Shoulder osteoarthritis

Shoulder pain can appear gradually and significantly reduce the patient's quality of life. To find out why the shoulder hurts, you need to see a doctor and undergo a full examination. The most common cause of this pain is osteoarthritis of the shoulder.

The disease requires adequate long-term treatment, which can only be prescribed by an experienced specialist.

What it is?

Shoulder arthrosis is a long-term and constantly progressive metabolic-dystrophic disease, resulting in the gradual destruction of articular cartilage, the protective growth of bone tissue with joint deformity and the loss of its function.

A wide range of arm movements is provided by the synchronous interaction of the joints of the shoulder complex:

• humeroscapular or simply humeral;
• acromioclavicular - between the clavicle and the acromial process of the scapula;
• sternoclavicular - between the sternum and the collarbone.

The shoulder joint is very mobile, which is ensured by the convex head of the humerus and the relatively flat articular fossa of the scapula. The joint is strengthened by the tendons of the muscles of the upper limb, above it is the coracoid-acromial ligament. Not too reliable reinforcement allows the joint to move in different directions, but at the same time increases the risk of injury.

The International Classification of Diseases 10th Revision (ICD-10) code for shoulder osteoarthritis is M19 (other types of osteoarthritis). Treatment for shoulder osteoarthritis should begin as early as possible. But even advanced stages of the disease can be successfully treated.

Causes of shoulder osteoarthritis

The main causes of osteoarthritis of the shoulder:

• consequences of acute injuries - dislocations, subluxations, intra-articular fractures, bruises;
• permanent long-term microtrauma linked to the profession or sports loads;
• acute and chronic infectious-inflammatory and autoimmune processes transferred to the shoulder joint - acute purulent arthritis, chronic rheumatoid, psoriatic and other arthritis;
• against the background of a chronic inflammatory process in the periarticular tissues - humeroscapular periarthritis, leading to impaired blood circulation and nutrition of the cartilage tissue;
• metabolic (exchange) joint disorders - gouty arthritis;
• hormonal disorders;
• congenital malformations (dysplasia) - for example, the articular surfaces of the shoulder joints.

Under the influence of one of these reasons (sometimes several at once), the composition and volume of the joint fluid that supplies the cartilage tissue of the joint is disturbed. Cartilage gradually decreases in volume, cracks, loses its cushioning properties. This leads to bone damage, its growth along the edges of the articular surfaces, deformation of the joints and a decrease in function. In the joint cavity, inflammation of the synovial membrane periodically occurs - synovitis. Due to synovitis, arthrosis is called arthrosis or arthrosis - depending on which process prevails (inflammatory or metabolic-dystrophic). As a result of inflammation and necrosis of the bone, small pieces of tissue are separated from it - sequestra or joint mice.

At risk :

• for microtrauma - blacksmiths, miners, tennis players, weightlifters, discus throwers;
• for acute injuries - gymnasts, athletes, circus performers;
• hereditary dependents;
• people with chronic joint diseases.

Symptoms of osteoarthritis of the shoulder

The disease begins gradually, gradually. The rate of its progression depends on the cause, the general condition of the patient and his heredity.

First signs

The first symptoms of arthrosis of the shoulder joint may not be noticed, especially if they occur against the background of an existing shoulder disease. These are minor, occurring periodically, mainly after exertion, pain, discomfort when moving the joint. Pain in the left joint can be confused with heart pain. They pass quickly, but it is worth paying attention.

If such symptoms reappear, it is better to consult a doctor immediately, since any disease is easier to treat in the early stages.

Overt symptoms

The pain increases, after exertion does not disappear immediately. Night pains appear, as well as pains related to a change of weather. Hand movements become painful, they are accompanied by a characteristic crunch. In the morning or when you stay in a certain position for a long time, stiffness of movement appears, to remove it, you need to move. Pain syndrome can be localized not only in the shoulder area, but also radiate to the arm, neck and upper back.

Periodically, the joint swells, a slight reddening of the skin appears on it, the pain intensifies, it becomes permanent. Body temperature may rise slightly. This is a sign of synovitis - aseptic (without infection) inflammation of the synovial membrane. If there are foci of infection in the body (decayed teeth, diseases of ENT organs, etc. ), then it can enter the joint through blood and lymph vessels, causing a purulent-inflammatory process. In this case, high fever, headaches may appear, the general condition may be greatly disturbed.

The combination of degenerative-dystrophic and inflammatory processes in the joint gradually leads to permanent loss of limb function and constant pain.

But even such patients can be helped, you just need to go to the clinic.

Dangerous symptoms

There are a number of symptoms of arthrosis of the shoulder joint, signaling that you need to see a doctor urgently. This:

• the appearance of edema and redness of tissues in the joint area, fever;
• aching pain in the joint, accompanied by a change in shape;
• joint pain radiates to the arm, neck or back;
• the old volume of movements in the arm is impossible, even just lifting it causes severe pain.

These symptoms indicate that your body needs help. Only a doctor can provide it.

What is the danger of arthrosis of the shoulder

In the absence of medical care, brachial arthrosis is dangerous with a steady progression with the development of a permanent pain syndrome, a decrease in the function of the limbs and various complications, sometimes fatal.

Degrees of arthrosis of the shoulder joint

There are three degrees of arthrosis of the shoulder joint:

• Arthrosis of the shoulder joint 1 degree- initial stage. All symptoms appear mildly and mostly after exercise. On x-rays, a slight narrowing of the joint space is sometimes visible, but more often it is not. It is possible to detect small violations of the cartilage tissue at this stage only with the help of magnetic resonance imaging (MRI).
• Arthrosis of the shoulder joint 2 degrees- progressive stage. The shoulder constantly hurts, the pains are aggravated by movements of the arm, they give way (in the elbow, in the forearm, in the hand) or in the neck, back, under the shoulder blade. There are difficulties with the functioning of the limb, signs of synovitis periodically develop. On X-rays, the joint space is significantly narrowed, bone growths (osteophytes) are visible along the edges of the joint surfaces, the bone tissue is compacted (osteosclerosis).
• Arthrosis of the shoulder joint 3 degrees- advanced stage. The pain in the joint is sharp, constant, with a pronounced crunch when moving the arm. The range of motion is limited, sometimes the arm is completely immobile due to pain. The joint is deformed, which sometimes leads to pinching of nerves and blood vessels. On x-ray: joint space is almost invisible, large bony growths with joint deformity, severe sclerosis and necrosis of bone tissue, joint mice.

Possible complications

Any localization and form of arthrosis leads to serious complications, so you should not delay treatment.

If you do not treat the disease or do not treat it yourself with folk remedies, you risk developing such complications as:

• significant deformity and limitation of joint mobility;
• intra-articular dislocations, subluxations and fractures with minor injuries or sudden movements;
• ruptures of tendons surrounding the joint of muscles and ligaments - they atrophy and tear easily;
• aseptic necrosis of the humeral head with complete destruction of the joint and loss of function;
• purulent-septic complications when an infection enters the joint cavity from other foci.

What to do with an exacerbation

Exacerbations of the pathological process are usually associated with increased stress on the limb or the development of inflammation - synovitis. In this case, the joint hurts more, there is a slight swelling, the body temperature rises. In such cases, you should adhere to the following self-help algorithm:

• call a doctor at home;
• take a tablet of one of the painkillers inside;
• apply anesthetic ointment to the skin at the diseased joint;
• tying a sore arm with a bandage-scarf - this will reduce the load;
• take an elevated position - sit with a pillow under your back - this will reduce tissue swelling.

Types of shoulder osteoarthritis

According to various criteria, the disease is divided into separate types.

For reasons of illness

In accordance with this criterion, a distinction is made between primary and secondary osteoarthritis. Primary shoulder osteoarthritis is primarily the result of age-related changes and develops after age 50. But sometimes the disease begins at a young age, but the cause of its occurrence cannot be established. In this case, we speak of primary idiopathic osteoarthritis of the shoulder. An important role in its development is played by hereditary predisposition: the presence of a similar disease in one of the close relatives.

Secondary arthrosis of the shoulder joint develops after previous injuries and diseases, but hereditary burdened here too: in a person, even a minor injury or acute arthritis can lead to the development of arthrosis, while in another, greater damage ends without consequences.

According to the characteristics of the flow

Assign deforming arthrosis of the shoulder, characterized by a rapid progression of bone deformities. A feature of this type of disease is a change in the shape of the joint and a frequent violation of nearby blood vessels and nerves. Compression of blood vessels leads to impaired blood circulation and rapid progression of degenerative-dystrophic disorders, and compression of nerves leads to impaired sensitivity of the limb and severe pain along peripheral nerves.

Origin

Post-traumatic arthrosis of the shoulder - the symptoms and treatment of this disease have their own characteristics associated with traumatic damage to certain articular structures. Exchange dystrophic changes occur after intra-articular fractures, dislocations, subluxations, ruptures of ligaments, tendons and simply bruising. Injuries occur as a result of a blow to the joint or a fall to the side with an adducted arm. Rupture of the joint capsule with dislocation usually occurs during a fall on the abducted arm.

Often, after a minor injury, a person does not notice the first signs of arthrosis for a long time and consults a doctor at the second stage of the disease. Significant injuries require long-term rehabilitation treatment, and arthrosis, as a rule, begins to be treated in the early stages.

Arthrosis of the shoulder after suffering from inflammatory diseases - the symptoms and course of such a pathology depend on the underlying disease. The shoulder joint is often affected in psoriatic arthritis, while osteoarthritis develops in a joint, it grows slowly, but is difficult to treat. With rheumatoid arthritis, both shoulders are affected, arthrosis develops in waves with frequent alternation of metabolic-dystrophic and inflammatory processes.

Distribution

Only one left or right joint can be affected and this is called monoarthrosis. The simultaneous defeat of two shoulder-scapular joints (left and right) is called oligoarthrosis.

Osteoarthritis of other joints of the shoulder complex

Acromioclavicular arthrosis - most often has a post-traumatic origin. It develops against the background of lifting weights with hands above horizontal. Accompanied by pain when raising the arm. With the growth of osteophytes on the articular surfaces, impingement syndrome may appear - damage to the tendons and muscles of the shoulder between the head of the humerus and the acromion of the scapula when rotating andshoulder abduction. This accelerates the progression of osteoarthritis and the decline of hand function.

Diagnostic

Without a correct diagnosis, it is impossible to treat this disease. A full examination is possible only in the clinic. During the initial consultation, the doctor asks the patient, examines him, prescribes additional research methods and specialist consultations:

• Laboratory tests on blood, joint fluid - inflammatory, autoimmune and degenerative-dystrophic processes are detected.
• Instrumental:
  1. x-ray of the shoulder joint - changes in bone tissue are detected;
  2. computed tomography (CT) - changes in cartilage and bone tissue in the early stages;
  3. magnetic resonance imaging (MRI) - joint and periarticular soft tissue changes;
  4. diagnostic arthroscopy - performed if necessary to clarify the nature of the pathological process.

Treatment of osteoarthritis of the shoulder joint

After establishing the final diagnosis, complex conservative treatment of shoulder arthrosis is prescribed. If conservative treatment is ineffective, surgical treatment is prescribed.

Conservative therapy

It includes pharmacological and non-pharmacological methods.

Medical treatment

The goals of drug treatment are to eliminate pain and slow the progression of osteoarthritis. To alleviate the patient's condition, appoint:

1. Group drugsnonsteroidal anti-inflammatory drugs (NSAIDs). Drugs are administered intramuscularly, orally or rectally; at the same time, drugs from the group of NSAIDs are prescribed externally in the form of ointments, gels or creams.
2. Group drugsmuscle relaxants- relax the muscles surrounding the joint; the spastic state of these muscles increases the pain;
3. Blockages of painwith local anesthetics.The drug solution is injected into the joint cavity or into the periarticular tissues - a quick analgesic effect.

The course of pathogenetic therapy (influencing disease mechanisms) as part of the medical treatment of arthrosis of the shoulder includes:

1. Chondroprotectors- drugs containing in their composition biologically active substances that restore cartilage tissue. They are prescribed orally in the form of tablets and powders, in the form of intramuscular and intra-articular injections, as well as externally in the form of ointments and creams.
2. Angioprotectors- Means that improve blood microcirculation. Assign tablets for oral administration and solutions for intravenous infusion.
3. Hyaluronic acid preparations- are introduced into the joint cavity to improve the damping properties and prevent the destruction of bone tissue.

Vitamin-mineral complexes to improve metabolic processes in joint and periarticular tissues.

Non-drug treatment

The basis of non-drug methods of treating arthrosis of the shoulder is a healthy, active lifestyle and proper nutrition. It is very important to get rid of such bad habits as smoking and alcohol abuse - they contribute to circulatory disorders and have a toxic effect on joint tissues.

Food, diet

There is no special diet for the treatment of osteoarthritis of the shoulder, but good nutrition is very important in this disease. It is recommended to include in the daily diet: sea fish, seafood, lean poultry meat, dairy products, cottage cheese, cheese, cereals (oatmeal, buckwheat), vegetables, fruits.

Excluded from the diet: easily digestible carbohydrates (candies, muffins, sweet carbonated drinks), fatty red meat, foods that irritate tissues and cause swelling - salt (excessive amount), spicy and spicy seasonings.

It is recommended to give preference to boiled, stewed and steamed dishes.

Orthopedic treatment to distribute the load on the limb

To prevent shoulder injuries, it is recommended to periodically wear an elastic protective retainer in the form of a short sleeve that connects to the opposite arm. The device improves blood circulation, eliminates swelling. But constantly wearing it is not recommended, as it leads to a rapid decrease in the range of motion of the shoulder.

Many specialists include adhesive tape in the complex treatment of arthrosis of the shoulder - fixing the tissues with sticky elastic bands. This gives elimination of pain, improvement of blood circulation and joint function.

Physiotherapy

Exercise therapy - daily performance of a set of exercises - with arthrosis of the shoulder is the main method of rehabilitation. Gymnastics complexes are prescribed by a doctor, mastered under the supervision of an exercise therapy instructor. After the patient has begun to perform the set of exercises correctly, it can be done at home.

Physiotherapy

Physiotherapy is included in complex therapy at any stage of the disease. These are electro- and phonophoresis with the use of painkillers, laser and magnetotherapy - stimulation of regenerative processes in joint tissues, courses of shock wave therapy (SWT) - sound exposure, whichhas a pronounced chondroprotective effect.

Folk remedies

Folk remedies will be of great help only if prescribed by a doctor. Here are a few:

• Decoction of viburnum branches for oral administration.Pour a glass of crushed raw materials before bedtime with 500 ml of water, bring to a boil, keep on low heat for 5 minutes, insist all night, then strain and drink 100 ml 3 times a day. It's an anesthetic.
• An ancient anesthetic ointment recipe made from wild rosemary.Take Vaseline or butter and dry chopped grass. In an enameled dish, alternately fold the fat base and grass to the top in layers, close the dish with a lid, smear the cracks with dough and put in the oven (preferably in the oven) on a small fire for 2 hours, remove from the oven, strain through a double gauze, store in the refrigerator and rub the skin on the diseased joint 2-3 times a day.

Surgical operations

With the ineffectiveness of conservative treatment of shoulder arthrosis, the following surgical interventions are performed:

• Arthroscopic operationsallowing to eliminate various defects of the articular cavity. They are carried out mainly with young people suffering from post-traumatic osteoarthritis. Arthroscopy allows you to tighten and tie the biceps tendon to the bone (tenodesis - this will eliminate loosening of the joint), remove bone growths - osteophytes (debridement), restore the joint cavity witha transplant, etc.
• Stents- replacement of a destroyed joint, lost of its function by an artificial one.

Approach to the treatment of the disease in clinics

Specialist clinicians have developed their own approach to the treatment of shoulder osteoarthritis. First of all, each patient is carefully examined using the most modern diagnostic equipment (including MRI). Then he is completely relieved of pain using both drug and non-drug methods. At the same time, individual complex therapy is selected for him, including:

• the most modern drug and non-drug methods, including plasmolifting;
• traditional oriental methods of treatment and restoration of the function of the joints and the whole organism as a whole; these are acupuncture, moxibustion, auriculotherapy, taping, etc.

This approach quickly relieves a person of pain and suppresses the progression of the disease. And regular preventive courses allow patients to forget about the disease and lead a normal life. Many patient reviews speak about the effectiveness of this treatment.

Combination of proven techniques from the Orient and innovative methods from Western medicine.

General Clinical Guidelines

For people with shoulder osteoarthritis, it is recommended:

• lead a healthy and mobile life, alternating physical activity and rest;
• eat well regularly;
• get rid of all bad habits;
• regularly perform therapeutic exercises, avoiding sudden movements;
• sleep on your back or sound side at night, placing a small pillow under your sore arm;
• give up heavy physical exertion, avoid injuries, prolonged stress and colds;
• during an exacerbation (development of synovitis), avoid thermal intervention;
• follow all recommendations of the attending physician.

Prevention

It is especially important for people with aggravated heredity to follow certain rules for the prevention of arthrosis of the shoulder. They should not engage in weightlifting, tennis, traumatic sports, work as hammerers, blacksmiths, miners. Everyone who wants to have healthy joints should lead an active lifestyle and eat well regularly.

Frequently asked questions about the disease

1. What is the pain of osteoarthritis of the shoulder?

   The pains are aching, aggravated by movement and lifting weights.

2. Why is the disease dangerous?

   The formation of a permanent pain syndrome and loss of limb function.

3. Which doctor treats deforming osteoarthritis of the shoulder?

   Post-traumatic - an orthopedist-traumatologist, against the background of inflammatory diseases - a rheumatologist.

4. Is blocking done for shoulder osteoarthritis?

   For severe pain, yes.

5. How effective are physiotherapy methods for this disease?

   Effective as part of complex treatment.

6. Is it possible to completely cure deforming osteoarthritis of the shoulder?

   No, but the doctor can suppress its progression and save the patient from pain.

Shoulder arthrosis should be treated for a long time, systematically and strictly under the supervision of a doctor. Attempts to cope with this disease on their own are fraught with complications and disability. But a qualified specialist can stop the process at any stage of the disease, save the patient from pain and significantly improve his quality of life.