platelets, it can have a stimulating effect on the cartilage plate and promote its renewal (this treatment is considered pathogenic). These injections help accelerate the synthesis of collagen and elastin fibers that form the basis of cartilage. As a result, the structure of the cartilage layer and the synovial membrane improves, which helps to increase the congruence of the articular surfaces. These intra-articular injections help to optimize the production of synovial fluid, which not only absorbs shock and hydrates cartilage, but also improves metabolic processes in chondrocytes, increasing their internal potential.
After reducing the acute process, physiotherapeutic rehabilitation methods (pulsing current, ultrasound and laser treatment) can be used as part of the complex treatment. These procedures have a complex positive effect on joint structures.
Surgery
Surgery is indicated for significant destruction of the cartilage plate, which is accompanied by persistent pain and dysfunction of the joint, leading to the inability to care for oneself and perform professional tasks. A modern method of surgical intervention for shoulder arthrosis is the implantation of an endoprosthesis. At SM-Clinic, the operation is performed in accordance with the strict adherence to the methodology using the latest generation endoprostheses. This is the key to achieving the best therapeutic results.
Prevention of shoulder joint arthrosis
The primary prevention of arthrosis of the shoulder joint is aimed at maintaining optimal metabolism in the osteochondral compartment. For this it is recommended:
- maintain normal body weight;
- adequately compensate for endocrine disorders in the body (consultation and dynamic monitoring by an endocrinologist is required);
- dosed strengthens the muscular corset of the shoulder girdle;
- Warm up regularly if your professional activity involves performing similar shoulder movements.
To prevent the progression of developed shoulder arthrosis, the following recommendations are important:
- avoid lifting heavy objects, incl. push-ups;
- carry out repeated courses of therapeutic massage;
- regularly engage in gymnastics to improve health (under the supervision of a physical therapy specialist).
reHabiLitatiON
After the endoprosthetics, plaster is applied, which provides the necessary level of immobilization. After removing the cast, the period of restoring the functional activity of the joint begins. For this, courses of therapeutic massage, physiotherapy and health-improving gymnastics under the supervision of a physical therapy specialist are recommended.
Question and answer
Which doctor treats arthrosis of the shoulder joint?
Diagnosis and treatment of the disease is carried out by a traumatologist-orthopedic.
Representatives of which professions develop arthrosis of the shoulder joint more often?
Athletes involved in volleyball, tennis, basketball, shot putters and loaders are at the greatest risk of degenerative-dystrophic destruction of the cartilage layer of the shoulder joint.
Does shoulder pain indicate the development of arthrosis?
In fact, pain is the main symptom of arthrosis. However, pain can also be a manifestation of other diseases - adhesive capsulitis, osteoarthritis, rotator cuff muscle damage, etc. A qualified orthopedic traumatologist will help you make the correct diagnosis and choose treatment.