Shoulder osteoarthritis

Shoulder osteoarthritisIt is chronica disease in which the tissue of the articular cartilage is destroyed and thinned, pathological changes in the soft tissues occur and bone growths are formed in the area of the joint. Manifested by pain and crunch in the affected area. In the later stages, the range of motion decreases. The pathology is chronic 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. When the joint is destroyed, arthroplasty is performed.

Main information

Osteoarthritis of the shoulder joint is a chronic disease in which, as a result of degenerative-dystrophic processes, the cartilage and other tissues of the joint are gradually destroyed. Osteoarthritis usually affects people aged 45 and over, but in some cases (after injury, inflammation) the disease can develop at a younger age. The pathology is equally common in women and men, it is more common in athletes and people engaged in heavy physical labor.

The reasons

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

• Developmental defects. The pathology can be detected in the underdevelopment of the head of the humerus or glenoid cavity, shoulder capamelia and other abnormalities of the upper limb.
• Traumatic injury.Osteoarthritis of traumatic etiology most often occurs after intra-articular fractures. A possible cause of the disease may be a dislocation of the shoulder, especially the usual one. Less often, severe bruises act as a provocative injury.
• Inflammatory processes.The disease can be diagnosed with long-term scapular periarthritis, previously suffering from nonspecific purulent arthritis and specific arthritis of the joint (with tuberculosis, syphilis and some other diseases).

Risk factors

Osteoarthritis is a polyetiological disease. There is a wide range of factors that increase the likelihood of this pathology:

• Hereditary predisposition.Many patients have close relatives who also suffer from osteoarthritis, including those from other locations (gonarthrosis, coxarthrosis, ankle osteoarthritis).
• Joint strain.It can occur in volleyball players, tennis players, basketball players, throwing sports equipment, as well as in people whose profession involves a constant high load on their hands (hammers, loaders).
• Other pathologies.Osteoarthritis is more common in patients suffering from autoimmune (rheumatoid arthritis), certain 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 adverse environmental conditions have a definite negative impact.

Pathogenesis

The main reason for the development of osteoarthritis of the shoulder joint is a change in the structure of the articular cartilage. The cartilage loses its smoothness and elasticity, sliding on the joint surfaces during movement becomes difficult. Microtraumas appear, which lead to further deterioration of the condition of the cartilage tissue. Small pieces of cartilage detach from the surface, forming loose joints, which also injure the inner surface of the joint.

Over time, the capsule and synovium thicken, and areas of fibrous degeneration appear in them. Due to thinning and reduced elasticity, the cartilage ceases to provide the necessary absorption of shocks, therefore the load on the underlying bone increases. The bone deforms and grows at the edges. The normal configuration of the joint is disturbed, there are restrictions in movement.

Classification

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

• The first- no gross changes in the cartilage tissue. The composition of the synovial fluid changes, the nutrition of the cartilage is disturbed. Cartilage does not tolerate stress, which occasionally causes joint pain (arthralgia).
• The second- cartilage tissue begins to thin, its structure changes, the surface loses its smoothness, cysts and areas of calcification appear in the depths of cartilage. The underlying bone is slightly deformed, bone growths appear on the edges of the joint platform. The pain becomes permanent.
• Third- marked thinning and destruction of the cartilage structure with extensive areas of destruction. The joint platform is deformed. Restricted range of motion, weakness of the ligament apparatus and atrophy of the periarticular muscles.

Symptoms

In the early stages, patients with osteoarthritis are concerned about discomfort or minor pain in the shoulder joint during exercise and certain body positions. Crunching may occur during movement. The joint does not change externally, there is no swelling. Then the intensity of pain increases, arthralgias become habitual, permanent, appear not only during exercise, but also at rest, including at night. Distinctive features of the pain syndrome:

• Many patients note the dependence of the pain syndrome on weather conditions.
• Along with the painful pain, over time there is acute pain during exercise.
• The pain may appear only in the shoulder joint, radiate to the elbow joint or spread throughout the arm. Possible back and neck pain on the affected side.

After some time, patients begin to notice noticeable morning stiffness in the joint. The range of motion decreases. Slight swelling of the soft tissues is possible after exercise or hypothermia. As the osteoarthritis progresses, movements become more limited, contractures develop, and limb function is severely impaired.

Diagnosis

The diagnosis is made by an orthopedic surgeon, taking into account the characteristic clinical and radiological signs of osteoarthritis of the shoulder joint. If you suspect secondary osteoarthritis, consult a surgeon, endocrinologist. At first the joint does not change, later it sometimes deforms or enlarges. On palpation, pain is determined. A traffic restriction may be detected. The following are recommended to confirm osteoarthritis:

• Radiography of the shoulder joint.Dystrophic changes and marginal bone growths (osteophytes) are found, in the later stages narrowing of the joint space, deformation and changes in the structure of the underlying bone are determined. The joint space may acquire a wedge shape, osteosclerotic changes and cystic formations can be seen in the bone.
• Tomographic examination.In suspicious cases, especially in the early 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 it is necessary to assess the condition of the soft tissues, magnetic resonance imaging is performed.

Differential diagnosis

The differential diagnosis of osteoarthritis is made with gouty, psoriatic, rheumatoid and reactive arthritis, as well as pyrophosphate arthropathy. In arthritis, a blood test shows signs of inflammation; the changes on the radiographs are not very pronounced, the osteophytes are absent, there are no signs of deformation of the joint surfaces.

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

Treatment of shoulder osteoarthritis

Patients are under the supervision of an orthopedic surgeon. It is necessary to limit the load on the arm, excluding sudden movements, lifting and prolonged carrying of weights. At the same time, it should be borne in mind that inaction also negatively affects the diseased joint. To keep the muscles in normal condition, as well as to restore the shoulder joint, you should regularly perform the therapeutic complex recommended by your doctor.

Conservative treatment

One of the most urgent tasks in osteoarthritis is the fight against pain. To eliminate pain and reduce inflammation, the following are prescribed:

• Medicines with general action.NSAIDs are prescribed in tablets during exacerbations. When used uncontrolled, they can irritate the stomach wall, have a negative effect on the condition of the liver and metabolism in the cartilage tissue, so they are taken only as directed by a doctor.
• Local remedies.NSAIDs are usually used in the form of gels and ointments. Self-administration is possible if symptoms occur or worsen. Less commonly, topical hormonal preparations are indicated, which should be administered in accordance with the doctor's recommendations.
• Hormones for intra-articular use.In case of severe pain syndrome, which cannot be eliminated by other methods, intra-articular administration of drugs (triamcinolone, hydrocortisone, etc. ) is performed. The blockades are carried out no more than 4 times a year.

To restore and strengthen the cartilage in stages 1 and 2 of osteoarthritis, agents from the group of chondroprotectors are used - drugs containing hyaluronic acid, chondroitin sulfate and glucosamine. The courses of treatment are long (from 6 months to a year or more), the effect becomes noticeable after 3 or more months.

Physiotherapeutic treatment

In osteoarthritis of the shoulder joint, massage, physiotherapy exercises and physiotherapy techniques are actively used. During the remission period, patients are referred for spa treatment. Attach:

• mud therapy and paraffin;
• healing baths;
• magnetic therapy and infrared laser therapy;
• ultrasound.

Surgery

In stage 3 of the disease, with significant destruction of cartilage, restriction of mobility and damage, joint replacement is performed. The recommendation 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 prostheses is 15 years or more.

Forecast

Osteoarthritis is a long-term, progressive disease. It cannot be completely cured, but it is possible to significantly slow down the development of pathological changes in the joint, to maintain efficiency and a high quality of life. To achieve the maximum effect, the patient must take his illness seriously and his desire to follow the doctor's recommendations, even during the period of remission.

Prevention

Preventive measures include reduction of domestic injuries, observance of safety at work, elimination of excessive loads on the shoulder joint when performing professional duties and sports. It is necessary to timely diagnose and treat pathologies that can provoke the development of arthritic changes.