Shoulder joint arthropathy is a dystrophic lesion of the cartilage plate covering the articular surfaces of the joint, with subsequent involvement of the underlying bone.
About the disease
With this disease, not only the cartilage layer and the subchondral bone are affected. The pathological process gradually also involves the joint capsule and ligamentous apparatus, the synovial membrane, the myotendinous compartment, as well as the subacromial region.
Arthritis 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 tingling during rotation. Most often, people over 40 are subject to this transformation.
The main symptoms of arthrosis of the shoulder joint are pain and limited mobility of the arm. To verify the diagnosis, imaging methods are informative - ultrasound and X-ray, computed tomography and magnetic resonance imaging.
According to 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 the patient's self-care is weakened, joint replacement is indicated.
Joint types of the shoulder joint
According to the classification, the following types of joints of the shoulder joint are distinguished:
- primary arthropathy, in the development of which genetics plays a large role, and even the most thorough examination does not allow us to identify the most important cause of the disease.
- secondary arthropathy, which is a consequence of the action of adverse factors on the joint (trauma, endocrine diseases, disorder of the joint anatomy).
Doctors judge the rate of progression of the pathological process by 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 articulation of the shoulder joint:
- first degree - the cartilage matrix swells and disintegrates, but the integrity of the surface zone of the cartilage is not yet compromised.
- second degree - the cells of the cartilage tissue located in the deep layers are affected, the surface plate of the cartilage is damaged.
- third degree - vertical cracks appear in the cartilage plate.
- fourth degree - the surface zone of the cartilage plate is gradually exfoliated, 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 borderline bone growths appear.
Arthritis symptoms of the shoulder joint
The main clinical signs of shoulder arthrosis are pain, stiffness in the joint to the point of complete loss of mobility, as well as joint deformity.
Distinctive features of pain with deforming arthropathy are:
- occur at the beginning of bending, extension or rotation.
- increased during physical activity.
- nocturnal character due to stagnation of venous blood in the intraosseous channels.
- the presence of blockades - sudden involvement in the joint due to the separation of separated osteochondral fragments between the articular surfaces.
- weather dependence - the pain intensifies when the weather changes (in wet and cold climates, the pain becomes more intense).
Arthritis 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 early initiation of treatment and the adequacy of lifestyle modification. 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 arthrosis of the shoulder joint
The causes of shoulder joint arthrosis are classified into 2 groups:
- modifiable - correction is possible.
- unmodifiable - it is not possible to influence their action.
Non-modifiable factors that may increase the risk of developing arthropathy changes in the shoulder joint include:
- gender - up to the age of 50, women are less vulnerable 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 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), dysplasia of connective tissue (usually, articular cartilage is represented by type 2 collagen fibers, with dysplasia, replacement with less resistant types of collagen), instability of the joint.
- genetic characteristics - hereditary dominance of collagen type 2, polymorphism of interleukin-1 and interleukin-2 genes.
Modifiable risk factors for osteoarthritis of the right or left shoulder joint are:
- traumatic joint damage;
- excessive physical activity (strength sports and martial arts, including barbell benching)
- obesity – for shoulder arthropathy, the important factor is not the increase in mechanical load, but the metabolic changes that occur in the connective tissue, including a state of chronic inflammation that accompanies obesity.
- weakness of the muscle corset of the shoulder joint, especially in those people who perform precise activities with their hands (jewelers, dentists, secretaries, writers).
- vitamin D deficiency, 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 – active and passive.
In shoulder arthropathy, 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 is reduced, fragmentation and cracking of the plate is observed, exposing the underlying bone. The increasing abnormal load on the bone leads to its compression, the appearance of cysts and osteophytes (marginal growths).
Diagnostics
The examination of a patient with shoulder joint pain should begin with radiographs. It is important to scan in multiple views to examine the joint in detail. Images can be taken in direct view, in internal and external rotation positions. To evaluate the soft tissue formations of the joint, especially in the initial stage of the joint, the ultrasound scan of the joint is more informative. If the diagnosis remains unclear, MRI/CT of the joint is recommended. In the next stage, the maintenance of joint functions is evaluated.
Expert opinion
All morphological formations of the joint are involved in the pathological process. The main symptom of osteoarthritis is pain in the joint area, caused not only by arthritis, but also by bone damage (osteitis, periostitis), peri-articular soft tissue damage (tendonitis, tendinitis, myalgia, enthesopathies, stretching of the synovial capsule). , degeneration of the menisci and involvement of the neurosensory system (for example, irritation of nerve trunks by large osteophytes). Therefore, the sooner treatment is started, incl. modification of the lifestyle, the more effective the control of the onset of pain will be.
Treatment
At the initial stage of the pathological process, the treatment of arthrosis of the shoulder joint is carried out by conservative methods, and with severe degeneration of the articular cartilage, surgical intervention (endoprosthetic) is indicated.
Conservative therapy
During the period of exacerbation of the process, the first priority is pain relief. Non-steroidal anti-inflammatory drugs are most often used for pain relief. 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, including platelet-rich, can have a stimulating effect on the cartilage plate and promote its renewal (this treatment is considered pathogenic). These injections help speed up the synthesis of the collagen and elastin fibers that form the basis of cartilage. As a result, the structure of the cartilage layer and synovial membrane is improved, which contributes to increasing the uniformity of the joint surfaces. These intra-articular injections help to optimize the production of synovial fluid, which not only absorbs shock and hydrates the cartilage, but also improves the metabolic processes in the chondrocytes, increasing their internal potential.
After the acute process subsides, physiotherapeutic methods of rehabilitation (pulse currents, ultrasound and laser therapy) can be used as part of complex treatment. These procedures have a complex positive effect on 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, leading to the inability to take care of oneself and perform professional tasks. A modern method of surgery for shoulder arthropathy is endoprosthesis implantation. At SM-Clinic, the operation is carried out with strict adherence to the methodology using the latest generation endoprostheses. This is the key to achieving the best therapeutic results.
Prevention of arthropathy of the shoulder joint
Primary prevention of shoulder joint arthropathy is aimed at maintaining optimal metabolism in the osteochondral compartment. For this it is recommended:
- maintaining a normal body weight.
- to adequately compensate for endocrine disorders in the body (consultation and dynamic monitoring by an endocrinologist is required).
- dosed strengthening of the muscle corset of the shoulder girdle.
- Warm up regularly if your job involves performing similar shoulder movements.
To prevent the progression of developed shoulder arthropathy, the following recommendations are important:
- avoid lifting heavy objects, eg bar push-ups;
- conducting repeated courses of therapeutic massage.
- regularly engage in exercise to improve health (under the supervision of a physical therapist).
Reform
After the endoprosthesis, plaster is applied, which provides the necessary degree of immobilization. After the removal of the cast, the period of restoration of the functional activity of the joint begins. For this, therapeutic massage, physiotherapy and health improvement exercise classes under the supervision of a physiotherapist are recommended.
questions and answers
Which doctor treats arthropathy of the shoulder joint?
The diagnosis and treatment of the disease is done by a traumatologist-orthopedic.
Representatives of which professions most often develop arthropathy of the shoulder joint?
Athletes involved in volleyball, tennis, basketball, shot putters, 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 arthritis?
Indeed, pain is the main sign of arthropathy. However, pain can also be a manifestation of other diseases - adhesive capsulitis, osteoarthritis, damage to the rotator cuff muscles, etc. A specialized orthopedic traumatologist will help you make the correct diagnosis and choose the treatment.