Osteoarthritis of the shoulder joint.

One third of people over sixty years of age suffer from 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: miners, builders, loaders, etc.

The disease causes great discomfort in daily life and drastically reduces work capacity. In severe cases, shoulder osteoarthritis causes disability. It is important to identify the disease in the initial stages. There are now treatment methods that inhibit disease progression when therapy is started in a timely manner.

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 that covers 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 qualities. Its ability to reduce impact loads that occur during flexion or extension of the arm is impaired.

Osteoarthritis also affects all structures, such as the joint capsule, its layer, bone 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, bone growths form on the articular surfaces.

The pathology is manifested by pain and crunching in the affected shoulder area. In the later stages of the disease, the range of motion of the shoulder joint is sharply reduced. Inflammation in it with this nature of the process is absent or weakly expressed. The pathology has a chronic and gradually progressive course.

Causes

The cascade of pathological changes in osteoarthritis is triggered by the natural aging of tissues. Damage to cartilage as a result of 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 usually diagnosed in older people. Secondary joint damage develops against the background of previous diseases. It happens at any age. The main causes of the disease are considered:

1. Developmental anomalies. Pathology is often found in patients with underdevelopment of the humeral head or glenoid cavity, as well as with the presence of other defects of the upper extremity.
2. Injuries. Traumatic osteoarthritis often develops after intra-articular fractures. Sometimes the cause of the pathology is a dislocation of the shoulder, more often usual. Occasionally, severe bruising provokes the development of pathology.
3. Inflammation. Osteoarthritis usually occurs when a patient suffers from glenohumeral periarthritis for a long period of time. This is also facilitated by previously suffered nonspecific purulent arthritis, as well as specific joint lesions that arise due to tuberculosis, syphilis and other diseases.

There is a group of risk factors that contribute to the appearance of said polyetiological disease. The following phenomena increase the likelihood of developing osteoarthritis:

• Genetic predisposition. Close relatives of many patients also suffer from osteoarthritis. They also have injuries with other locations. Typically the knee, ankle and other joints are affected.
• Surge. It often occurs in athletes who play volleyball, tennis, basketball, and throw sports teams. This condition also occurs in people if their profession is characterized by constant high load on the upper extremities (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 cartilage degenerative processes.

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

Symptoms

At the beginning of the disease, patients with osteoarthritis experience a feeling of 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 positions, the pain goes away.

When the patient moves his hand, a crunching sensation occurs. There are no external changes in the joint, nor swelling. Over time, the pain becomes more intense. Constantly bothers the patient, regardless of body position. The pain has a pulling or aching character.

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

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

Before long, the patient is bothered by morning stiffness in the shoulder. The range of active movements in the joint decreases. After physical activity, in addition to hypothermia, slight swelling of the soft tissues in the shoulder area is detected.

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

Stages of development

With this disease, three stages of the pathological process in the joint are distinguished. They reflect the severity of 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:

1. First. The absence of important structural changes in the thickness of the cartilaginous tissue is observed. The composition of the intra-articular fluid changes. The nutrition of the cartilage is altered. He does not tolerate stress well, which causes periodic pain.
2. Second. At this stage, a thinning of the cartilage tissue occurs. Its structure is changing. The surface becomes rough. Cysts form in the thickness of the cartilaginous layer and foci of calcification appear. The areas of bone adjacent to the joint are moderately deformed. The edges of the articular platform are covered with bone growths. The discomfort becomes constant.
3. Third. A pronounced degree of thinning of the cartilaginous layer and alteration of its structure is observed. Extensive areas of cartilage destruction are identified. A significant deformation of the articular platform is found. Limited range of motion is revealed. There is weakness of the ligaments, as well as decreased 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.

Diagnosis

The appearance of osteoarthritis symptoms forces the patient to go to the doctor. You need to see a therapist. The specialist will make an initial diagnosis. After determining the cause of the joint damage, he or she will refer the patient to a rheumatologist, endocrinologist, surgeon, or orthopedist-traumatologist.

Doctors make the diagnosis in the presence of typical clinical manifestations and radiological signs of osteoarthritis. During the initial examination, the joint tissues 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 a deformation of the joint or its increase in volume. To confirm the presence of osteoarthritis, the following studies are recommended:

1. Bone scan. In the joint, the presence of dystrophic changes in the cartilaginous layer is detected. Along the edge of the joint cavity, characteristic bone growths are identified. At a later stage, they discover that the joint space narrows. A change in the shape and structure of the bone adjacent to the cartilage is determined. The shape of the joint space becomes wedge-shaped. In the thickness of the bone, signs of rarefaction and the presence of cyst-like formations are seen.
2. computed tomography. This study in the initial stages of the disease provides the opportunity to evaluate the state of bone and cartilage using layer-by-layer imaging.
3. MRI image. The method evaluates 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. Ultrasonography. Changes in the joint are detected using ultrasound. The method is safe for the body, as it does not produce harmful radiation.
5. Arthroscopy. It is done using an endoscope. A manipulator with a camera is inserted into the joint. The doctor clearly sees the damaged areas. The softening zones in the thickness of the cartilage are determined. It reveals the presence of deep cracks that penetrate deep into the subchondral (subchondral) plate of the bone. Deep cartilage ulcerations, erosion and superficial cracks are detected.

Making a diagnosis of osteoarthritis 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 osteoarthritis is carried out by orthopedic traumatologists or rheumatologists. At the stage of restoration of motor functions, rehabilitation specialists are actively involved in the treatment process.

To relieve pain and restore function in the case of osteoarthritis of the extremity, it is important to receive immediate medical attention and follow all doctor's orders. It is necessary to limit the load on the joint and avoid sudden hand movements. 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 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 medications are prescribed:

1. Preparations for general anesthesia.. Non-steroidal drugs are prescribed to patients for a short course during an exacerbation. With prolonged and uncontrolled use, they irritate the gastric mucosa and slow down the joint recovery process.
2. Local remedies. When symptoms increase, gels and ointments containing non-steroidal anti-inflammatory compounds are used. Drugs containing hormones and local action are used less frequently. They relieve inflammation and swelling.
3. Means for intra-articular injections.. For persistent and severe pain that cannot be eliminated by other means, glucocorticoids are injected into the joint. Blockings cannot be carried out 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 therapy becomes noticeable only after three months of continuous use of the drug.

Additionally, vasodilators are used for osteoarthritis 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 osteoarthritis, when there is significant destruction of the joint with limited mobility and loss of the ability to work, endoprosthetic surgery is performed. Before deciding whether to carry out an intervention, age, level of physical activity and general health are taken into account.

Installation of modern ceramic, plastic and metal endoprostheses completely restores the function of the joint. The devices have a guaranteed useful life of more than fifteen years.

Non-pharmacological treatment

Physiotherapeutic techniques are actively used in the phase of de-escalation of the exacerbation in the treatment of joint osteoarthritis. Its ongoing use gives good results when included in a complex therapy program. For osteoarthritis, the following physiotherapy methods are used:

1. Amplipulse. The treatment method affects the joint locally using alternating electrical current. It relieves pain and has a vasodilating effect. The procedure improves tissue nutrition.
2. ultrahigh frequency. 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. Improves blood flow. Cartilage is saturated with nutrients. The magnet removes decomposition products from the cells. Suppresses autoimmune reactions.
4. Electrophoresis. This technique favors the penetration of drugs into the affected joint, which is guaranteed by the effect of the electric current on the tissue. During treatment, blood flow in the joint structures increases. The procedure reduces inflammation and swelling. Unpleasant sensations in the hand are relieved. Muscle spasm is eliminated.
5. Balneotherapy. Therapeutic baths with radon, saline and other beneficial solutions are actively used for osteoarthritis of the shoulder. Improves blood flow, which improves nutrition and accelerates cellular recovery. Inflammation is relieved.
6. electrical stimulation. With this method of treatment, electrical stimulation of the nerve trunks and muscles is carried out using electrodes, which transmit a current that has certain parameters.

Therapeutic massage is performed once the exacerbation is relieved. Restores blood flow and increases the elasticity of ligaments. Muscle spasm in the joint is reduced. The range of movements increases. For osteoarthritis, exercise therapy is helpful.

The gymnastics complex is performed when the pain subsides. When carrying out mechanotherapy, special simulators are used for rehabilitation. Active-passive movements are carried out 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 osteoarthritis. The laser beam has a beneficial effect on the affected joint tissue. Devices that produce low-intensity infrared laser rays are used for therapy. Laser therapy is prescribed to accelerate cellular metabolism.

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 improved. Reserve capillaries expand. Laser therapy has an anti-inflammatory effect.

To receive procedures, it is not necessary to constantly visit a medical center. Treatment of shoulder osteoarthritis at home is performed using portable laser therapy devices. With regular use, the pain decreases. Shoulder joint function 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 hand injuries. It is important to avoid excessive impact on the shoulder joint when performing professional tasks, as well as during sports. It is necessary to quickly treat diseases that contribute to the development of osteoarthritis.