Osteoarthritis of the shoulder joint is a dystrophic damage to the cartilage plate covering the articular surfaces of the joint, with subsequent involvement of the underlying bone.
About the disease
In this disease, not only the cartilage layer and the subchondral bone are affected. The pathological process gradually covers the joint capsule and ligament apparatus, the synovium, the muscle-tendon department, as well as the subacromial region.
Arthrosis of the shoulder joint at a certain stage 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 crunching during rotation. People over 40 are most often subjected to this transformation.
The main symptoms of arthrosis of the shoulder joint are pain and limited mobility of the arm. To verify the diagnosis, imaging methods are informative - ultrasound and X-ray scanning, computer tomography and nuclear magnetic resonance.
In accordance with clinical recommendations, the treatment of the disease in the initial stages is carried out using conservative methods, and in the later stages, when there is significant damage to the cartilage layer and the patient's self-care 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 big role and even the most thorough research does not allow us to identify the most important cause of the disease;
- secondary arthrosis, which is a consequence of the action of adverse factors on the joint (trauma, endocrine diseases, disturbed anatomy of the joint).
Doctors judge the rate of progression of the pathological process by the degree of the disease. The more aggressive the process, the faster the destruction of the articular cartilage and the involvement of the underlying bone. From a morphological point of view, there are 6 degrees of arthrosis of the shoulder joint:
- first degree - the cartilage matrix swells and disintegrates, but the integrity of the surface area of the cartilage is still not disturbed;
- second degree - the cells of the cartilage tissue located in the 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 area of the cartilage plate is gradually exfoliated, erosive defects are formed and cystic cavities appear in the underlying bone;
- fifth degree - at this stage the underlying bone is exposed;
- sixth degree - the subchondral zone thickens significantly, the cysts become more pronounced and marginal bone growths appear.
Symptoms of arthrosis of the shoulder joint
The main clinical signs of shoulder arthrosis are pain, stiffness in the joint up to complete loss of mobility, as well as deformation of the joint.
Distinctive features of pain in deforming arthrosis are:
- onset of flexion, extension, or rotation;
- increased during physical activity;
- nocturnal character due to stagnation of venous blood in intraosseous channels;
- presence of blockages - sudden jamming in the joint due to detachment of separated osteochondral fragments falling between the joint surfaces;
- weather dependence - the pain intensifies when the weather changes (in a humid and cold climate, the pain becomes more intense).
Arthrosis is a chronic pathology. In the initial stage of the disease, pain appears periodically (during exacerbation of the disease). The speed of progression of the pathology is determined by the timeliness of the start of treatment and the adequacy of lifestyle changes. Shoulder pain becomes chronic if it lasts 6 months or more. The transition from acute to chronic pain indicates the progression of the pathological process.
Causes of arthrosis of the shoulder joint
The causes of arthrosis of the shoulder joint are classified into 2 groups:
- modifiable – correction is possible;
- unmodifiable – it is not possible to influence their action.
Non-modifiable factors that can increase the risk of developing arthrotic changes in the shoulder joint include:
- gender - up to the age of 50, women are less susceptible to the disease than men; after approximately 50 years, the prevalence of pathology among representatives of both sexes becomes approximately the same;
- the age of the person - the older the patient is, the higher the risks (and from the age of about 30 in the cartilage tissue, the degeneration process proceeds faster than the regeneration process, which creates prerequisites for the development of the disease);
- congenital anomalies of the structure of the shoulder - excessively increased mobility (hypermobility), dysplasia of the connective tissue (normally, the articular cartilage is represented by collagen fibers type 2, in dysplasia, replacement with less durable types of collagen occurs), instability of the articulation;
- genetic features - hereditary predominance of collagen type 2, interleukin-1 and interleukin-2 gene polymorphism.
Modifiable risk factors for deforming osteoarthritis of the right or left shoulder joint are:
- traumatic damage to the joints;
- excessive physical activity (power sports and martial arts, including barbell press);
- obesity - for shoulder arthrosis, the important factor is not the increase in mechanical load, but the metabolic changes that occur in the connective tissue, incl. a state of chronic inflammation accompanying obesity;
- weakness of the muscle corset of the shoulder joint, especially in people who perform precise activities with their hands (jewelers, dentists, secretaries, writers);
- deficiency of vitamin D, which actively participates in maintaining the health of the musculoskeletal system;
- a diet low in vitamin C, which is an important link in the body's calcium-phosphorus metabolism;
- hormonal imbalance - thyroid disease, diabetes, etc. ;
- smoking - active and passive.
In shoulder arthrosis, the main targets of the pathological process are the articular cartilage, the subchondral bone and the synovium. In the affected cartilage, the synthesis of proteoglycans decreases, there is fragmentation and cracking of the plate, exposing the underlying bone. An increase in the non-physiological load on the bone leads to its compaction, the appearance of cysts and osteophytes (marginal growths).
Diagnosis
The examination of a patient with shoulder joint pain should begin with X-rays. It is important to scan in multiple views to view the joint in detail. Images can be taken in direct projection, in internal and external rotation positions. To evaluate the formations of the soft tissues of the joint, especially in the early stage of arthrosis, the ultrasound scan of the joint is the most informative. If the diagnosis remains unclear, MRI/CT of the joint is recommended. At the next stage, the preservation of the articulation functions is assessed.
Expert opinion
All morphological formations of the joint are included in the pathological process. The main symptom of osteoarthritis is pain in the joint area, caused not only by synovitis, but also by bone damage (osteitis, periostitis), involvement of periarticular soft tissues (tendinitis, tenosynovitis, myalgia, enthesopathies, stretching of the joint capsule), degeneration of the menisciand involvement of the neurosensory system (eg, irritation of nerve trunks by large osteophytes). Therefore, the earlier the treatment begins, incl. changing the way of life, the more effective the control of the occurrence of pain will be.
Treatment
At the initial stage of the pathological process, the treatment of arthrosis of the shoulder joint is carried out using conservative methods, and in case of severe degeneration of the articular cartilage, surgical intervention (endoprosthesis) is indicated.
Conservative treatment
In the period of exacerbation of the process, the first priority is pain relief. Most often, nonsteroidal anti-inflammatory drugs are 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 injections). 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, incl. enriched with platelets, can have a stimulating effect on the cartilage plate and promote its renewal (this treatment is considered pathogenetic). These injections help accelerate the synthesis of collagen and elastin fibers that form the basis of cartilage. As a result, the structure of the cartilage layer and the synovial membrane is improved, which helps to increase the congruence of the joint surfaces. These intra-articular injections help to optimize the production of synovial fluid, which not only absorbs the shock and moisturizes the cartilage, but also improves the metabolic processes in the chondrocytes, increasing their internal potential.
After the acute process subsides, 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, which leads to the impossibility of self-care and the performance of professional tasks. A modern method of surgical intervention in shoulder arthrosis is the implantation of an endoprosthesis. In SM-Clinic, the operation is performed in strict compliance with the latest generation endoprosthetic technique. This is the key to achieving the best therapeutic results.
Prevention of arthrosis of the shoulder joint
The primary prevention of arthrosis of the shoulder joint is aimed at maintaining optimal metabolism in the osteochondral department. For this it is recommended:
- maintaining a normal body weight;
- adequate compensation of endocrine disorders in the body (consultation and dynamic monitoring by an endocrinologist is necessary);
- dosed strengthening of the muscle corset of the shoulder girdle;
- Warm up regularly if your professional activity involves making similar movements in the shoulder.
In order to prevent the progression of developed shoulder arthrosis, the following recommendations are important:
- avoid lifting heavy objects, incl. push-ups with a barbell;
- conducting multiple courses of therapeutic massage;
- regularly engage in therapeutic gymnastics (under the supervision of a physiotherapist).
Rehabilitation
After endoprosthetics, a plaster cast is placed, 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, courses in therapeutic massage, physiotherapy and remedial gymnastics under the supervision of a specialist in physiotherapy are recommended.
Questions and Answers
Which doctor treats arthrosis of the shoulder joint?
The diagnosis and treatment of the disease is carried out by a traumatologist-orthopedic.
Representatives of which professions most often develop arthrosis of the shoulder joint?
Athletes involved in volleyball, tennis, basketball, throwers and loaders are at the greatest risk of degenerative-dystrophic destruction of the cartilage layer of the shoulder joint.
Does shoulder pain indicate the development of arthrosis?
In fact, pain is the leading sign of osteoarthritis. However, the pain can also be a manifestation of other diseases - adhesive capsulitis, osteoarthritis, damage to the muscles of the rotator cuff, etc. A qualified orthopedic traumatologist will help you establish the correct diagnosis and choose treatment.