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 also affects the joint capsule and the ligamentous apparatus, the synovium, the muscle-tendon compartment and the subacromial region.
Osteoarthritis of the shoulder joint can lead to the development of osteoarthritis at a certain stage. This condition is characterized by the following symptoms: chronic pain, limited mobility in the joint, intra-articular crunch during rotation. People over 40 are most often affected by this transformation.
The main symptoms of osteoarthritis of the shoulder joint are pain and limited mobility of the arm. To check the diagnosis, imaging examination methods are informative - ultrasound and X-ray examination, computer tomography and magnetic resonance imaging.
According to clinical recommendations, the treatment of the disease in the initial stages is carried out using conservative methods; in the late stages, when the cartilage layer is significantly damaged 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 large role and even the most thorough examination does not allow us to identify the main cause of the disease;
- secondary arthrosis, which is a consequence of the impact on the joint of unfavorable factors (trauma, endocrine diseases, impaired joint anatomy).
Doctors assess the progression of the pathological process based on the extent 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 dissolves, but the integrity of the superficial zone of the cartilage is not yet compromised;
- second degree – the cells of the cartilage tissue 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 superficial zone of the cartilage plate gradually exfoliates, 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 osteoarthritis of the shoulder joint
The main clinical signs of shoulder osteoarthritis are pain, stiffness of the joint up to complete loss of mobility and deformation of the joint.
Characteristic features of pain in deforming osteoarthritis are:
- Occurs at the beginning of flexion, extension or rotation;
- increased with physical activity;
- nocturnal character due to stagnation of venous blood in intraosseous channels;
- the presence of blockages – sudden blockages in the joint due to the separation of separate osteochondral fragments passing between the articular surfaces;
- Weather Dependence – Pain increases when the weather changes (pain increases in wet and cold climates).
Osteoarthritis is a chronic pathology. At the initial stage of the disease, pain occurs regularly (at the time of exacerbation of the disease). The speed of progression of pathology is determined by the timeliness of the start of treatment and the adequacy of lifestyle changes. Shoulder pain becomes chronic when it lasts 6 months or longer. The transition from acute to chronic pain indicates the progression of the pathological process.
Causes of osteoarthritis of the shoulder joint
The causes of osteoarthritis of the shoulder joint are divided into 2 groups:
- changeable – correction is possible;
- cannot be changed – it is not possible to influence their effect.
The non-modifiable factors that can increase the risk of osteoarthritis changes 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 in representatives of both sexes is approximately the same;
- the age of the person - the older the patient, the higher the risk (and from about 30 years old, the degeneration process in cartilage tissue proceeds faster than the regeneration process, which creates the conditions for the development of the disease);
- congenital anomalies of the structure of the shoulder - excessively increased mobility (hypermobility), connective tissue dysplasia (usually the articular cartilage is represented by collagen fibers of type 2, with dysplasia there is replacement by less durable types of collagen), instability of articulation;
- genetic features - hereditary predominance of collagen type 2, polymorphism of the interleukin-1 and interleukin-2 genes.
Modifiable risk factors for deforming osteoarthritis of the right or left shoulder joint are:
- traumatic joint damage;
- excessive physical activity (weight training and martial arts, including barbell bench press);
- Obesity – in shoulder arthrosis it is not the increase in mechanical stress that is important, but rather the metabolic changes in the connective tissue, including a state of chronic inflammation that is associated with obesity;
- Weakness of the muscular corset of the shoulder joint, especially in people who perform precise tasks with their hands (jewelers, dentists, secretaries, writers);
- Lack of vitamin D, which is actively involved 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 – both active and passive.
In shoulder arthrosis, the main targets of the pathological process are the articular cartilage, subchondral bone and synovium. In the affected cartilage, the synthesis of proteoglycans decreases, fragmentation and cracking of the plate occur, exposing the underlying bone. Increasing unphysiological stress on the bone leads to its compaction and the appearance of cysts and osteophytes (marginal growths).
diagnosis
The examination of a patient with pain in the shoulder joint should begin with an x-ray. To examine the joint in detail, it is important to scan multiple projections. Images can be captured in direct projection, in the position of internal and external rotation. To assess the soft tissue formations of the joint, especially in the early stages of osteoarthritis, an ultrasound examination of the joint is the most informative. If the diagnosis remains unclear, magnetic resonance imaging/computed tomography of the joint is recommended. The next step is to assess the preservation of articulation functions.
Expert opinion
All morphological formations of the joint are involved in the pathological process. The main symptom of arthrosis is pain in the joint area, which is caused not only by synovitis, but also by bone damage (osteitis, periostitis), involvement of the periarticular soft tissues (tendinitis, tenosynovitis, myalgia, enthesopathies, stretching of the joint capsule). , degeneration of the menisci and involvement of the neurosensory system (e. g. irritation of nerve trunks by large osteophytes). Therefore, the earlier the treatment begins, including the change in lifestyle, the more effective the control over the occurrence of pain.
Treatment
At the initial stage of the pathological process, treatment of arthrosis of the shoulder joint is carried out using conservative methods; in cases of severe degeneration of the articular cartilage, surgical intervention (endoprosthetics) is indicated.
Conservative treatment
During the exacerbation of the process, pain relief comes first. Nonsteroidal anti-inflammatory drugs are most often used to relieve pain. They can be used externally (in the form of creams and ointments), injected into the joint cavity or systemically (tablets, intramuscular injections). In some patients, the pain may be so severe that a short course of corticosteroids is required for relief.
Intra-articular injection of hyaluronic acid or plasma, including 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, which form the basis of cartilage. This improves the structure of the cartilage layer and the synovial membrane, thereby increasing the congruence of the articular surfaces. These intra-articular injections help optimize the production of synovial fluid, which not only absorbs shock and moisturizes the cartilage, but also improves metabolic processes in the chondrocytes, thus increasing their internal potential.
After the acute process has subsided, physiotherapeutic rehabilitation methods (pulse currents, ultrasound and laser treatment) can be used as part of complex treatment. These procedures have a complex positive effect on the joint structures.
surgery
The operation is indicated for significant destruction of the cartilage plate, which is accompanied by persistent pain and dysfunction of the joint and leads to the inability to care for oneself and perform professional tasks. A modern surgical procedure for shoulder osteoarthritis is the implantation of an endoprosthesis. In the SM clinic, the operation is carried out in strict adherence to the methodology using the latest generation endoprostheses. This is the key to achieving the best therapy results.
Prevention of osteoarthritis of the shoulder joint
The primary prevention of osteoarthritis of the shoulder joint is aimed at maintaining optimal metabolism in the osteochondral compartment. For this we recommend:
- maintaining normal body weight;
- adequately compensate for endocrine disorders in the body (consultation and dynamic monitoring by an endocrinologist are required);
- strengthen the muscle corset of the shoulder girdle in doses;
- Warm up regularly if you perform similar shoulder movements as part of your job.
To prevent the progression of developed shoulder arthrosis, the following recommendations are important:
- Avoid lifting heavy objects, including barbell push-ups;
- conduct repeated courses of therapeutic massage;
- Participate in health-promoting gymnastics regularly (under the supervision of a physical therapist).
rehabilitation
After the endoprosthetics, a plaster cast is applied to provide the necessary immobilization. After the plaster cast is removed, the phase of restoring the functional activity of the joint begins. For this purpose, courses for therapeutic massage, physiotherapy and health-promoting gymnastics under the supervision of a physiotherapist are recommended.
questions and answers
Which doctor treats osteoarthritis of the shoulder joint?
Diagnosis and treatment of the disease is carried out by a traumatologist-orthopedist.
Representatives of which professions most often develop arthrosis of the shoulder joint?
Athletes involved in volleyball, tennis, basketball, projectile throwers and loaders are at greatest risk of degenerative-dystrophic destruction of the cartilage layer of the shoulder joint.
Does shoulder pain indicate the development of osteoarthritis?
In fact, pain is the main symptom of osteoarthritis. However, pain can also be a manifestation of other diseases - adhesive capsulitis, arthrosis, damage to the rotator cuff muscles, etc. A qualified orthopedic traumatologist will help you make the correct diagnosis and choose treatment.