One-third of all adults over sixty years of age report pain in the shoulder joint. The cause of pain in this area in most cases is the development of arthrosis. Young people whose profession is connected with constant heavy physical exertion are also sick - miner, builder, loader, 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 stage. There are now treatment methods that suppress the progression of the disease when therapy 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. Osteoarthritis of the shoulder is classified as a group of pathologies of a non-infectious nature. First, the cartilage tissue covering 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-absorbing properties. Its ability to reduce impact loads occurring during arm flexion or extension is impaired.
Osteoarthritis also affects all structures, such as the joint capsule, its shell, bone surfaces adjacent to 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, bone growths are formed on the joint surfaces.
The pathology is manifested by pain and crunching 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 it with this nature of the process is either absent or weakly expressed. The pathology has a chronic, gradually progressive course.
reasons
The cascade of pathological changes in osteoarthritis is triggered by the natural aging of tissues. Damage to cartilage as a result of severe mechanical stress can contribute to the initiation of cartilage destruction. This is also facilitated by various pathological processes.
Primary shoulder arthrosis 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 abnormalities. The pathology is often detected in patients with underdevelopment of the head of the humerus or the 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, most often usual. Sometimes strong bruises provoke the development of pathology.
- Inflammation. Osteoarthritis often occurs when the patient suffers from glenohumeral periarthritis for a long time. This is also facilitated by the previous 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. The knee, ankle and other joints are usually affected.
- Overvoltage. It is common in athletes involved 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 insufficiency, which is characterized by excessive mobility of the joints, 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 experience a feeling of discomfort and moderate pain in the shoulder area. There is a dependence of pain on time. They become more intense after physical activity. The pain intensifies with a certain position of the body. After resting or changing the position, the pain disappears.
When the patient moves his arm, a crunching sensation occurs. There are no external changes in the joint, no edema. Over time, the pain becomes more intense. 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 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 the following:
- along with the appearance of aching pain over time, acute pain occurs during physical activity;
- unpleasant sensations are registered only in the joint area, radiate to the elbow area, and then can spread over the entire surface of the arm;
- 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, as well as hypothermia, a slight swelling of the soft tissues in the shoulder area is detected.
As joint damage progresses, there is an increase in range of motion limitations. The patient develops a contracture (stiffness), which significantly impairs the functioning of the limb. If the arthrosis 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 the damage to the joint structures and the presence of certain symptoms of damage to the shoulder joint. Experts distinguish the following stages of the pathological process:
- First. The absence of gross structural changes in the thickness of the cartilage tissue is noted. The composition of the intra-articular fluid changes. Cartilage nutrition is impaired. He does not tolerate stress well, which leads to periodic pains.
- Second. At this stage, thinning of the cartilage tissue occurs. Its structure changes. The surface becomes rough. Cysts form in the thickness of the cartilage layer and foci of calcification appear. Areas of 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 noted. Extensive areas of cartilage destruction are identified. A significant deformation of the articular platform is established. Range of motion limitation is revealed. There is weakness of the ligaments, as well as reduction in size and laxity of the periarticular muscles.
This approach to classifying lesions of the shoulder joint allows doctors to choose an appropriate treatment tactic that takes into account the severity of the pathological process.
Diagnosis
The appearance of symptoms of arthrosis forces the patient to go to the doctor. He needs to see a therapist. The specialist will conduct an initial diagnosis. After establishing the cause of joint damage, he will refer the patient to a rheumatologist, endocrinologist, surgeon or orthopedic traumatologist.
Doctors make the diagnosis in the presence of characteristic clinical manifestations and X-ray signs of arthrosis. At 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 studied. The doctor detects deformation of the joint or its increase in volume. To confirm the presence of arthrosis, the following tests are recommended:
- Radiography. Dystrophic changes in the cartilage layer are found in the joint. On the edge of the joint cavity, characteristic bony outgrowths are established. At a later stage, they found that the joint space was narrowed. A change in the shape and structure of the bone adjacent to the cartilage is determined. The shape of the joint cleft becomes wedge-shaped. In the thickness of the bone, signs of thinning and the presence of cystic formations are visible.
- CT. This examination in the initial stages of the disease makes it possible to assess the state of bones and cartilage with the help of layer-by-layer images.
- Magnetic resonance. The method evaluates the condition of soft tissue formations (cartilage, ligaments, joint capsule, etc. ). Clear layer-by-layer images help determine the extent of damage to joint and peri-articular structures.
- Ultrasound. Changes in the joint are detected using ultrasound. The method is safe for the body, as 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. 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 ulcers, erosion and superficial cracks are found.
Making a diagnosis of 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 origin of joint pathology against the background of other diseases.
Treatment
Treatment of arthrosis is carried out by orthopedic traumatologists or rheumatologists. At the stage of recovery of motor functions, rehabilitators actively participate in the treatment process.
To relieve pain and restore function in arthrosis of the limb, it is important to get timely medical help and follow all the doctor's prescriptions. 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 dosed loading under the supervision of specialists, as complete inactivity has a negative impact on the affected limb. Treatment options include conservative therapy and surgical interventions. The choice of methods depends on the prevalence of certain symptoms and the stage of the disease.
Drug therapy
An important goal in the treatment of osteoarthritis is the elimination of 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 processes in the joint.
- Local remedies. In case of intensification of symptoms, gels and ointments containing non-steroidal anti-inflammatory compounds are used. Medicines containing hormones with local action are less often used. They relieve inflammation and swelling.
- Means for intra-articular injections. In case of persistent and severe pain, which cannot be removed in any other way, glucocorticoid drugs are injected into the joint. Blockades can be carried out 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 the therapy becomes noticeable only after three months of continuous use of the drug.
In addition, vasodilators are used for arthrosis of the shoulder. They increase blood flow and relieve 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 capacity, endoprosthetic surgery is performed. Age, level of physical activity and general health are taken into account before a decision is made to perform an intervention.
The installation of modern ceramic, plastic and metal endoprostheses completely restores the functioning of the joint. The devices have a guaranteed service life of more than fifteen years.
Non-drug treatment
Physiotherapy techniques are actively used in the attenuation phase of the exacerbation in the treatment of arthrosis of the joints. Their course use gives good results when it is included in a complex therapeutic program. The following physiotherapeutic methods are used for arthrosis:
- Amplipulse. The treatment method locally affects the joint using an alternating electric current. It relieves pain and has a vasodilating 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 with 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 provided 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 relieved. Muscle spasm is eliminated.
- Balneotherapy. Therapeutic baths with radon, saline and other useful solutions are actively used for shoulder arthrosis. Blood flow improves, which improves nutrition and accelerates cell regeneration. The inflammation is relieved.
- Electrical stimulation. With this method of treatment, electrical stimulation of the nerve trunks and muscles is carried out using electrodes that transmit current with certain parameters.
The therapeutic massage is performed after the aggravation has subsided. It restores blood flow and increases the elasticity of the ligaments. Muscle spasm in the joint decreases. Range of motion increases. Exercise therapy is useful for arthrosis.
The complex of gymnastics is performed when the pain subsides. When conducting mechanotherapy, special rehabilitation 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. To accelerate cellular metabolism, laser therapy is prescribed.
All physicochemical 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 dilate. Laser therapy has an anti-inflammatory effect.
To receive procedures, you do not need to constantly visit a medical facility. Treatment of arthrosis of the shoulder at home is carried out using portable laser therapy devices. With their regular use, the pain decreases. Shoulder joint function improves with laser treatment for osteoarthritis at home.
Prognosis and prevention
Shoulder arthrosis cannot be completely cured. But it is possible to slow down the progression of pathological joint changes. With regular treatment, the ability to work is preserved. It is important to follow the doctor's recommendations.
It is necessary to prevent injury to the hand. It is important to avoid excessive impact on the shoulder joint when performing professional duties, as well as during sports. It is necessary to promptly treat diseases that contribute to the development of arthrosis.