Osteoarthritis of the shoulder joint

Osteoarthritis of the shoulder joint (Deforming osteoarthritis of the shoulder joint, Deforming osteoarthritis of the shoulder joint, Osteoarthritis of the shoulder joint)

Osteoarthritis of the shoulder joint is a chronic disease in which the articular cartilage tissue is destroyed and thinned, pathological changes in soft tissues occur, bone growths form in the joint area. It is manifested by pain and crunching in the affected area. In the later stages, the volume of movements decreases. The pathology proceeds chronically and gradually progresses. The diagnosis is made taking into account the clinical picture and radiological signs. Treatment is usually conservative: physiotherapy, anti-inflammatory drugs, chondroprotectors, exercise therapy. When the joint is destroyed, an endoprosthesis is performed.

General information
Osteoarthritis of the shoulder joint is a chronic disease in which, as a result of degenerative–dystrophic processes, cartilage and other joint tissues are gradually destroyed. Usually arthrosis affects people 45 years and older, but in some cases (after injury, inflammation), the disease may develop at a younger age. Pathology occurs equally often in women and men, it is more often observed in athletes and in people engaged in heavy physical labor.

Reasons
The starting point of changes in osteoarthritis of the shoulder joint can be both the normal aging process of tissues, and damage or disruption of the cartilage structure as a result of mechanical influences and various pathological processes. Primary arthrosis is usually detected in the elderly, secondary (developed against the background of other diseases) can occur at any age. The main reasons are:

Malformations of development. Pathology can be detected with underdevelopment of the head of the humerus or articular cavity, capomelia of the shoulder and other anomalies of the upper limb.
Traumatic injuries. Arthrosis of traumatic etiology most often occurs after intra-articular fractures. A possible cause of the disease may be dislocation of the shoulder, especially the usual one. Less often, severe bruises act as a provoking injury.
Inflammatory processes. The disease can be diagnosed with long-term shoulder periarthritis, previously transferred nonspecific purulent arthritis and specific joint arthritis (tuberculosis, syphilis and some other diseases).
Risk factors
Arthrosis is a polyethological disease. There is an extensive group of factors that increase the likelihood of this pathology:

Hereditary predisposition. Many patients have close relatives who also suffer from arthrosis, including other localizations (gonarthrosis, coxarthrosis, arthrosis of the ankle joint).
Overstrain of the joint. It can occur in volleyball players, tennis players, basketball players, throwers of sports equipment, as well as in people whose profession implies a constant high load on their hands (hammers, movers).
Other pathologies. Arthrosis is more often detected in patients suffering from autoimmune (rheumatoid arthritis), some endocrine diseases and metabolic disorders, systemic connective tissue insufficiency and excessive joint mobility.
The likelihood of developing the disease increases dramatically with age. Frequent hypothermia and unfavorable environmental conditions have a certain negative impact.

Pathogenesis
The main reason for the development of osteoarthritis of the shoulder joint is a change in the structure of articular cartilage. The cartilage loses its smoothness and elasticity, the sliding of articular surfaces becomes difficult during movements. Microtrauma occurs, which leads to further deterioration of the cartilage tissue. Small pieces of cartilage “come off” from the surface, forming free-lying articular bodies, which also injure the inner surface of the joint.

Over time, the capsule and synovial membrane thicken, areas of fibrous degeneration appear in them. Due to thinning and decreased elasticity, the cartilage ceases to provide the necessary cushioning, so the load on the underlying bone increases. The bone is deformed and grows at the edges. The normal configuration of the joint is disrupted, there are restrictions on movement.

Classification
In traumatology and orthopedics, a three-stage systematization is usually used, reflecting the severity of pathological changes and symptoms of arthrosis of the shoulder joint. This approach allows you to choose the optimal medical tactics, taking into account the severity of the process. There are the following stages:

The first is that there are no gross changes in cartilage tissue. The composition of the synovial fluid is changed, the cartilage nutrition is disrupted. Cartilage does not tolerate loads well, so from time to time there is pain in the joint (arthralgia).
The second is that the cartilage tissue begins to thin, its structure changes, the surface loses its smoothness, cysts and calcification areas appear in the depth of the cartilage. The underlying bone is slightly deformed, bone growths appear along the edges of the articular area. The pain becomes permanent.
The third is marked thinning and disruption of the cartilage structure with extensive areas of destruction. The joint pad is deformed. There is a limitation of the volume of movements, weakness of the ligamentous apparatus and atrophy of the periarticular muscles.
Symptoms
In the early stages, patients with arthrosis are concerned about discomfort or minor pain in the shoulder joint during exertion and certain body positions. Crunching may occur during movements. The joint is not externally changed, there is no swelling. Then the intensity of pain increases, arthralgias become habitual, permanent, appear not only in exercise, but also at rest, including at night. Distinctive features of pain syndrome:

Many patients note the dependence of pain syndrome on weather conditions.
Along with the aching pain, over time, there is a sharp soreness during physical exertion.
Pain can occur only in the shoulder joint, radiate into the elbow joint or spread throughout the arm. Possible back and neck pain on the affected side.
After a while, patients begin to notice noticeable morning stiffness in the joint. The volume of movements decreases. After exertion or hypothermia, slight swelling of soft tissues is possible. With the progression of arthrosis, movements are increasingly limited, contractures develop, and limb function is seriously impaired.

Diagnostics
The diagnosis is made by an orthopedic surgeon taking into account the characteristic clinical and radiological signs of arthrosis of the shoulder joint. If secondary arthrosis is suspected, consultations with a surgeon, an endocrinologist are prescribed. The joint is not changed at first, and later it is sometimes deformed or enlarged in volume. When palpation is determined by soreness. Movement restriction may be detected. To confirm arthrosis , the following are recommended:

Radiography of the shoulder joint. Dystrophic changes and marginal bone growths (osteophytes) are detected, in the later stages, narrowing of the articular gap, deformation and change in the structure of the underlying bone are determined. The articular gap can acquire a wedge-shaped shape, osteosclerotic changes and cyst-like formations are visible in the bone.
Tomographic studies. In doubtful cases, especially in the initial stages of the disease, a CT scan of the shoulder joint is performed to obtain additional data on the condition of the bone and cartilage. If necessary, magnetic resonance imaging is performed to assess the condition of soft tissues.
Differential diagnosis
Differential diagnosis of arthrosis is performed with gouty, psoriatic, rheumatoid and reactive arthritis, as well as with pyrophosphate arthropathy. With arthritis, signs of inflammation are detected in the blood test; changes in the radiographs are not pronounced, osteophytes are absent, there are no signs of deformation of the articular surfaces.

With psoriatic arthritis, along with articular manifestations, rashes on the skin are often found. In rheumatoid arthritis, a positive rheumatoid factor is determined. With pyrophosphate arthropathy and gouty arthritis, corresponding changes are detected in the biochemical analysis of blood (an increase in the level of uric acid salts, etc.).

Radiography of shoulder joints. Pronounced narrowing of the articular gap (green arrows), compaction of the closing articular surfaces, moderate osteophytosis (red arrows) on both sides Degenerative changes of the acromioclavicular joint
Radiography of shoulder joints. Pronounced narrowing of the articular gap (green arrows), compaction of the closing articular surfaces, moderate osteophytosis (red arrows) on both sides Degenerative changes of the acromioclavicular joint
Treatment of arthrosis of the shoulder joint
Patients are under the supervision of an orthopedic doctor. It is necessary to limit the load on the arm, eliminating sudden movements, lifting and long-term carrying of weights. At the same time, it should be borne in mind that inaction also negatively affects the diseased joint. To maintain the muscles in a normal state, as well as to restore the shoulder joint, it is necessary to regularly perform the exercise therapy complex recommended by the doctor.

Conservative treatment
One of the most urgent tasks in arthrosis is the fight against pain syndrome. To eliminate pain and reduce inflammation , prescribe:

Drugs of general action. NSAIDs are prescribed in tablets during the period of exacerbation. With uncontrolled use, they can irritate the stomach wall, have a negative effect on the condition of the liver and metabolism in cartilage tissue, therefore they are taken only as prescribed by a doctor.
Means of local action. NSAIDs are usually used in the form of gels and ointments. It is possible to use it independently when symptoms occur or increase. Less often, hormone-containing topical preparations are indicated, which should be applied in accordance with the doctor’s recommendations.
Hormones for intra-articular administration. With severe pain syndrome, which is not eliminated by other methods, intra-articular administration of drugs (triamcinolone, hydrocortisone, etc.) is performed. Blockades are carried out no more than 4 times a year.
To restore and strengthen cartilage at stages 1 and 2 of arthrosis, agents from the group of chondroprotectors are used – preparations containing hyaluronic acid, chondroitin sulfate and glucosamine. The treatment courses are long (from 6 months to a year or more), the effect becomes noticeable after 3 or more months.

Physiotherapy treatment
With arthrosis of the shoulder joint, massage, physical therapy and physiotherapy techniques are actively used. During the period of remission, patients are referred for sanatorium treatment. Apply:

mud treatment and paraffin;
therapeutic baths;
magnetotherapy and infrared laser therapy;
ultrasound.
Surgical treatment
At stage 3 of the disease, with significant destruction of cartilage, limited mobility and disability, joint replacement is performed. Referral for surgery is given taking into account the age of the patient, the level of his activity, the presence of severe chronic diseases. The use of modern ceramic, plastic and metal endoprostheses allows you to fully restore the function of the joint. The service life of the prostheses is 15 years or more.

Forecast
Arthrosis is a long–term, gradually progressive disease. It cannot be completely cured, but it is possible to significantly slow down the development of pathological changes in the joint, maintain working capacity and high quality of life. To achieve maximum effect, it is necessary to take the patient seriously to his illness and his willingness to follow the doctor’s recommendations even during remissions.

Prevention
Preventive measures provide for the reduction of domestic injuries, compliance with safety regulations at work, the exclusion of excessive loads on the shoulder joint when performing professional duties and sports. It is necessary to diagnose and treat pathologies that can provoke the development of arthrotic changes in a timely manner.

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