Osteoarthritis of the shoulder joint is a dystrophic lesion of the cartilaginous plate covering the articular surfaces of the joint, resulting in involvement of 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 ligament system, 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 arthrosis. This condition is characterized by the following symptoms: chronic pain, decreased range of motion of the joint, intra-articular crunch during rotation. Most often, people over the age of 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, image examination methods are informative: ultrasound and X-ray scanning, computed tomography and magnetic resonance imaging.
In accordance with clinical recommendations, treatment of the disease in the initial 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 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 thorough 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 the joint anatomy).
Doctors judge the speed of progression of the disease 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 occurs. From a morphological point of view, there are 6 degrees of arthrosis of the shoulder joint:
- first degree: the cartilaginous matrix swells and disintegrates, but the integrity of the superficial 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 area of the cartilaginous plate gradually exfoliates, erosive defects form and cystic cavities appear in the underlying bone;
- fifth degree: in this phase the underlying bone is exposed;
- sixth degree: the subchondral zone thickens significantly, the cysts become more pronounced and marginal bone growths appear.
Symptoms of arthrosis of the shoulder joint
The main clinical signs of shoulder arthrosis are pain, stiffness of the joint up to complete loss of mobility and deformation of the joint.
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 the stagnation of venous blood in the intraosseous channels;
- the presence of blockages - sudden jams in the joint due to the separation of separate osteochondral fragments that fit between the joint surfaces;
- climate dependence: the pain intensifies when the weather changes (in humid and cold climates, the pain becomes more intense).
Osteoarthritis is a chronic disease. In the initial stage of the disease, pain appears periodically (at the time of exacerbation of the disease). The speed of progression of the pathology is determined by the timeliness of starting treatment and the adequacy of lifestyle modification. Shoulder pain becomes chronic if it persists for 6 months or longer. The transition from acute to chronic pain indicates the progression of the pathological process.
Causes of arthrosis of the shoulder joint
The causes of arthrosis of the shoulder joint are classified into 2 groups:
- editable – correction is possible;
- not modifiable: it is not possible to influence their action.
Non-modifiable factors that may increase the risk of developing arthritic 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 among representatives of both sexes becomes approximately the same;
- the age of the person - the older the patient, the greater the risks (and from about 30 years in cartilage tissue the process of degeneration proceeds faster than the process of regeneration, which creates the prerequisites for the development of the disease);
- congenital anomalies of the structure of the shoulder - 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: hereditary predominance of type 2 collagen, polymorphism of interleukin-1 and interleukin-2 genes.
Modifiable risk factors for deforming arthrosis 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 increased mechanical load, but the metabolic changes occurring 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);
- deficiency 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 metabolism of calcium-phosphorus in the body;
- hormonal imbalance – thyroid disease, diabetes, etc. ;
- smoking – both active and passive.
In shoulder osteoarthritis, 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 rupture 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).
Diagnostics
Examination of a patient with pain in the shoulder joint should begin with x-rays. It is important to scan in several projections to examine the joint in detail. Images can be taken in direct projection, in the internal and external rotation position. To evaluate the soft tissue formations of the joint, especially in the initial stage of arthrosis, ultrasound scanning of the joint is more informative. If the diagnosis remains unclear, magnetic resonance imaging/computed tomography of the joint is recommended. In the next phase, the preservation of the joint functions is evaluated.
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, 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 (for example, irritation of the nerve trunks by large osteophytes). Therefore, the earlier treatment begins, incl. by changing your lifestyle, the more effective the control over 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 with 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 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 corticosteroid medications may be used to relieve it.
Intra-articular injection of hyaluronic acid or plasma, incl. enriched in platelets, it can have a stimulating effect on the cartilaginous plaque and promote its renewal (this treatment is considered pathogenetic). These injections help accelerate the synthesis of collagen and elastin fibers that form the basis of cartilage. As a result, the structure of the cartilaginous layer and 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 metabolic processes in chondrocytes, increasing their internal potential.
After the acute process has calmed down, 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 case of significant destruction of the cartilaginous plate, accompanied by persistent pain and dysfunction of the joint, leading to the inability to take care of oneself and carry out professional tasks. A modern method of surgical intervention for shoulder arthrosis is the implantation of an endoprosthesis. At the SM-Clinic the operation is performed in strict compliance with the methodology using the latest generation 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 is aimed at maintaining optimal metabolism in the osteochondral compartment. For this reason we recommend:
- maintain normal body weight;
- adequately compensate for endocrine disorders in the body (consultation and dynamic monitoring by an endocrinologist is required);
- dosed strengthen the muscular corset of the shoulder girdle;
- Warm up regularly if your professional activity involves performing similar movements in the shoulder.
To prevent the progression of developed shoulder osteoarthritis, the following recommendations are important:
- avoid lifting heavy objects, incl. barbell push-ups;
- conduct repeated courses of therapeutic massage;
- regularly engage in health-improving gymnastics (under the supervision of a physiotherapy specialist).
Rehabilitation
After the endoprosthesis, a plaster cast is applied which provides the necessary degree of immobilization. After removal of the cast, the period of restoration of the functional activity of the joint begins. For this purpose, courses in therapeutic massage, physiotherapy and healthy gymnastics are recommended under the supervision of a physiotherapy specialist.
Questions and answers
Which doctor treats arthrosis 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 chargers 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, arthrosis, damage to the rotator cuff muscles, etc. A qualified orthopedic traumatologist will help you establish the correct diagnosis and select treatment.