Osteoarthritis of the shoulder joint is a dystrophic lesion of the cartilage plate that covers the articular surfaces of the joint, with subsequent involvement of the lower bone.
About the disease
This disease does not only affect the cartilage layer and subchondral bone. The pathological process gradually affects the joint capsule and ligament apparatus, synovium, musculotendinous compartment, as well as the subacromial region.
Arthrosis of the shoulder joint at a certain stage can lead to the development of osteoarthritis. This condition is characterized by the following symptoms: chronic pain, reduced range of motion in the joint, intra-articular grinding during rotation. Most often, people over 40 are susceptible to this transformation.
The main symptoms of arthrosis of the shoulder joint are pain and limited mobility of the arm. Imaging methods of examination - ultrasound and X-ray scanning, computer tomography and magnetic resonance - are informative for checking the diagnosis.
In accordance with clinical recommendations, the treatment of the disease in the initial stages is carried out by conservative methods, and in the later stages, when there is significant damage to the cartilage layer and impaired self-care of the patient, 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 thorough examination does not allow us to identify the most significant cause of the disease;
- secondary arthrosis, which is a consequence of the action of unfavorable factors on the joint (trauma, endocrine diseases, disturbed anatomy of the joint).
Doctors assess the speed of progression of the pathological process according to the degree of the disease. The more aggressive the process, the faster the articular cartilage is destroyed and the underlying bone is affected. From a morphological point of view, there are 6 degrees of arthrosis of the shoulder joint:
- first degree - the matrix of the cartilage becomes swollen and disintegrated, but the integrity of the surface zone of the cartilage is not yet threatened;
- second degree - cartilage tissue cells located in deep layers are affected, the surface plate of cartilage is damaged;
- third degree - vertical cracks appear on the cartilage plate;
- fourth degree - the surface zone of the cartilage plate gradually peels off, erosive defects are formed, and cystic cavities appear in the lower bone;
- fifth degree - in this phase 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, joint stiffness up to complete loss of mobility, as well as joint deformation.
Recognizable characteristics of pain in deforming arthrosis are:
- occurrence 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 - sudden jamming in the joint due to the separation of separate osteochondral fragments that enter between the joint surfaces;
- dependence on weather conditions - 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 occurs periodically (during the worsening of the disease). The speed of the 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 for 6 months or more. The change of acute pain 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 divided into 2 groups:
- changeable – correction is possible;
- immutable - it is not possible to influence their action.
Non-modifiable factors that can increase the risk of developing arthrosis 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 becomes approximately the same;
- the age of the person - the older the patient, the greater the risks (and from about 30 years of age, the process of degeneration in cartilage tissue runs faster than the process of regeneration, which creates preconditions for the development of the disease);
- congenital abnormalities of the shoulder structure - excessively increased mobility (hypermobility), dysplasia of connective tissue (normally, articular cartilage is represented by collagen fibers of type 2, with dysplasia, it is replaced by less durable types of collagen), instability of articulation;
- genetic characteristics - hereditary predominance of type 2 collagen, interleukin-1 and interleukin-2 gene polymorphism.
Variable risk factors for arthrosis deformation of the right or left shoulder joint are:
- traumatic joint damage;
- excessive physical activity (strength sports and martial arts, including weightlifting);
- obesity - for arthrosis of the shoulder, an important factor is not an increase in mechanical load, but 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);
- lack of vitamin D, which is actively involved in maintaining the health of the musculoskeletal system;
- diet with a low content of vitamin C, which is an important link in the metabolism of calcium and phosphorus in the body;
- hormonal imbalance – thyroid disease, diabetes, etc. ;
- smoking – both active and passive.
In shoulder arthrosis, the main targets of the pathological process are articular cartilage, subchondral bone and synovium. In the affected cartilage, the synthesis of proteoglycans decreases, fragmentation and cracking of the plate is observed, revealing the underlying bone. Increased non-physiological load on the bone leads to its compaction, the appearance of cysts and osteophytes (marginal growths).
Diagnostics
Examination of a patient with pain in the shoulder joint should begin with an X-ray. It is important to scan in several projections to examine the joint in detail. Images can be recorded in direct projection, in the position of internal and external rotation. For the assessment of joint soft tissue formations, especially in the early stages of arthrosis, an ultrasound scan of the joint is the most informative. If the diagnosis remains unclear, magnetic resonance imaging/computed tomography of the joint is recommended. In the next phase, preservation of articulation functions is evaluated.
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, enthesopathy, stretching of the joint capsule), degeneration of the meniscus and involvement of the neurosensory system (onexample, irritation of nerve trees by large osteophytes). Therefore, the sooner treatment begins, incl. lifestyle modifications, it will be more effective control over the occurrence of pain.
Treatment
In the initial stage of the pathological process, the treatment of arthrosis of the shoulder joint is carried out by conservative methods, and in case of severe degeneration of the articular cartilage, surgical intervention (endoprosthetics) is indicated.
Conservative treatment
In the period of deterioration of the process, the first priority is pain relief. 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 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, it can stimulate the cartilage and encourage 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 improves, which helps to increase the fit of the joint 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 subsides, physiotherapeutic methods of rehabilitation (pulse currents, ultrasound and laser treatment) can be used as part of complex treatment. These procedures have a complex positive effect on joint structures.
Operation
The operation is indicated for significant destruction of the cartilage plate, which is accompanied by persistent pain and dysfunction of the joint, which leads to the impossibility of self-care and professional work. A modern method of surgical intervention in shoulder arthrosis is the installation of an endoprosthesis. In SM-Clinic, the operation is performed in accordance with strict adherence to the methodology with the use of endoprostheses of the latest generation. 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 part. This is recommended for:
- maintain a normal body weight;
- adequately compensate for endocrine disorders in the body (consultation and dynamic supervision of an endocrinologist is required);
- dosed strengthening of the muscle corset of the shoulder girdle;
- Warm up regularly if your professional activity involves performing similar shoulder movements.
To prevent the progression of developed shoulder arthrosis, the following recommendations are important:
- avoid lifting heavy objects, incl. push-ups with a barbell;
- conduct repeated courses of therapeutic massage;
- regularly engage in gymnastics to improve your health (under the supervision of a physical therapy specialist).
Rehabilitation
After endoprosthetics, plaster is applied to ensure the required degree of immobilization. After removing the cast, the period of restoring the functional activity of the joint begins. For this, courses of therapeutic massage, physiotherapy and health gymnastics under the supervision of a physical therapy specialist 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 who play volleyball, tennis, basketball, missile throwers and chargers are at the highest 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 sign of arthrosis. However, pain can also be a manifestation of other diseases - adhesive capsulitis, osteoarthritis, rotator cuff muscle damage, etc. A qualified orthopedic traumatologist will help you make the correct diagnosis and choose treatment.