Osteoarthritis of the shoulder joint is a dystrophic lesion of the cartilaginous plate covering the articular surfaces of the joint, with subsequent damage to the underlying bone.
About the disease
With this disease, not only the cartilaginous layer and the 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 when rotating. Most often, it is people over 40 who undergo 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 radiography, computed tomography and magnetic resonance imaging.
In accordance with clinical recommendations, treatment of the disease in the early stages is carried out using conservative methods, and in later stages, when the cartilaginous layer is significantly damaged and the patient's self-care is impaired, aArthroplasty is indicated.
Types of osteoarthritis of the shoulder joint
According to the classification, the following types of osteoarthritis of the shoulder joint are distinguished:
- primary osteoarthritis, in the development of which genetics plays an important role, and even the most thorough examination does not allow identifying the most important cause of the disease;
- secondary osteoarthritis, a consequence of the action of unfavorable factors on the joint (trauma, endocrine diseases, alteration of joint anatomy).
Doctors judge the rate of progression of the pathological process based on the degree 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 osteoarthritis of the shoulder joint:
- first degree - the cartilaginous matrix swells and disintegrates, but the integrity of the surface area of the cartilage is not yet compromised;
- second degree – the cells of the cartilage tissue located in the deep layers are affected, the superficial plate of the cartilage is damaged;
- third degree - vertical cracks appear on the cartilaginous plate;
- fourth degree - the superficial zone of the cartilaginous plate gradually exfoliates, erosive defects are formed and cystic cavities appear in the underlying bone;
- fifth degree - at this point 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, stiffness of the joint which can lead to a complete loss of mobility, as well as deformation of the joint.
Distinctive features of pain associated with deforming osteoarthritis are:
- appearance at the beginning of flexion, extension or rotation;
- increased during physical activity;
- nocturnal nature due to stagnation of venous blood in the intraosseous canals;
- the presence of blockages - a sudden blockage of the joint due to separation of separate osteochondral fragments lying between the joint surfaces;
- climate dependence - pain intensifies when the weather changes (in humid and cold climates, pain becomes more intense).
Osteoarthritis is a chronic pathology. At 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 the start of treatment and the adequacy of lifestyle modification. Shoulder pain becomes chronic if it persists for 6 months or more. The transition from acute to chronic pain indicates the progression of the disease process.
Causes of osteoarthritis of the shoulder joint
The causes of osteoarthritis of the shoulder joint are classified into 2 groups:
- editable – a correction is possible;
- non-modifiable - it is not possible to influence their action.
Non-modifiable factors that may increase the risk of developing osteoarthritic changes in the shoulder joint include:
- gender - up to 50 years old, 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 higher the risks (and from about 30 years old in cartilage tissue, the degeneration process takes place faster than the regeneration process, which creates theprerequisites for the development of the disease);
- congenital abnormalities 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 collagenoccurs), instability of the joint;
- genetic characteristics - hereditary predominance of type 2 collagen, polymorphism of interleukin-1 and interleukin-2 genes.
Modifiable risk factors for deforming osteoarthritis of the right or left shoulder joint are:
- traumatic joint injuries;
- excessive physical activity (strength sports and martial arts, including barbell bench press);
- obesity – for shoulder osteoarthritis, 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 accompanying obesity;
- weakness of the muscular corset of the shoulder joint, especially in people who perform precise activities with their hands (jewelers, dentists, secretaries, writers);
- deficiency of vitamin D, which actively participates 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 osteoarthritis, the main targets of the disease process are the articular cartilage, subchondral bone, and synovium. In affected cartilage, proteoglycan synthesis decreases, fragmentation and cracking of the plaque is observed, exposing the underlying bone. The increase in non-physiological load on the bone leads to its compaction, the appearance of cysts and osteophytes (marginal growths).
Diagnostic
Examination of a patient with pain in the shoulder joint should begin with x-rays. It is important to scan several projections to examine the joint in detail. Images can be taken in direct projection, internal and external rotation position. To assess the soft tissue formations of the joint, especially in the early stage of osteoarthritis, ultrasound of the joint is most informative. If the diagnosis remains uncertain, magnetic resonance imaging/computed tomography of the joint is recommended. In the next step, the preservation of joint functions is assessed.
Expert opinion
All morphological formations of the joint are involved in the pathological process. The main symptom of osteoarthritis is pain in the joint, caused not only by synovitis, but also by bone lesions (osteitis, periostitis), damage to periarticular soft tissues (tendinitis, tenosynovitis, myalgia, enthesopathies, stretching of the joint capsule). , degeneration of the menisci and damage to the neurosensory system (for example, irritation of the nerve trunks by large osteophytes). Therefore, the sooner treatment begins, incl. By changing lifestyle, the more effective the control of the onset of pain will be.
Treatment
At the initial stage of the pathological process, treatment of arthrosis of the shoulder joint is carried out using conservative methods, and in case of severe degeneration of the articular cartilage, surgical intervention (endoprostheses) 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 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 corticosteroids may be used to relieve it.
Intra-articular injection of hyaluronic acid or plasma, incl. enriched in platelets, can have a stimulating effect on the cartilaginous plaque and promote its renewal (this treatment is considered pathogenetic). These injections accelerate the synthesis of collagen and elastin fibers which constitute the basis of cartilage. As a result, the structure of the cartilaginous layer and the synovial membrane improves, which helps to increase the congruence of the joint surfaces. These intra-articular injections help optimize the production of synovial fluid, which not only absorbs shock and hydrates the cartilage, but also improves the metabolic processes of chondrocytes, increasing their internal potential.
After the acute process has subsided, 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 joint structures.
Surgery
The operation is indicated in cases of significant destruction of the cartilaginous plate, which is accompanied by persistent pain and dysfunction of the joint, leading to the inability to take care of oneself and perform professional duties. A modern method of surgical intervention for shoulder osteoarthritis is implantation of an endoprosthesis. At SM-Clinic, the operation is carried out in strict compliance with the methodology using the latest generation endoprostheses. This is the key to achieving the best therapeutic results.
Prevention of osteoarthritis of the shoulder joint
Primary prevention of osteoarthritis 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 are necessary);
- dosed to strengthen the muscular corset of the shoulder girdle;
- Warm up regularly if your work activity involves performing similar shoulder movements.
To prevent the progression of developed shoulder osteoarthritis, the following recommendations are important:
- avoid lifting heavy objects, incl. push-ups with dumbbells;
- carry out repeated courses of therapeutic massage;
- regularly practice health exercises (under the supervision of a physiotherapy specialist).
Rehabilitation
After the stent, a plaster is applied, which provides the necessary degree of immobilization. After the cast is removed, the period of restoration of the functional activity of the joint begins. For this, courses of therapeutic massage, physiotherapy and therapeutic gymnastics under the supervision of a physiotherapy specialist are recommended.
Questions and answers
Which doctor treats shoulder osteoarthritis?
Diagnosis and treatment of the disease is carried out by a traumatologist-orthopedist.
Representatives of which professions most often develop osteoarthritis of the shoulder joint?
Athletes involved in volleyball, tennis, basketball, projectile throwers and loaders are at the greatest risk of degenerative-dystrophic destruction of the cartilaginous layer of the shoulder joint.
Does shoulder pain indicate the development of osteoarthritis?
Indeed, pain is the first 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 make the correct diagnosis and choose treatment.