Shoulder Arthrosis

Arthrosis of the shoulder joint is a chronic disease, which is based on damage to the cartilage tissue, followed by the appearance of bone growths and limited mobility. Most often, elderly people suffer, but hard physical labor and inflammatory processes contribute to the early development of pathology. Without timely treatment, movements in the affected joint are completely blocked.

General information

Cartilage is a smooth layer between the contacting areas of the bones. It ensures their easy sliding relative to each other, guaranteeing free and painless joint work. Excessive stress, inflammation or trauma can trigger a degenerative process that gradually spreads over the entire surface.

As a result, the smoothness of the articular surfaces is disturbed, and the movements begin to cause pain. At the same time, bone growths begin to appear along the edges of the joint, replacing the affected cartilage. As the degenerative process progresses, it involves not only the bones but also the surrounding tissues. The limb is deformed, the muscles spasm, and the ligaments become weak and lose elasticity. Without treatment, the person loses the ability to move the arm.

Classification

Depending on the cause of development, there can be primary and secondary arthrosis. The primary form occurs on its own, most often against the background of excessive overload of the joint. The secondary form is provoked by a third-party pathology, for example, trauma, intense inflammation, metabolic disorders, etc. Both forms of the disease are similar in symptoms.

Causes of shoulder arthrosis

Unlike the knee, ankle and hip joints, the shoulder does not experience significant stress when walking, which is why this form of arthrosis occurs much less frequently. Pathology can be caused by:

• regular excessive physical activity: lifting weights, professional sports, vibration;
• congenital abnormalities of the structure of the shoulder joint and adjacent structures;
• rheumatoid arthritis, systemic lupus erythematosus and other autoimmune diseases;
• congenital weakness of the connective tissue, accompanied by hypermobility of the joints;
• injuries: dislocations, sprains and ligament ruptures, intra-articular bone fractures;
• hormonal changes and disruptions (including pregnancy, menopause);
• inflammatory diseases of the joint and periarticular structures (arthritis, bursitis, etc.);
• metabolic disorders, including gout, diabetes mellitus.

An important role in the predisposition to arthrosis is played by heredity.

Degrees

Doctors identify 3 degrees of deforming arthrosis of the shoulder joint, which determine its symptoms and the choice of treatment tactics:

1. Minimal symptoms: pain occurs only with intense or prolonged exertion and quickly passes after rest, and X-ray reveals subchondral sclerosis of the articular surfaces;
2. The pain becomes much stronger, a person has to use pain relievers to make them feel better; the radiograph shows a pronounced narrowing of the joint space, extensive areas of cartilage destruction, as well as bone growths (osteophytes);
3. Constant intense pain, joint mobility is significantly limited, and the picture shows complete destruction of cartilage tissue, deformation of bone structures and a large number of osteophytes.

Symptoms

The main symptoms of shoulder arthrosis include:

• pain: arises from a decrease in the smoothness of the articular surfaces, the growth of osteophytes and bone deformation; the intensity, duration and nature of sensations depends on the degree of damage;
• crunching is one of the characteristic symptoms of the disease that appears in the early stages; it differs from the physiological in a coarser tonality, and is also often accompanied by pain;
• restriction of mobility: associated with pathological growths and particles of destroyed cartilage inside the joint; at the first stages, it is represented by a slight morning stiffness, later it grows up to complete immobility (ankylosis);
• deformation: a change in the contours of the joint and the hand,  it occurs in the late stages of the disease and indicates the complete destruction of cartilage and the involvement of bones, muscles and ligaments in the pathological process.

The progression of symptoms can take years or even decades, but ultimately arthrosis of the shoulder joint leads to the inability to move the arm and severe pain.

Diagnostics

Diagnosis of shoulder arthrosis requires an integrated approach. To accurately determine the diagnosis and determine the extent of the lesion, the doctor uses the following methods:

• questioning and collecting anamnesis: the patient’s complaints are recorded, the symptoms are determined; the joint damage is clarified;
• examination: the doctor evaluates the joint visually, determines the range of motion, the zone of greatest pain, etc.;
• X-ray and CT: the main diagnostic method that allows you to see the characteristic symptoms of osteoarthritis;
• ultrasound: makes it possible to assess the condition of cartilage, bones, ligaments, joint capsule and muscles;
• MRI: allows you to get virtual slices of all structures of the affected area;
• laboratory diagnostics: a blood test reveals an active inflammatory process, often accompanying arthrosis;
• arthroscopy: examination of the joint from the inside using a camera inserted through a small puncture.

If the disease is secondary, examinations and consultations of narrow specialists on the underlying pathology are mandatory.

Shoulder arthrosis treatment

Treatment of shoulder arthrosis depends on the degree of the lesion: at stages 1 and 2, the disease can be successfully stopped or delayed by the correct selection of drugs. With extensive destruction, the only way to restore mobility and completely stop pain is a surgical operation – arthroscopy with “cleaning” the joint.

Drug treatment

Medical treatment for shoulder arthrosis is aimed at reducing symptoms and restoring cartilage tissue. For this, the following groups of drugs are used:

• non-steroidal anti-inflammatory drugs (diclofenac, ibuprofen, nimesulide, meloxicam, or their derivatives): they block inflammatory reactions and reduce pain; they are available in the form of tablets, ointments, suppositories and injectables;
• hormonal agents (corticosteroids): they are used when NSAIDs are ineffective, have a similar effect; a good effect is provided by drugs of prolonged action, injected directly into the joint cavity;
• antispasmodics, B vitamins: they are used to reduce the muscle spasm that inevitably accompanies advanced arthrosis;
• chondroprotective drugs (chondroitin, glucosamine and their combinations): intended for long-term use, aimed at restoring cartilage tissue;
• drugs that improve microcirculation (nicotinic acid, pentoxifylline, and others): they indirectly stimulate regeneration processes by improving the blood supply to the affected area;
• enzyme blockers: they partially slow down the destruction of cartilage tissue.

The drugs, their dose, frequency of administration and duration of the course are determined only by a doctor! It is important to remember that self-medication can cause accelerated joint degeneration and other side effects.

Physiotherapy

Physiotherapy techniques and exercises greatly facilitate the course of the disease and enhance the effect of drugs. The following procedures have been proven to have a good effect:

• magnetotherapy: relieves pain, relieves inflammation, improves microcirculation and stimulates the regeneration of cartilage tissue;
• shock wave therapy: exposure to acoustic waves of a certain frequency contributes to the destruction of osteophytes, which facilitates movement in the affected joint;
• electrophoresis, phonophoresis: the introduction of drugs (painkillers, chondroprotectors) into tissues using electrical impulses or ultrasound; promotes better absorption of drugs;
• massage and physiotherapy exercises: dosed loads on the joint and intense manual action stimulate blood circulation in the tissues.

Like drugs, physiotherapy, massage and exercise therapy should be prescribed and carried out under the supervision of a specialist.

Surgery

The last stage of shoulder arthrosis is accompanied by severe symptoms and requires surgical treatment. Most of the changes that have occurred as a result of degeneration are irreversible, which is why the only way to restore mobility to a person is endoprosthetics. The affected joint is replaced with a modern prosthesis, which fully takes over its functions. This operation is especially effective in young and middle age, as it allows patients to live without pain for years.

Prevention

Like any joint disease, shoulder arthrosis is easier to prevent than to cure. Orthopedists recommend adhering to the following rules:

• exclude or minimize occupational risk factors (vibration, weight lifting);
• avoid excessive physical inactivity: it is better to choose a moderate training option;
• control nutrition and weight;
• undergo regular examinations to identify possible problems.

Diet

If you have shoulder arthrosis of any degree, it is important to monitor nutrition:

• avoid overeating and excess weight;
• minimize harmful products: fatty, spicy, salty, alcohol, canned food, smoked meats;
• eat a sufficient amount of foods high in collagen (jellied meat, aspic) and omega-3 (fatty fish, olive oils);
• give preference to boiled, steamed or stewed food rather than fried foods;
• reduce the amount of fast-digesting carbohydrates.

The diet should include the required amount of vitamins, minerals and nutrients.

Consequences and complications

Even a slight pain and crunch in the shoulder can turn into unpleasant consequences. Without treatment, arthrosis leads to:

• significant limitation of mobility up to ankylosis (bone fusion);
• severe pain even at rest;
• severe deformity of the shoulder and the entire arm.

Shoulder arthrosis quiz

During the past 4 weeks……

1. How would you describe the worst pain you had from your shoulder?

• None
• Mild
• Moderate
• Severe
• Unbearable

2. Could you brush/comb your hair with the affected arm?

• Yes, easily
• With little difficulty
• With moderate difficulty
• With extreme difficulty
• No, impossible

3. Have you had any trouble dressing yourself because of your shoulder?

• No trouble at all
• Little trouble
• Moderate trouble
• Extreme difficulty
• Impossible to do

4. How would you describe the pain you usually had from your shoulder?

• None
• Very mild
• Mild
• Moderate
• Severe

5. Have you had any trouble getting in and out of a car or using public transport because of your shoulder?

• No trouble at all
• Very little trouble
• Moderate trouble
• Extreme difficulty
• Impossible to do

6. Could you hang your clothes up in a wardrobe, using the affected arm? (whichever you tend to use)

• Yes, easily
• With little difficulty
• With moderate difficulty
• With great difficulty
• No, impossible

7. Have you been able to use a knife and fork at the same time?

• Yes, easily
• With little difficulty
• With moderate difficulty
• With extreme difficulty
• No, impossible

8. Have you been able to wash and dry yourself under both arms?

• Yes, easily
• With little difficulty
• With moderate difficulty
• With extreme difficulty
• No, impossible

9. Could you do the household shopping on your own?

• Yes, easily
• With little difficulty
• With moderate difficulty
• With extreme difficulty
• No, impossible

10. How much has pain from your shoulder interfered with your usual work (including housework)?

• Not at all
• A little bit
• Moderately
• Greatly
• Totally

11. Could you carry a tray containing a plate of food across a room?

• Yes, easily
• With little difficulty
• With moderate difficulty
• With extreme difficulty
• No, impossible

12. Have you been troubled by pain from your shoulder in bed at night?

• No nights
• Only 1 or 2 nights
• Some nights
• Most nights
• Every night