Shoulder osteoarthritis

Shoulder osteoarthritisIs chronica disease in which the articular cartilage tissue is destroyed and thinned, pathological changes occur in the soft tissues, and bony growths form in the joint area. It is manifested by pain and cracking in the affected area. In the later stages, the range of motion decreases. The pathology is chronic and progresses gradually. The diagnosis is made taking into account the clinical picture and radiological signs. Treatment is usually conservative: physical therapy, anti-inflammatories, chondroprotectors, exercise therapy. When the joint is destroyed, an arthroplasty is performed.

General 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 45 years of age or older, but in some cases (after injury, inflammation), the disease can develop at a younger age. The pathology occurs with equal frequency in women and men, and is observed more frequently in athletes and in people who perform intense physical work.

The reasons

The starting point for changes in osteoarthritis of the shoulder joint can be both the normal aging process of tissues and damage or alteration of the cartilage structure as a result of mechanical influences and various pathological processes. Primary osteoarthritis is usually detected 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 with underdevelopment of the head of the humerus or glenoid cavity, capomelia of the shoulder, and other abnormalities of the upper limb.
• Traumatic injuryOsteoarthritis of traumatic etiology occurs more frequently after intra-articular fractures. A possible cause of the disease can be a shoulder dislocation, especially the usual one. Less often, severe bruising acts as a provocative injury.
• Inflammatory processes.The disease can be diagnosed with long-term shoulder scapular periarthritis, previously suffered from non-specific purulent arthritis and joint-specific arthritis (with tuberculosis, syphilis and some other diseases).

Risk factor's

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

• Hereditary predisposition.Many patients have close relatives who also suffer from osteoarthritis, including those in other locations (gonarthrosis, coxarthrosis, osteoarthritis of the ankle joint).
• Overexertion of the joint.It can occur in volleyball players, tennis players, basketball players, throwers of sports equipment, as well as in people whose profession involves a constant high load on their hands (hammers, chargers).
• Other pathologies.Osteoarthritis is most often detected in patients suffering from autoimmune diseases (rheumatoid arthritis), some endocrine diseases and metabolic disorders, systemic connective tissue failure, and excessive joint mobility.

The probability 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 the articular cartilage. Cartilage loses its softness and elasticity, the gliding of the joint surfaces during movement becomes difficult. Microtrauma occurs, which leads to further deterioration of the state of cartilage tissue. Small pieces of cartilage break away from the surface, forming freely lying articular bodies, which also damage the inner surface of the joint.

Over time, the capsule and synovium thicken, areas of fibrous degeneration appear on them. Due to thinning and decreased elasticity, the cartilage no longer provides the necessary shock absorption, thus increasing the load on the underlying bone. The bone becomes deformed and grows along the edges. The normal configuration of the joint is disrupted, there are limitations of movement.

Classification

In traumatology and orthopedics, a three-stage systematization is generally used, reflecting the severity of pathological changes and 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:

• First- there are no major changes in the cartilage tissue. The composition of the synovial fluid changes, the nutrition of the cartilage is affected. Cartilage does not tolerate stress, therefore joint pain (arthralgia) occurs from time to time.
• The second- The cartilage tissue begins to thin, its structure changes, the surface loses its smoothness, cysts and areas of calcification appear in the depths of the cartilage. The underlying bone is slightly deformed, bony growths appear along the edges of the articular platform. The pains become permanent.
• Third- marked thinning and breakage of the cartilage structure with extensive areas of destruction. The articular platform is deformed. Revealed limitation of range of motion, weakness of the ligamentous apparatus, and atrophy of the periarticular muscles.

Symptoms

In the early stages, osteoarthritis patients are concerned about discomfort or mild pain in the shoulder joint during exertion and certain body positions. Crackling may occur during movement. The joint is not externally modified, there is no edema. Then the intensity of pain increases, arthralgias become habitual, constant, they appear not only during exercise, but also at rest, even at night. Distinctive features of pain syndrome:

• Many patients note the dependence of pain syndrome on weather conditions.
• Along with the pain, over time, there is a sharp pain during physical exertion.
• The pain can occur 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 a while, patients begin to notice a noticeable morning stiffness in the joint. Range of motion decreases. After exercise or hypothermia, slight soft tissue swelling may occur. With the progression of osteoarthritis, 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 osteoarthritis of the shoulder joint. If you suspect secondary osteoarthritis, consult a surgeon, endocrinologist. At first, the joint is not changed, then sometimes it is deformed or enlarged. On palpation, pain is determined. A movement restriction may be detected. To confirm osteoarthritis, the following are recommended:

• X-ray of the shoulder joint.Dystrophic changes and marginal bone growths (osteophytes) are found, in the later stages the narrowing of the joint space, deformation and changes in the underlying bone structure are determined. The joint space may become wedge-shaped, osteosclerotic changes and cystic formations are visible in the bone.
• Tomographic research. In doubtful 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 state of soft tissues, an MRI is performed.

Differential diagnosis

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

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

Treatment of osteoarthritis of the shoulder

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 a normal state, as well as to restore the shoulder joint, you should regularly perform the complex of exercise therapy recommended by the 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:

• General action drugs.NSAIDs are prescribed in tablets during an exacerbation. With uncontrolled use, they can irritate the stomach wall, have a negative effect on the state of the liver and metabolism in cartilage tissue, therefore they are only taken as directed by a doctor.
• Local remedies.NSAIDs are commonly used in the form of gels and ointments. Self-administration is possible if symptoms arise or intensify. Less often, topical hormonal preparations are indicated, which should be applied according to the doctor's recommendations.
• Hormones for intra-articular administration.In case of severe pain syndrome, which cannot be eliminated by other methods, intra-articular administration of drugs (triamcinolone, hydrocortisone, etc. ) is carried out. Locks are carried out no more than 4 times a year.

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

Physiotherapy treatment

With osteoarthritis of the shoulder joint, massage, physical therapy exercises and physical therapy techniques are actively used. During the remission period, patients are referred for a spa treatment. Apply for:

• mud and paraffin therapy;
• medicinal baths;
• magnetotherapy and infrared laser therapy;
• ultrasound.

Surgery

In stage 3 of the disease, with significant cartilage destruction, mobility limitation, and disability, joint replacement is performed. Referral for the operation is given taking into account the age of the patient, the level of his activity, the presence of serious chronic diseases. The use of modern ceramic, plastic and metal endoprostheses allows you to fully restore the function of the joint. The useful life of prostheses is 15 years or more.

Forecast

Osteoarthritis is a disease with long-term gradual progression. It cannot be completely cured, however, it is possible to significantly slow down the development of pathological changes in the joint, to preserve the ability to work and a high quality of life. To achieve maximum effect, the patient must take his illness seriously and his willingness to follow the doctor's recommendations, even during the period of remission.

Prophylaxis

Preventive measures include reducing domestic injuries, observing safety at work, eliminating excessive loads on the shoulder joint when performing professional tasks, and playing sports. It is necessary to diagnose and treat in time the pathologies that can provoke the development of arthritic changes.