Osteoarthritis of the shoulder

24 June 2021

Osteoarthritis of the shoulderis chronic shoulder osteoarthritis a disease in which the tissue of the articular cartilage is destroyed and thinned, pathological changes in soft tissue occur, and bone growths form in the area of the joint. It manifests as 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 the radiological signs. Treatment is generally conservative: physiotherapy, anti-inflammatory drugs, chondroprotectors, exercise therapy. When the joint is destroyed, an arthroplasty is performed.

general informations

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 typically affects people 45 years of age and older, but in some cases (after injury, inflammation) the disease can develop at a younger age. Pathology also often occurs in women and men, more often observed in athletes and people engaged in hard physical labor.

The reasons

The starting point of changes in osteoarthritis of the shoulder joint can be both the normal aging process of the tissues and damage or disruption of the structure of the cartilage resulting from mechanical influences and various processes. pathological. 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. 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 injury.Osteoarthritis of traumatic aetiology most often occurs after intra-articular fractures. A possible cause of the disease can be a dislocation of the shoulder, especially the usual one. Less often, severe bruising acts like a provoking injury.
Inflammatory processes.The disease can be diagnosed with long-term shoulder-scapular periarthritis, having previously suffered from nonspecific purulent arthritis and specific arthritis of the joint (with tuberculosis, syphilis and some other diseases).

Risk factors

Osteoarthritis is a polyetiologic disease. There is a large group of factors that increase the likelihood of this pathology:

Hereditary predisposition.Many patients have relatives who also suffer from osteoarthritis, including those from other locations (knee osteoarthritis, hip osteoarthritis, ankle osteoarthritis).
Overwork of the joint.It can occur in volleyball players, tennis players, basketball players, sports equipment throwers, as well as people whose profession involves a constant high load on their hands (hammers, loaders).
Other pathologies.Osteoarthritis is more often detected in patients with autoimmune diseases (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 unfavorable environmental conditions have some 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 softness and elasticity, the sliding of the joint surfaces during movement becomes difficult. Microtrauma occurs, which leads to further deterioration in the condition of cartilage tissue. Small pieces of cartilage break off from the surface, forming free joint bodies, which also damage the inner surface of the joint.

Over time, the capsule and synovium thicken, areas of fibrous degeneration appear in it. Due to thinning and decreased elasticity, the cartilage stops providing the necessary shock absorption, therefore, the load on the underlying bone increases. The bone deforms and grows along the edges. The normal configuration of the joint is disturbed, there are limitations of movement.

Classification

In traumatology and orthopedics, a three-stage systematization is usually 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. A distinction is made between the following stages:

The first one- there are no gross changes in the cartilage tissue. The composition of the synovial fluid is changed, the nutrition of the cartilage is impaired. Cartilage cannot 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 joint platform. The pain becomes permanent.
The third- marked thinning and rupture of the cartilaginous structure with large 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

At first, patients with osteoarthritis are concerned about discomfort or minor pain in the shoulder joint during exertion and certain body positions. A cracking sound may occur during movement. The joint is not changed externally, there is no edema. Then the intensity of the pain increases, arthralgias become habitual, constant, appear not only with exertion, but also at rest, including at night. Distinctive features of pain syndrome:

Many patients note the dependence of the pain syndrome on weather conditions.
Along with aching pain, over time there is a strong pain during physical exertion.
Pain can only occur 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 noticeable morning stiffness in the joint. Range of motion decreases. After exercise or hypothermia, a slight swelling of the soft tissues is possible. With the progression of osteoarthritis, movement is increasingly limited, contractures develop and limb function is severely impaired.

Diagnostic

The diagnosis is made by an orthopedic surgeon taking into account the clinical and radiological signs characteristic of osteoarthritis of the shoulder joint. If you suspect secondary osteoarthritis, consult a surgeon, endocrinologist. At first, the joint is not changed, then it is sometimes deformed or enlarged. On palpation, the pain is determined. Movement restriction can 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 a narrowing of the joint space, deformation and changes in the structure of the underlying bone are determined. The joint space can acquire a wedge-shaped shape, 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 done to obtain additional data on the condition of the bone and cartilage. If it is necessary to assess the condition of soft tissues, magnetic resonance imaging is performed.

Differential diagnosis

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

In psoriatic arthritis, in addition to 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 (increased 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 weight bearing. 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, you need to regularly perform the complex of exercise therapy recommended by the doctor.

Conservative treatment

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

Systemic drugs.NSAIDs are prescribed in tablets during an exacerbation. When used uncontrollably, they can irritate the stomach wall, have a negative effect on the condition of the liver and the metabolism of 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 appear or intensify. Less frequently, 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. Blockages are not carried out more than 4 times a year.

To restore and strengthen 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 cures are long (from 6 months to a year or more), the effect becomes noticeable after 3 months or more.

Physiotherapy treatment

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

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

Surgery

In stage 3 of the disease, with significant destruction of cartilage, limited mobility and disability, a joint prosthesis is performed. The reference for the operation is given taking into account the age of the patient, his level of activity, the presence of severe chronic diseases. The use of modern ceramic, plastic and metal stents allows you to completely restore the function of the joint. The service life of prostheses is 15 years or more.

Provide

Osteoarthritis is a long-term, gradually progressive disease. It can not be completely cured, however, it is possible to significantly slow down the development of pathological changes in the joint, in order to preserve the working capacity and a high quality of life. To get the maximum effect, the patient should be serious about his illness 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 timely diagnose and treat pathologies that can provoke the development of arthritic changes.