Osteoarthritis of the shoulder joint is a dystrophic lesion of the cartilage plate covering the articular surfaces of the joint, which later covers the main bone.
About the disease
Not only the cartilage layer and subchondral bone are affected by this disease. The pathological process gradually involves the articular capsule and ligamentous apparatus, synovium, muscle-tendon section, as well as the subacromial region.
At a certain stage, arthrosis of the shoulder joint can lead to the development of arthrosis. This condition is characterized by the following symptoms: chronic pain, reduced range of motion in the joint, intra-articular crisis during rotation. Often, people over 40 years of age undergo this transformation.
The main symptoms of arthrosis of the shoulder joint are pain and limited mobility of the arm. To verify the diagnosis, imaging examination methods are informative - ultrasound and X-ray scanning, computed tomography and magnetic resonance imaging.
According to clinical recommendations, the initial stages of the disease are treated with conservative methods, and in the later stages, when the cartilage layer is seriously damaged and the patient's self-care ability is impaired, joint replacement is indicated.
Types of arthrosis of the shoulder joint
According to the classification, the following types of arthrosis of the shoulder joint are distinguished:
- primary arthrosis, in the development of which genetics plays a major role, and even the most comprehensive examination does not allow to determine the most important cause of the disease;
- secondary arthrosis resulting from adverse factors (trauma, endocrine diseases, disturbed joint anatomy) in the joint.
Doctors evaluate the rate of development of the pathological process according to the degree of the disease. The more aggressive the process, the faster the destruction of the articular cartilage and capture of the underlying bone. From the morphological point of view, there are 6 degrees of arthrosis of the shoulder joint:
- first degree - the cartilage matrix swells and breaks down, but the integrity of the surface zone of the cartilage is not yet broken;
- second degree – cells of the cartilage tissue located in deep layers are affected, the surface plate of the cartilage is damaged;
- third degree - vertical cracks appear on the cartilage plate;
- fourth degree - the surface zone of the cartilaginous plate is gradually eroded, erosive defects are formed, and cystic cavities appear in the main bone;
- fifth degree - at this stage, the main bone is exposed;
- sixth grade - the subchondral zone is significantly thickened, cysts are more visible and marginal bone growths are visible.
Symptoms of arthrosis of the shoulder joint
The main clinical symptoms of arthrosis of the shoulder are pain, stiffness up to complete loss of mobility in the joint, and deformation of the joint.
Distinctive features of pain with deforming arthrosis are:
- appearance at the beginning of flexion, extension or rotation;
- increases during physical activity;
- nocturnal character due to stagnation of venous blood in intraosseous channels;
- the presence of blockages - a sudden blockage in the joint due to the detachment of separated osteochondral fragments that enter between the joint surfaces;
- weather dependence - the pain intensifies when the weather changes (the pain is stronger in humid and cold climates).
Arthrosis is a chronic pathology. In the initial stage of the disease, pain appears periodically (during exacerbation of the disease). The speed of development of the pathology is determined by the timely initiation of treatment and the adequacy of lifestyle changes. Shoulder pain is chronic if it lasts for 6 months or more. The transition from acute to chronic pain indicates the development of the pathological process.
Causes of arthrosis of the shoulder joint
The causes of arthrosis of the shoulder joint are divided into 2 groups:
- changeable - correction is possible;
- cannot be changed - it is impossible to influence their activity.
Non-modifiable factors that can increase the risk of developing arthrosis changes in the shoulder joint include:
- gender - up to the age of 50, women are less susceptible to the disease than men, after about 50 years, the prevalence of pathology among representatives of both sexes is approximately the same;
- the age of the person - the older the patient, the higher the risks (and from the age of about 30, the degeneration process in the cartilage tissue goes faster than the regeneration process that creates the initial conditions for the development of the disease);
- congenital abnormalities of the shoulder structure - excessive mobility (hypermobility), connective tissue dysplasia (normally, articular cartilage is represented by type 2 collagen fibers, replaced by dysplasia, less durable types of collagen), instability of articulation;
- genetic characteristics - an inherited predominance of type 2 collagen, polymorphism of interleukin-1 and interleukin-2 genes.
Modifiable risk factors for osteoarthritis of the right or left shoulder joint include:
- traumatic joint injury;
- excessive physical activity (strength sports and martial arts, including barbell bench press);
- obesity - an important factor for shoulder arthrosis is not an increase in mechanical load, but metabolic changes occurring in the connective tissue, including. chronic inflammatory condition accompanied by obesity;
- weakness of the muscle corset of the shoulder joint, especially in people who make precise movements with their hands (jewelers, dentists, secretaries, writers);
- lack of vitamin D, which actively participates in the protection of the health of the musculoskeletal system;
- a diet low in vitamin C, an important link in the body's calcium-phosphorus metabolism;
- hormonal imbalance - thyroid disease, diabetes, etc. ;
- smoking - both active and passive.
The main targets of the pathological process in shoulder arthrosis are articular cartilage, subchondral bone and synovium. In the affected cartilage, the synthesis of proteoglycans decreases, the plate splits and cracks, exposing the underlying bone. An increase in the non-physiological load on the bone causes its compression, the appearance of cysts and osteophytes (marginal growths).
Diagnostics
Examination of a patient with pain in the shoulder joint should begin with X-rays. It is important to scan in several projections to examine the joint in detail. Images can be captured in direct projection, internal and external rotation. Ultrasound examination of the joint is the most informative to evaluate the formation of soft tissues of the joint, especially in the early stage of arthrosis. If the diagnosis is unclear, magnetic resonance imaging/computed tomography of the joint is recommended. At the next stage, preservation of articulation functions is evaluated.
Expert opinion
All morphological formations of the joint are involved in the pathological process. The main symptom of osteoarthritis is not only synovitis, but also pain in the joint area caused by bone damage (osteitis, periostitis), involvement of periarticular soft tissues (tendinitis, tenosynovitis, myalgia, enthesopathies, stretching of the joint capsule). , degeneration of the meniscus and involvement of the neurosensory system (for example, irritation of nerve trunks by large osteophytes). Therefore, the sooner the treatment begins, including. lifestyle changes will be more effective in controlling the occurrence of pain.
Treatment
At the initial stage of the pathological process, the treatment of arthrosis of the shoulder joint is carried out using conservative methods, and with severe degeneration of the articular cartilages, surgical intervention (endoprosthetic) is indicated.
Conservative treatment
In the period of exacerbation of the process, the first thing is to eliminate pain. Nonsteroidal anti-inflammatory drugs are most often used to relieve pain. They can be applied locally (in the form of creams and ointments), injected into the joint cavity or used systemically (tablets, intramuscular injection). In some patients, the pain may be so severe that a short course of corticosteroid medication may be used to relieve it.
Intra-articular injection of hyaluronic acid or plasma, including. enriched with platelets, can have a stimulating effect on the cartilage plate and promote its renewal (this treatment is considered pathogenetic). These injections help to accelerate the synthesis of collagen and elastin fibers, which are the basis of cartilage. As a result, the structure of the cartilage layer and synovial membrane improves, which helps to improve the compatibility of the articular surfaces. These intra-articular injections help to optimize the production of synovial fluid, which not only absorbs shock and moisturizes cartilage, but also improves metabolic processes in chondrocytes, increasing their internal potential.
After the acute process stops, physiotherapeutic rehabilitation methods (impulse currents, ultrasound and laser treatment) can be used as part of complex treatment. These procedures have a complex positive effect on joint structures.
Surgery
The operation is indicated for significant destruction of the cartilage plate, which is accompanied by constant pain and dysfunction of the joint, leading to the inability to take care of oneself and perform professional duties. A modern method of surgical intervention for shoulder arthrosis is the implantation of an endoprosthesis. At SM-Clinic, the operation is performed with strict adherence to the methodology using the latest generation endoprostheses. This is the key to achieving the best therapeutic results.
Prevention of arthrosis of the shoulder joint
Primary prevention of arthrosis of the shoulder joint is aimed at maintaining optimal metabolism in the osteochondral unit. It is recommended for:
- maintain normal body weight;
- adequately compensate for endocrine disorders in the body (endocrinologist consultation and dynamic monitoring are required);
- strengthen the muscle corset of the shoulder girdle in dosage;
- If your professional activity involves performing similar movements on the shoulder, warm up regularly.
The following recommendations are important to prevent the development of advanced shoulder arthrosis:
- Avoid lifting heavy objects, incl. barbell push-ups;
- conducting repeated therapeutic massage courses;
- regularly doing rehabilitative gymnastics (under the supervision of a physical therapist).
Rehabilitation
After endoprosthetics, a cast is applied, which ensures the necessary degree of immobilization. After the plaster is removed, the period of restoring the functional activity of the joint begins. For this, therapeutic massage, physiotherapy and rehabilitation gymnastics courses are recommended under the supervision of a physical therapist.
Questions and answers
Which doctor treats arthrosis of the shoulder joint?
Diagnosis and treatment of the disease is carried out by a traumatologist-orthopedic.
Representatives of which professions are more likely to develop arthrosis of the shoulder joint?
Athletes involved in volleyball, tennis, basketball, shot putters and loaders are at risk of degenerative-dystrophic destruction of the cartilage layer of the shoulder joint.
Does shoulder pain indicate the development of arthrosis?
Indeed, pain is the leading symptom of arthrosis. However, pain can also be a manifestation of other diseases - adhesive capsulitis, osteoarthritis, damage to the rotator cuff muscles, etc. A qualified orthopedic traumatologist will help to make the correct diagnosis and choose the treatment.