Osteoarthritis of the shoulder joint: causes of development, symptoms, treatment
The content of the article:
- Reasons for the development of DOAPS
-
The mechanism of development of the disease
- Impaired metabolism of cartilage tissue
- Formation of cysts, microcracks and osteophytes
- DOAPS symptoms
- Diagnosis of the disease
-
Shoulder DOA treatment
- Conservative treatment
- Surgery
- Video
Osteoarthritis of the shoulder joint (DOAPS) is a slowly progressive destruction of articular cartilage with the gradual involvement of all tissues of the joint, bones and muscles in the process. It is accompanied by pain, deformity and restriction of mobility in the affected area.
In osteoarthritis, all tissues of the articulation, bones and muscles are gradually involved in the process of destruction of the articular cartilage.
Osteoarthritis (DOA) is the most common orthopedic disease in people over the age of 40. It is more common in women, which is explained by the structural features of the connective tissue and age-related changes in hormonal levels (menopause). In recent years, there has been a tendency to rejuvenate the disease. Signs of cartilage destruction are found in young men or even children.
The joints are more susceptible to degenerative changes, which during their life received a great load:
- knee;
- hip;
- first metatarsophalangeal;
- interphalangeal joints of the hands.
The fact that the shoulder joint is affected is in most cases associated with professional or sports activities. Cartilage destruction occurs more often on the right than on the left arm.
Reasons for the development of DOAPS
The immediate cause of the development of osteoarthritis of any localization is the chronic mechanical overload of the joint, which it is unable to withstand.
One of the risk factors for the development of pathology is excessive sports loads
Risk factors for developing osteoarthritis of the shoulder joint:
- professional activity: work of the same type with static tension of the shoulder girdle;
- the presence of dysplasia: a congenital defect that violates statics;
- chronic diseases such as rheumatoid arthritis;
- humerus periarthritis;
- excessive sports loads;
- violation of microcirculation: associated with poor venous outflow;
- changes in the metabolism of cartilage tissue: chondroitin sulfate is gradually washed out of the cartilage, and the concentration of sulfopolysaccharides in the synovial fluid decreases;
- changes in the structure of the synovial fluid, namely the deterioration of its lubricating function;
- age-related changes in tissues;
- hereditary predisposition;
- obesity and endocrine diseases;
- the consequences of injuries and surgical interventions in the shoulder area;
- fracture of the humerus with the extension of the fracture line to the articular surface.
The mechanism of development of the disease
Impaired metabolism of cartilage tissue
In the initial stages of the disease, a gradual disruption of the metabolism of cartilage tissue occurs. Destruction processes prevail over restoration. Over time, tissues lose elasticity, thicken and become more fragile.
Hyaluron disappears from the synovial fluid, it ceases to perform its cushioning and lubricating function. Cartilage resists mechanical stress ever worse, becomes thinner, cracks, irregularities and roughness form on its surface.
Broken off cartilage particles float freely in the synovial cavity, thereby hindering movement, further injuring the cartilaginous surfaces. Over time, ulcerative defects with bone exposure are formed there.
The bone located under the cartilage is under increased stress, as a result of which subchondral sclerosis develops. Degenerative changes in bone lead to venous congestion, further deterioration of cartilage nutrition.
Formation of cysts, microcracks and osteophytes
As a result of chronic insufficiency of blood flow, oval defects (cysts) form on the surface of the bone. This leads to a decrease in bone strength.
In places of contact of cartilage with soft tissues (capsule, ligaments), bone growths occur - osteophytes, which further limit the mobility of the shoulder.
Constant pain causes reflex muscle spasm, which in turn increases pressure on the articular surface and aggravates discomfort. A vicious circle is formed.
DOAPS symptoms
The clinical picture of pathology depends on the severity of the disease. Osteoarthritis is not characterized by an acute onset.
Pain is a characteristic symptom of DOAPS.
Signs of arthrosis of the shoulder joint:
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pain (discomfort): in the initial stages of the disease, discomfort occurs after prolonged exertion and quickly disappears after its termination.
As the disease progresses, starting pains appear - discomfort at the beginning of movement (more often in the morning). In advanced stages, night pains join, as a sign of secondary changes in all structures of the joint;
- irradiation of pain along the muscles (sometimes to the fingertips): this is caused by reactive tendobursitis and synovitis;
- a symptom of crepitus (crunching) when moving;
- swelling of the affected shoulder after sleep: caused by impaired venous outflow;
- limitation of movement: decreased range of motion, especially up and back;
- the presence of muscle contractures: severe spasm caused by pain that limits movement in the affected joint;
- joint deformity, muscle wasting: occurs in the late stage of the disease.
The severity of symptoms depending on the degree of the disease:
| Sign | Osteoarthritis of the shoulder joint 1 degree | Osteoarthritis of the shoulder joint 2nd degree | Shoulder osteoarthritis grade 3 |
| Pain | With prolonged load | It is sharply expressed during normal exertion, after sleep, irradiation along the muscles is characteristic | Constant, increases with movement |
| Crepitus | May be absent | Hearable, intensity may decrease after walking | Can be clearly heard in the distance |
| Amplitude of motion | Not limited, but pain may be present in extreme positions | Reduced | Sharply limited, to the point of immobility |
| Deformation | No | On palpation, bone growths are felt, swelling may occur | Sharply expressed, the axis of the limb is broken |
| Contractures | No | Weakly expressed, of muscular origin. Pass after unloading the joint | Persistent, accompanied by muscle wasting and even greater limitation of mobility, shortening of the limb |
| X-ray changes | Slight narrowing of the joint space, small bony growths, areas of cartilage ossification | The joint gap is narrowed 2-3 times, rough bone growths, subchondral osteosclerosis, bone cysts | The joint gap is almost completely absent, the articular surfaces are sharply deformed, osteoporosis against the background of gross sclerosis |
Diagnosis of the disease
The diagnosis of DOA can only be established by a doctor after a thorough examination, questioning and additional research. The most characteristic sign of a shoulder joint lesion is the inability of the patient to close his hands behind his back.
A clinical analysis of blood and urine in this case is not very informative. Even in the presence of reactive inflammation, the erythrocyte sedimentation rate (ESR) does not increase more than 20-25 mm / hour.
Diagnosis can be confirmed with X-ray
To confirm the diagnosis, the patient needs to undergo the following examinations:
- Ro- graphy of the affected area: the most accessible and inexpensive method;
- ultrasound: allows you to assess the condition of all tissues and measure the thickness of the cartilage;
- analysis of synovial fluid: reflects the processes that occur in the cartilage tissue and synovium;
- MRI or CT: allows you to identify the smallest changes in the cartilage at the initial stage;
- densitometry: determination of bone density.
Shoulder DOA treatment
All therapeutic methods for this pathology are aimed at reducing pain, slowing down the processes of cartilage degradation and improving the patient's quality of life.
How to treat pathology is determined by the doctor, the amount of therapy is selected for each patient individually and depends on the following factors:
- localization of the lesion;
- the severity of the course of the disease;
- general state;
- the presence of chronic diseases.
Conservative treatment
Components of conservative treatment:
- unloading of the joint;
- drug therapy;
- physiotherapy;
- physiotherapy measures;
- orthopedic treatment.
Manual and traction therapy is indicated for unloading the joint.
Unloading the joint involves a moderate limitation of the load, wearing a special fixing bandage, and conducting manual and traction therapy (elimination of pathological muscle spasm).
Physiotherapy methods are widely used as part of complex treatment.
Physiotherapy treatment is most effective in stages 1–2 of the disease and includes:
- UHF (ultra high frequency therapy);
- phonophoresis;
- magnetotherapy;
- mud therapy;
- radon and hydrogen sulfide baths.
The choice of drugs and the method of their administration is based on the severity of the pathology
Medication therapy for osteoarthritis is usually limited to the following drugs:
- non-steroidal anti-inflammatory drugs in the form of ointments, patches, tablets or suppositories: preference should be given to COX-2 inhibitors, which do not affect the gastric mucosa and are suitable for long-term use;
- long-acting glucocorticosteroids: used intra-articular;
- hyaluronic acid preparations: injected into the joint cavity;
- chondroprotectors: course reception.
The complex of exercise therapy (physiotherapy exercises) includes:
- a special set of exercises depending on the affected area;
- massage of regional muscles;
- classes in the pool, therapeutic swimming.
Surgery
Surgical intervention is indicated for patients with stages 2–3 of the disease, in whom conservative methods of therapy were unable to slow down the process of cartilage destruction, severe pain syndrome persists, deformity increases and joint function decreases.
Modern surgical techniques suggest a low risk of complications, relatively quick recovery of functions (6–12 weeks). Endoprosthetics allows patients to return to their previous life and even resume moderate exercise.
Video
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Anna Kozlova Medical journalist About the author
Education: Rostov State Medical University, specialty "General Medicine".
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