Osteoarthritis of the shoulder joint

A third of people over the age of sixty report pain in the shoulder joint. The cause of pain in this area in most cases is the development of osteoarthritis. The disease also affects young people whose profession involves intense and constant physical activity - miner, builder, loader, etc.

The disease causes great inconvenience in daily life and considerably reduces work capacity. In severe cases, shoulder osteoarthritis causes disability. It is important to identify the disease in the early stages. Now there are treatment methods that suppress the progression of the disease when treatment is started on time.

What is pathology

Osteoarthritis of the shoulder joint is a chronic disease in which degenerative processes destroy and thin the cartilage. Shoulder osteoarthritis is classified as a group of pathologies of a non-infectious nature. First, the cartilaginous tissue covering the joint surfaces is destroyed.

Cartilage loses its strength and elasticity. It gradually thins and flattens. Due to changes in the cartilaginous layer, it loses its shock-absorbing qualities. Its ability to reduce shock loads that occur during flexion or extension of the arm deteriorates.

Osteoarthritis also affects all structures, such as the joint capsule, its shell, bony surfaces adjacent to the cartilaginous layer, ligaments and adjacent muscles. This is accompanied by pathological changes in other soft tissues located near the joint. As a result of the disease, bony growths form on the joint surfaces.

The pathology manifests itself as pain and cracking in the affected shoulder. In later stages of the disease, the range of movement of the shoulder joint is greatly reduced. Inflammation with this nature of the process is either absent or weakly expressed. The pathology has a chronic and gradually progressive course.

Causes

The cascade of pathological changes in osteoarthritis is triggered by natural tissue aging. Damage to cartilage resulting from strong mechanical stress can contribute to the onset of cartilage destruction. This is also facilitated by various pathological processes.

Primary osteoarthritis of the shoulder is generally diagnosed in older people. Secondary joint damage develops against the background of previous diseases. This happens at any age. The main causes of the disease are:

1. Developmental anomalies. Pathology is often found in patients with underdevelopment of the humeral head or glenoid cavity, as well as the presence of other defects of the upper limb.
2. Injuries. Traumatic osteoarthritis often develops after intra-articular fractures. Sometimes the cause of the pathology is shoulder dislocation, most often habitual. Sometimes severe bruising provokes the development of pathology.
3. Inflammation. Osteoarthritis often occurs when a patient has had glenohumeral periarthritis for a long time. This is also facilitated by previously suffered nonspecific purulent arthritis, as well as specific joint damage 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 risk of developing osteoarthritis:

• Genetic predisposition. Relatives of many patients also suffer from osteoarthritis. They also present lesions with other locations. Usually the knee, ankle and other joints are affected.
• Overvoltage. This often occurs in athletes involved in volleyball, tennis, basketball, and throwing sports equipment. This condition also occurs in people whose profession is characterized by constant and high load on the upper limbs (loaders, miners and others).
• Diseases. Osteoarthritis often develops in patients suffering from autoimmune joint diseases. Certain endocrine diseases, metabolic disorders and connective tissue insufficiency, characterized by excessive joint mobility, also contribute to degenerative processes in cartilage.

The incidence of degenerative joint damage in patients increases sharply with age. Frequent hypothermia also negatively affects the joints.

Symptoms

At the beginning of the disease, patients suffering from osteoarthritis experience discomfort and moderate pain in the shoulder area. There is a dependence of pain on the weather. They become more intense after physical activity. The pain intensifies in a certain position of the body. After rest or a change of position, the pain disappears.

When the patient moves his hand, a crunching sensation appears. There are no external changes in the joint, no swelling. Over time, the pain becomes more intense. This constantly bothers the patient, regardless of body position. The pain has a pulling or aching nature.

Pain in the shoulder joint becomes habitual and constant. Painful sensations appear both during exercise and at rest. They can disturb the patient at night. The characteristic features of pain syndrome in osteoarthritis of the joint are:

• Along with the onset of aching pain over time, sharp pain occurs during physical activity;
• unpleasant sensations are recorded only in the joint area, they radiate to the elbow area, then can spread over the entire surface of the arm;
• the pain may spread to the back and neck on the affected side.

Shortly after, the patient is bothered by morning stiffness in the shoulder. The range of active movements in the joint decreases. After physical activity, as well as hypothermia, slight swelling of soft tissues in the shoulder area is detected.

As joint damage progresses, there is an increase in the extent of movement restrictions. The patient develops a contracture (stiffness), which significantly impairs the functioning of the limb. If the osteoarthritis is on the right side, the patient cannot take care of himself.

Developmental stages

With this disease, the pathological process of the joint has three stages. They reflect the severity of damage to joint structures and the presence of certain symptoms of damage to the shoulder joint. Experts distinguish the following stages of the pathological process:

1. First of all. The absence of gross structural changes in the thickness of the cartilaginous tissue is noted. The composition of the intra-articular fluid changes. Cartilage nutrition is disrupted. He tolerates stress poorly, which leads to periodic pain.
2. Second. At this stage, thinning of the cartilage tissue occurs. Its structure is evolving. The surface becomes rough. Cysts form in the thickness of the cartilaginous layer and foci of calcification appear. The bony areas adjacent to the joint are moderately deformed. The edges of the joint platform are covered with bony growths. The discomfort becomes constant.
3. Third. A pronounced degree of thinning of the cartilaginous layer and disruption of its structure is noted. Large areas of cartilage destruction are identified. A significant deformation of the joint platform is noted. A limitation of the range of movements is revealed. There is weakness of the ligaments, as well as a decrease in the size and flaccidity of the periarticular muscles.

This approach to classifying injuries of the shoulder joint allows doctors to select appropriate treatment tactics that take into account the severity of the pathological process.

Diagnostic

The appearance of symptoms of osteoarthritis requires the patient to consult a doctor. He needs to see a therapist. The specialist will carry out an initial diagnosis. After determining the cause of joint damage, he will refer the patient to a rheumatologist, endocrinologist, surgeon or orthopedist-traumatologist.

Doctors make the diagnosis in the presence of typical clinical manifestations and radiographic signs of osteoarthritis. During the initial examination, the tissues of the joint are palpated to determine the degree of pain.

The possibility of performing active and passive movements in the affected area is being studied. The doctor detects a deformation of the joint or its increase in volume. To confirm the presence of osteoarthritis, the following studies are recommended:

1. X-ray. The presence of dystrophic changes in the cartilaginous layer is detected in the joint. Characteristic bony growths are identified along the edge of the joint socket. Later, they notice that the joint space is narrowed. A change in the shape and structure of the bone adjacent to the cartilage is determined. The shape of the joint space becomes cuneiform. In the thickness of the bone, signs of rarefaction and the presence of cyst-like formations are visible.
2. CT scan. This study in the early stages of the disease makes it possible to assess the condition of bones and cartilage using layer-by-layer images.
3. Magnetic resonance imaging. The method assesses the state of soft tissue formations (cartilage, ligaments, joint capsule, etc. ). Clear layer-by-layer images help determine the extent of damage to joint and periarticular structures.
4. Ultrasound. Changes in the joint are detected by ultrasound. The method is safe for the body, as it does not produce any harmful radiation.
5. Arthroscopy. It is carried out using an endoscope. A manipulator with a camera is inserted into the joint. The doctor clearly sees the damaged areas. Areas of softening in the thickness of the cartilage are determined. It reveals the presence of deep cracks penetrating deep into the subchondral (subchondral) plate of the bone. Deep cartilage ulcerations, erosions and superficial cracks are detected.

Diagnosing osteoarthritis of the shoulder joint in later stages does not present any difficulty for doctors. When assessing the nature of joint damage, it is necessary to take into account the possible secondary origin of joint pathology against the background of other diseases.

Treatment

The treatment of osteoarthritis is carried out by orthopedic traumatologists or rheumatologists. At the stage of restoration of motor functions, rehabilitation specialists actively participate in the treatment process.

To relieve pain and restore function in cases of osteoarthritis of the limb, it is important to receive prompt medical care and follow all doctor's instructions. It is necessary to limit the load on the joint and avoid sudden movements of the hand. It is important to avoid lifting or carrying heavy objects for long periods of time.

The joint needs a dosed load under the supervision of specialists, since complete inactivity has a negative impact on the affected limb. Treatment options include conservative treatment and surgical interventions. The choice of methods depends on the prevalence of certain symptoms and the stage of the disease.

Drug therapy

Eliminating pain is an important goal of osteoarthritis treatment. To eliminate discomfort and reduce the severity of inflammation, the following drugs are prescribed:

1. Preparations for general anesthesia. Nonsteroidal drugs are prescribed to patients for a short time during an exacerbation. With prolonged and uncontrolled use, they irritate the gastric mucosa and slow down the recovery process of the joint.
2. Local remedies. Gels and ointments containing nonsteroidal anti-inflammatory compounds are used when symptoms worsen. Drugs containing hormones with local action are less commonly used. They relieve inflammation and swelling.
3. Means for intra-articular injections. In case of persistent and severe pain that cannot be eliminated by other means, glucocorticoids are injected into the joint. Blocks cannot be carried out more than four times per year.

At 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 treatment becomes noticeable only after three months of continuous use of the drug.

Additionally, vasodilators are used for shoulder osteoarthritis. They increase blood flow and relieve capillary spasms. Muscle relaxers are prescribed to relax the muscles in the shoulder area when spasms are detected.

Surgical methods

At the third stage of osteoarthritis, when there is significant destruction of the joint with limited mobility and loss of working capacity, endoprosthetic surgery is performed. Before deciding whether or not to perform an intervention, age, level of physical activity and general health are taken into account.

Installation of modern endoprostheses made of ceramic, plastic and metal completely restores the functioning of the joint. The devices have a guaranteed lifespan of more than fifteen years.

Non-drug treatment

Physiotherapeutic techniques are actively used in the phase of attenuated exacerbation in the treatment of joint osteoarthritis. Their ongoing use gives good results when included in a complex therapeutic program. For osteoarthritis, the following physiotherapeutic methods are used:

1. Amplipulse. The treatment method locally affects the joint using alternating electric current. It relieves pain and has a vasodilator effect. The procedure improves tissue nutrition.
2. UHF. The joint is exposed to ultra-high frequency waves. The method reduces pain, relieves inflammation and swelling.
3. Magnetotherapy. Joint structures are affected by a pulsed magnetic field. This improves blood circulation. Cartilage is saturated with nutrients. The magnet removes decay products from cells. It suppresses autoimmune reactions.
4. Electrophoresis. This technique promotes the penetration of drugs into the affected joint, which is ensured by the effect of electric current on the tissues. During treatment, blood flow in the joint structures increases. The procedure reduces inflammation and swelling. Unpleasant sensations in the hand are relieved. Muscle spasms are eliminated.
5. Balneotherapy. Therapeutic baths with radon, saline and other beneficial solutions are actively used for shoulder osteoarthritis. Blood circulation improves, which improves nutrition and accelerates cell recovery. The inflammation is relieved.
6. Electrical stimulation. With this method of treatment, electrical stimulation of nerve trunks and muscles is carried out using electrodes that transmit a current with certain parameters.

Therapeutic massage is performed after the exacerbation is relieved. It restores blood circulation and increases the elasticity of ligaments. Muscle spasms in the joint decrease. The range of movements increases. For osteoarthritis, exercise therapy is useful.

The gymnastic complex is performed when the pain subsides. During mechanotherapy, special simulators are used for rehabilitation. Active-passive movements are carried out there. They restore the function of the affected joint.

How to treat at home?

Laser therapy is considered an effective method in the treatment of shoulder osteoarthritis. The laser beam has a beneficial effect on the affected joint tissues. Devices producing low intensity infrared laser beams are used for therapeutic purposes. Laser therapy is prescribed to accelerate cellular metabolism.

All physicochemical reactions are stimulated in the tissues. Cartilage cell functions are activated. Laser treatment provides an analgesic effect. Blood circulation improves and swelling is eliminated. Local immunity is strengthened. The reserve capillaries dilate. Laser therapy has an anti-inflammatory effect.

To receive procedures, you do not have to constantly visit a medical institution. Treatment of shoulder osteoarthritis at home is carried out using portable laser therapy devices. With their regular use, pain decreases. The function of the shoulder joint improves with laser treatment of osteoarthritis at home.

Prognosis and prevention

Osteoarthritis of the shoulder cannot be completely cured. But it is possible to slow down the progression of pathological changes in the joints. With regular treatment, the ability to work is maintained. It is important to follow the doctor's recommendations.

It is necessary to avoid injury to your hand. It is important to avoid excessive impact on the shoulder joint when performing professional functions as well as when participating in sports activities. It is necessary to promptly treat diseases that contribute to the development of osteoarthritis.