Shoulder joint arthrosis is a dystrophic lesion of the cartilaginous plate covering the articular surface of the joint, with subsequent involvement of the underlying bone.
About the disease
With this disease, not only the cartilaginous layer and subchondral bone are affected. The pathological process gradually also involves the articular 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, decreased range of motion in the joints, intra-articular spasms during rotation. Most often, people over the age of 40 are subject to these changes.
The main symptoms of arthrosis of the shoulder joint are pain and limited mobility of the arm. To confirm the diagnosis, imaging examination methods are informative - ultrasound and X-ray scanning, computed tomography and magnetic resonance imaging.
In accordance with clinical recommendations, the treatment of the disease in the early 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 affected, joint replacement is indicated.
Types of arthrosis of the shoulder joint
According to the classification, the following types of shoulder joint arthrosis are distinguished:
- primary arthrosis, in the development of which genetics plays a large role, and even the most careful examination does not allow us to identify the most significant cause of the disease;
- secondary arthrosis, which is the result of the action of unfavorable factors on the joint (trauma, endocrine diseases, impaired joint anatomy).
Doctors evaluate the rate of development of the pathological process according to the level of the disease. The more aggressive the process, the faster the destruction of the articular cartilage and the involvement of the underlying bone occurs. From a morphological point of view, there are 6 degrees of shoulder joint arthrosis:
- first degree - the cartilage matrix becomes swollen and destroyed, but the integrity of the superficial zone of cartilage has not been affected;
- second degree - cartilage tissue cells located in the inner layer are affected, cartilage surface plate is damaged;
- third degree - vertical cracks appear on the cartilage plate;
- fourth degree - the superficial zone of the cartilaginous plate gradually peels off, 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, cysts become more pronounced, and marginal bone growth appears.
Symptoms of arthrosis of the shoulder joint
The main clinical signs of shoulder arthrosis are pain, stiffness in the joint until complete loss of mobility, as well as joint deformation.
The characteristic features of pain with deforming arthrosis are:
- appearance at the beginning of flexion, extension or rotation;
- increases during physical activity;
- nocturnal character due to stagnation of venous blood in the intraosseous vessels;
- the presence of blockage - sudden congestion in the joint due to the separation of osteochondral fragments that are separated between the articular surfaces;
- weather dependence - the pain intensifies when the weather changes (in humid and cold climates, the pain becomes stronger).
Arthritis is a chronic pathology. In the early stages of the disease, pain appears periodically (at the time of exacerbation of the disease). The rate of pathological development is determined by the timeliness of treatment initiation and the adequacy of lifestyle modifications. Shoulder pain becomes chronic if it persists for 6 months or more. The change from acute to chronic pain indicates the development of the pathological process.
Causes of shoulder joint arthrosis
The causes of shoulder joint arthrosis are classified into 2 groups:
- can be modified - corrections can be made;
- cannot be modified - cannot possibly influence their actions.
Non-modifiable factors that can increase the risk of developing arthrosis changes in the shoulder joint include:
- gender - up to the age of 50, women are less prone to this disease than men, after about 50 years, the prevalence of pathology among representatives of both sexes becomes more or less the same;
- a person's age - the older the patient, the higher the risk (and from about 30 years in the cartilage tissue, the degeneration process proceeds faster than the regeneration process, which creates a prerequisite for the development of the disease);
- congenital abnormalities of the shoulder structure - excessively increased mobility (hypermobility), connective tissue dysplasia (usually, articular cartilage is represented by type 2 collagen fibers, with dysplasia, replacement with a less durable collagen type occurs), joint instability;
- genetic characteristics - the dominance of type 2 collagen is determined by heredity, interleukin-1 and interleukin-2 gene polymorphisms.
Modifiable risk factors for arthrosis deformity of the right or left shoulder joint are:
- traumatic joint damage;
- excessive physical activity (strength sports and martial arts, including barbell bench 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, including. chronic inflammatory conditions that accompany obesity;
- muscle corset weakness of the shoulder joint, especially in people who perform precise activities with their hands (goldsmiths, dentists, secretaries, writers);
- lack of vitamin D, which is actively involved in maintaining the health of the musculoskeletal system;
- 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 articular cartilage, subchondral bone and synovium. In the affected cartilage, the synthesis of proteoglycan is reduced, fragmentation and cracking of the plate is observed, revealing the underlying bone. Increasing the non-physiological load on the bones leads to compaction, the appearance of cysts and osteophytes (marginal growth).
Diagnostics
Examination of patients 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 taken in direct projection, in internal and external rotation positions. To evaluate the formation of the soft tissue of the joint, especially in the early stages of arthrosis, an ultrasound scan of the joint is the most informative. If the diagnosis is still unclear, magnetic resonance imaging/computed tomography of the joint is recommended. At the next stage, preservation of articulation function is assessed.
Expert opinion
All morphological formations of joints are involved in the pathological process. The main symptom of osteoarthritis is pain in the joint area, not only caused by synovitis, but also by bone damage (osteitis, periostitis), periarticular soft tissue involvement (tendinitis, tenosynovitis, myalgia, enthesopathies, joint capsule stretching), degeneration of the menisci and involvement of the neurosensory system. (eg, nerve trunk irritation by large osteophytes). Therefore, faster treatment begins, incl. lifestyle modification, more effective control of the incidence of pain will.
Treatment
At the initial stage of the pathological process, the treatment of arthrosis of the shoulder joint is carried out using conservative methods, and with severe degeneration of the articular cartilage, surgical intervention (endoprosthetics) is indicated.
Conservative treatment
During the period of exacerbation of the process, the first priority is pain relief. Nonsteroidal anti-inflammatory drugs are most often used to relieve pain. They can be used topically (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 cartilage plates and promote their renewal (this treatment is considered pathogenetic). This injection helps accelerate the synthesis of collagen and elastin fibers that form the basis of cartilage. As a result, the structure of the cartilage layer and synovial membrane improves, which helps improve the congruence of the articular surface. This intra-articular injection helps to optimize the production of synovial fluid, which not only absorbs shock and moisturizes the cartilage, but also increases metabolic processes in chondrocytes, increasing their internal potential.
After the acute process has subsided, physiotherapeutic rehabilitation methods (pulsed current, ultrasound and laser treatment) can be used as part of complex treatment. This procedure has a complex positive effect on the joint structure.
Surgery
This operation is indicated for significant destruction of the cartilage plate, which is accompanied by constant pain and joint dysfunction, which leads to the inability to take care of oneself and perform professional tasks. A modern method of surgical intervention for shoulder arthrosis is endoprosthesis implantation. At SM-Clinic, operations are carried out in strict compliance with the methodology using the latest generation of endoprostheses. This is the key to achieving the best therapeutic results.
Prevention of shoulder joint arthrosis
The main prevention of arthrosis of the shoulder joint is aimed at maintaining optimal metabolism in the osteochondral compartment. For this it is recommended:
- maintain a normal weight;
- adequately compensate for endocrine disorders in the body (consultation and dynamic monitoring by an endocrinologist is required);
- doses strengthen the muscle corset of the shoulder girdle;
- Warm up regularly if your professional activity involves performing similar movements on the shoulders.
To prevent the development of advanced shoulder arthrosis, the following recommendations are important:
- avoid lifting heavy objects, incl. barbell push-ups;
- conduct repeated courses of therapeutic massage;
- regularly engage in health-enhancing gymnastics (under the supervision of a physical therapist).
Restoration
After endoprosthetics, a plaster cast is used, which provides the necessary level of immobilization. After the cast is removed, the period of recovery of the functional activity of the joint begins. For this, a course of therapeutic massage, physiotherapy and health-improving gymnastics under the supervision of a physical therapist is recommended.
Question and answer
Which doctor treats arthrosis of the shoulder joint?
Diagnosis and treatment of this disease is carried out by a traumatologist-orthopedic.
Representatives of the profession that most often suffer from arthrosis of the shoulder joint?
Athletes involved in volleyball, tennis, basketball, shot putters, and loaders are at greatest risk for degenerative-dystrophic destruction of the cartilage layer of the shoulder joint.
Does shoulder pain indicate the development of arthrosis?
Indeed, pain is the main symptom of arthrosis. However, pain can also be a manifestation of other diseases - adhesive capsulitis, osteoarthritis, damage to the rotator cuff muscles, etc. A certified orthopedic traumatologist will help you establish the correct diagnosis and choose treatment.