Arthrosis of the shoulder joint is a dystrophic lesion of the cartilaginous plate covering the articular surfaces 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 joint capsule and the ligamentous apparatus, the synovium, the musculotendinous compartment, as well as the subacromial region.
Osteoarthritis 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 of the joint, intra-articular crunching during rotation. Most often, people over 40 are subject to this transformation.
The main symptoms of osteoarthritis of the shoulder joint are pain and limited mobility of the arm. To verify the diagnosis, imaging examination methods are informative - ultrasound and X-ray, computed tomography and magnetic resonance imaging.
According to 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 cartilaginous layer 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 an important role, and even the most in-depth examination does not allow identifying 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, impairment of joint anatomy).
Doctors assess the rate of progression of the pathological process by the degree of the disease. The more aggressive the process, the faster the destruction of articular cartilage and involvement of the underlying bone occurs. From a morphological point of view, there are 6 degrees of arthrosis of the shoulder joint:
- first degree - the cartilage matrix is swollen and disintegrated, but the integrity of the superficial cartilage zone is not yet compromised;
- second degree – cartilage tissue cells located in the deep layers are affected, the surface cartilage plate is damaged;
- third degree - vertical cracks appear in the cartilaginous plate;
- fourth degree - the superficial zone of the cartilaginous plate gradually exfoliates, erosive defects form 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 growths appear.
Symptoms of osteoarthritis of the shoulder joint
The main clinical signs of shoulder osteoarthritis are pain, joint stiffness to the point of total loss of mobility, as well as joint deformation.
The distinctive features of pain with deforming arthrosis are:
- appearance at the beginning of flexion, extension or rotation;
- increased during physical activity;
- nocturnal character due to stagnation of venous blood in the intraosseous channels;
- the presence of blockages - sudden blockage in the joint due to the separation of separate osteochondral fragments lying between the articular surfaces;
- climate dependence - the pain intensifies when the climate changes (in humid and cold weather, the pain becomes more intense).
Osteoarthritis is a chronic pathology. In the initial stage of the disease, pain appears periodically (at the time of exacerbation of the disease). The rate of progression of the pathology is determined by the timeliness of starting treatment 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 progression of the pathological process.
Causes of osteoarthritis of the shoulder joint
The causes of arthrosis of the shoulder joint are classified into 2 groups:
- modifiable – correction is possible;
- non-modifiable - cannot influence its action.
Non-modifiable factors that may increase the risk of developing osteoarthritis changes in the shoulder joint include:
- sex - up to 50 years of age, women are less susceptible to the disease than men, after approximately 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 the age of 30 in cartilaginous tissue, the degeneration process proceeds faster than the regeneration process, which creates the prerequisites for the development of the disease );
- congenital anomalies of the shoulder structure - excessively increased mobility (hypermobility), connective tissue dysplasia (normally, articular cartilage is represented by type 2 collagen fibers, with dysplasia, replacement with less durable types of collagen occurs), instability of the joint;
- genetic characteristics - hereditarily determined predominance of type 2 collagen, polymorphism of the interleukin-1 and interleukin-2 genes.
The modifiable risk factors for deforming osteoarthritis of the right or left shoulder joint are:
- traumatic joint damage;
- excessive physical activity (strength sports and martial arts, including barbell bench presses);
- obesity – for shoulder arthrosis, the important factor is not the increased mechanical load, but the metabolic changes that occur in the connective tissue, incl. a state of chronic inflammation that accompanies obesity;
- weakness of the muscular corset of the shoulder joint, especially in those people who perform precise activities with their hands (jewelers, dentists, secretaries, writers);
- vitamin D deficiency, 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, the subchondral bone and the synovium. In the affected cartilage, the synthesis of proteoglycans decreases, fragmentation and cracking of the plaque are observed, exposing the underlying bone. An increase in non-physiological load on the bone leads to its compaction, the appearance of cysts and osteophytes (marginal growths).
Diagnosis
Examination of a patient with pain in the shoulder joint should begin with x-rays. It is important to scan in multiple projections to examine the joint in detail. Images can be obtained in direct projection, in internal and external rotation positions. To assess soft tissue formations of the joint, especially at the initial stage of arthrosis, ultrasound of the joint is more informative. If the diagnosis remains uncertain, MRI/CT of the joint is recommended. In the next stage, the preservation of joint functions is assessed.
Opinion of an 'expert
All morphological formations of the joint are involved in the pathological process. The main symptom of osteoarthritis is pain in the joint region, caused not only by synovitis, but also by bone damage (osteitis, periostitis), involvement of 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 sooner treatment begins, incl. lifestyle modification, the more effective it will be to control 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, and in severe degeneration of the articular cartilage, surgical intervention (endoprosthesis) 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 for pain relief. They can be applied 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 medications may be used to relieve it.
Intra-articular injection of hyaluronic acid or plasma, incl. enriched with platelets, it can have a stimulating effect on the cartilaginous plate and promote its renewal (this treatment is considered pathogenetic). These injections help speed up the synthesis of collagen and elastin fibers that form the basis of cartilage. As a result, it improves the structure of the cartilaginous layer and the synovial membrane, which helps to increase the congruity of the articular surfaces. These intra-articular injections help optimize the production of synovial fluid, which not only absorbs shock and hydrates the cartilage, but also improves metabolic processes in chondrocytes, increasing their internal potential.
After the acute process subsides, physiotherapeutic rehabilitation methods (pulsed 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 cartilaginous plate, which is accompanied by persistent pain and joint dysfunction, leading to the inability to take care of oneself and perform professional tasks. A modern method of surgical intervention for shoulder arthrosis is the implantation of an endoprosthesis. At SM-Clinic the operation is carried out strictly following the methodology using state-of-the-art endoprostheses. This is the key to achieving the best therapeutic results.
Prevention of arthrosis of the shoulder joint
Primary prevention of arthrosis of the shoulder joint aims to maintain optimal metabolism in the osteochondral compartment. For this it is recommended:
- maintain normal body weight;
- adequately compensate for endocrine disorders in the body (consultation and dynamic monitoring by an endocrinologist is required);
- dosed strengthens the muscular 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. barbell push-ups;
- carry out repeated courses of therapeutic massage;
- regularly practice gymnastics to improve health (under the supervision of a physiotherapist).
Rehabilitation
After the endoprosthesis, a plaster cast is applied, which provides the necessary degree of immobilization. After removing the plaster, the period of restoration of the functional activity of the joint begins. To achieve this, courses in therapeutic massage, physiotherapy and recreational 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 are 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 carriers are at increased risk of degenerative dystrophic destruction of the cartilaginous layer of the shoulder joint.
Does shoulder pain indicate the development of osteoarthritis?
In fact, pain is the main sign of osteoarthritis. However, pain can also be a manifestation of other diseases - adhesive capsulitis, osteoarthritis, damage to the rotator cuff muscles, etc. A qualified orthopedic traumatologist will help you establish the correct diagnosis and select treatment.