A third of all elderly 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 arthrosis. The disease also affects young people whose profession involves constant heavy physical activity - miners, builders, loaders, etc.
The disease causes great inconvenience in everyday life and sharply reduces the ability to work. In severe cases, shoulder arthrosis leads to disability. It is important to identify the disease in the initial stages. There are now treatment methods that suppress the progression of the disease when therapy is started in time.
What is pathology
Osteoarthritis of the shoulder joint is a chronic disease in which degenerative processes destroy and thin the cartilage. Osteoarthritis of the shoulder is classified as a group of pathologies that are non-infectious in nature. First, the cartilage tissue that covers the joint surfaces is destroyed.
Cartilage loses strength and elasticity. It gradually thins and flattens. Due to changes in the cartilage layer, it loses its cushioning properties. Its ability to reduce impact loads that occur during arm flexion or extension is impaired.
Osteoarthritis also affects all structures, such as the joint capsule, its shell, bone surfaces with the cartilage 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 is manifested by pain and grinding in the area of the affected shoulder. In the later stages of the disease, the range of motion in the shoulder joint is sharply reduced. Inflammation in him with this nature of the process is either absent or weakly expressed. Pathology has a chronic, gradually progressive course.
Causes
The cascade of pathological changes in osteoarthritis is triggered by the natural aging of tissues. Cartilage damage as a result of strong mechanical stress can contribute to cartilage destruction. Various pathological processes also contribute to this.
Primary osteoarthritis of the shoulder is usually diagnosed in older people. Secondary joint damage develops against the background of previous diseases. It occurs at any age. The main causes of the disease are considered:
- 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.
- Injuries. Traumatic arthrosis often develops after intra-articular fractures. Sometimes the cause of the pathology is a dislocation of the shoulder, which is usually common. Sometimes severe bruising causes the development of pathology.
- Inflammation. Arthrosis often occurs when the patient suffers from glenohumeral periarthritis for a long time. Non-specific purulent arthritis that has been cured before, as well as specific joint lesions caused by tuberculosis, syphilis and other diseases, contribute to this.
There is a group of risk factors that contribute to the emergence of this 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 localizations. The knee, ankle and other joints are usually affected.
- Overvoltage. It often occurs in athletes who play volleyball, tennis, basketball and throw sports equipment. This condition also occurs in people if their profession is characterized by a constant high load on the upper limbs (loaders, miners and others).
- Diseases. Osteoarthritis often develops in patients suffering from autoimmune joint diseases. Some endocrine diseases, metabolic disorders and connective tissue insufficiency, which is characterized by excessive joint mobility, also contribute to the degenerative processes in the cartilage.
The incidence of degenerative joint lesions in patients increases sharply with age. Frequent hypothermia also negatively affects the joints.
Symptoms
At the beginning of the disease, patients with arthrosis feel 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 resting or changing the position, the pain disappears.
When the patient moves the arm, a creaking sensation occurs. There are no external changes on the wrist, no swelling. Over time, the pain becomes more intense. It constantly bothers the patient, regardless of the position of the body. The pain has a pulling or aching character.
Pain in the shoulder joint becomes common and constant. Painful sensations occur both during exercise and at rest. They can disturb the patient at night. The characteristic features of the pain syndrome in osteoarthritis of the joint are as follows:
- with the appearance of painful pains over time, sharp pain occurs during physical activity;
- unpleasant sensations are registered only in the wrist area, radiate to the elbow area, and then can spread over the entire surface of the hand;
- the pain may spread over the back and neck on the affected side.
After a short time, the patient suffers from morning stiffness in the shoulder. The range of active movements in the joint decreases. After physical activity, as well as hypothermia, a slight swelling of the soft tissues in the shoulder area is revealed.
As joint damage progresses, an increase in the range of motion limitations is observed. The patient develops contracture (stiffness), which significantly impairs the functioning of the extremities. 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 joint structures and the presence of certain symptoms of damage to the shoulder joint. Experts distinguish the following stages of the pathological process:
- First. Absence of gross structural changes in cartilage tissue thickness was observed. The composition of the intra-articular fluid changes. Cartilage nutrition is disturbed. He does not tolerate stress well, which leads to periodic pain.
- A second. In this phase, cartilage tissue becomes thinner. Its structure is changing. The surface becomes rough. Cysts are formed in the thickness of the cartilage layer and foci of calcification appear. The areas of the bone adjacent to the joint are moderately deformed. The edges of the articular platform are covered with bone growths. Discomfort becomes constant.
- Third. A pronounced degree of thinning of the cartilage layer and disruption of its structure is observed. Large areas of cartilage destruction were identified. A significant deformation of the joint platform was determined. Range of motion limitation is detected. There is weakness of the ligaments, as well as reduction in size and flaccidity of the periarticular muscles.
This approach to the classification of lesions of the shoulder joint allows doctors to choose the appropriate treatment tactics that take into account the severity of the pathological process.
Diagnostics
The appearance of arthrosis symptoms forces the patient to go to the doctor. He needs to see a therapist. The specialist will conduct an initial diagnosis. After determining the cause of joint damage, he will refer the patient to a rheumatologist, endocrinologist, surgeon or orthopedic traumatologist.
Doctors make a diagnosis in the presence of typical clinical manifestations and X-ray signs of arthrosis. During the initial examination, the tissues of the joint are felt to determine the degree of pain.
The possibility of performing active and passive movements in the affected area is studied. The doctor detects the deformation of the joint or its volume increase. To confirm the presence of arthrosis, the following studies are recommended:
- Radiography. The presence of dystrophic changes in the cartilage layer is revealed in the joint. Characteristic bony outgrowths are identified along the edge of the joint cavity. At a later stage, they discover that the joint space is narrowed. A change in the shape and structure of the bone along with the cartilage is determined. The shape of the joint space becomes wedge-shaped. Signs of thinning and the presence of cystic formations are visible in the thickness of the bone.
- CT scanner. This study in the initial stages of the disease provides an opportunity to assess the condition of bones and cartilage using layer-by-layer images.
- M. R. I. The method assesses the state of soft tissue formations (cartilage, ligaments, joint capsule, etc. ). Layer-by-layer clear images help determine the extent of damage to articular and periarticular structures.
- Ultrasonography. Changes in the joint are detected by 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 areas of damage. Softening zones are determined in the thickness of the cartilage. It reveals the presence of deep cracks that penetrate deep into the subchondral (subchondral) plate of the bone. Deep cartilage ulcerations, erosions and surface cracks are revealed.
Diagnosing arthrosis of the shoulder joint in the later stages does not pose any difficulties 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
Treatment of osteoarthritis is carried out by orthopedic traumatologists or rheumatologists. In the phase of restoration of motor functions, rehabilitators actively participate in the treatment process.
To relieve pain and restore function in the case of arthrosis of the extremities, it is important to get immediate medical help and follow all the 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 an expert, because complete inactivity has a negative effect on the affected extremity. Treatment options include conservative therapy and surgical interventions. The choice of methods depends on the frequency of certain symptoms and the stage of the disease.
Drug therapy
An important goal in the treatment of arthrosis is to eliminate pain. To eliminate discomfort and reduce the severity of inflammation, the following drugs are prescribed:
- Preparations for general anesthesia. Nonsteroidal drugs are prescribed to patients for a short course during an exacerbation. With long-term uncontrolled use, they irritate the gastric mucosa and slow down the recovery process in the joint.
- Local remedies. When symptoms intensify, gels and ointments containing non-steroidal anti-inflammatory compounds are used. Medicines containing hormones of local action are used less frequently. They relieve inflammation and swelling.
- Means for intra-articular injections. For persistent and severe pain that cannot be relieved by other means, glucocorticoid drugs are injected into the joint. Blockades can be implemented a maximum of 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 for long courses of six months or more. The effect of the therapy becomes visible only after three months of continuous use of the drug.
Additionally, vasodilators are used for osteoarthritis of the shoulder. They increase blood flow and alleviate capillary spasms. Muscle relaxants are prescribed to relax the muscles in the shoulder area when spasms are detected.
Surgical methods
In the third stage of arthrosis, when there is significant destruction of the joint with limited mobility and loss of working ability, endoprosthetic surgery is performed. Age, level of physical activity and general health are taken into account before deciding whether to perform an intervention.
By installing modern endoprostheses made of ceramics, plastic and metal, the functioning of the joint is completely restored. The devices have a guaranteed service life of more than fifteen years.
Treatment without drugs
Physiotherapeutic techniques are actively used in the phase of abating exacerbation in the treatment of osteoarthritis of the joints. Their course use gives good results when included in a complex therapeutic program. The following physiotherapeutic methods are used for arthrosis:
- Amplipulse. The treatment method acts locally on the joint using an alternating electric current. It relieves pain and acts as a vasodilator. The procedure improves tissue nutrition.
- UHF. The joint is exposed to ultra high frequency waves. The method reduces pain, relieves inflammation and swelling.
- Magnetotherapy. Articular structures are under the influence of a pulsed magnetic field. Improves blood flow. Cartilage is saturated with nutrients. The magnet removes decay products from the cells. Suppresses autoimmune reactions.
- Electrophoresis. This technique promotes the penetration of drugs into the affected joint, which is ensured by the effect of electric current on the tissue. During the treatment, the blood flow in the joint structures increases. The procedure reduces inflammation and swelling. Unpleasant sensations in the hand are alleviated. Muscle spasm is eliminated.
- Balneotherapy. Therapeutic baths with radon, physiological solution and other useful solutions are actively used for shoulder arthrosis. Blood flow improves, which improves nutrition and accelerates cell recovery. The inflammation subsides.
- Electrical stimulation. With this method of treatment, electrical stimulation of nerve trunks and muscles is performed using electrodes, which transmit a current that has certain parameters.
Therapeutic massage is performed after alleviating the exacerbation. It restores blood flow and increases the elasticity of ligaments. The muscle spasm in the joint is reduced. Range of motion increases. Exercise therapy is useful for arthrosis.
The gymnastic complex is performed when the pain subsides. During mechanotherapy for rehabilitation, special simulators are used. 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 in the treatment of shoulder arthrosis. The laser beam has a beneficial effect on the affected joint tissue. Devices that produce low-intensity infrared laser beams are used for therapy. Laser therapy is prescribed to speed up cellular metabolism.
All physical-chemical reactions are stimulated in the tissues. The functions of cartilage cells are activated. Laser treatment provides an analgesic effect. Blood flow improves and swelling is eliminated. Local immunity is strengthened. Reserve capillaries expand. Laser therapy has an anti-inflammatory effect.
To receive the procedures, you do not need to visit a medical facility all the time. Treatment of shoulder arthrosis at home is carried out with portable devices for laser therapy. Their regular use reduces pain. The function of the shoulder joint improves with laser treatment of arthrosis at home.
Prognosis and prevention
Shoulder arthrosis cannot be completely cured. But it is possible to slow down the progression of pathological joint changes. Working capacity is maintained with regular treatment. It is important to follow the doctor's recommendations.
It is necessary to prevent hand injuries. It is important to avoid excessive impact on the shoulder joint when performing professional duties, as well as during sports. It is necessary to timely treat diseases that contribute to the development of arthrosis.