Diagnosis and treatment of glenohumeral periarthritis

Frozen shoulder is a condition characterized by inflammation, scarring, and tightening of the connective tissues surrounding the shoulder joint, resulting in shoulder pain and severely decreased range of motion.

The shoulder joint is a ball joint. There is a notch in the shoulder blade (rosette), and the head of the humerus is spherical. The dense connective tissue surrounding this hinge holds the joint in place and is called the joint capsule. And when inflammation of the joint capsule occurs, then after the inflammatory process resolves, scarring of the capsule tissue occurs and its elastic properties are impaired. This process results in a condition called glenohumeral periarthritis, which typically results in severe loss of range of motion.

Periarthritis of the humeroscapula is most common in people over 40 years of age and tends to occur more often in women than men.

Causes of periarthritis

Although the exact causes are not known, the disease is believed to result from injuries to the shoulder joint or the tissues surrounding it. In these cases, the disease most likely develops due to lack of proper treatment. Quite often, this condition occurs due to insufficient rest during excessive loads or adherence to the principle “pain must be overcome.” The likelihood of this disease is also increased with prolonged immobilization (after injury or surgery). The main factors predisposing to the development of periarthritis are the following:

• history of recent trauma
• history of shoulder surgery
• inadequate treatment after shoulder injury or surgery (especially immobilization for too long)
• diabetes
• autoimmune diseases
• age over 40 years
• bad posture

How to diagnose the disease

If a person experiences pain in the shoulder area or limited mobility, it is recommended to immediately contact an experienced specialist. To diagnose glenohumeral periarthritis, the patient needs to visit a therapist. After examining the patient, the therapist can give a referral for examination by a specialist (surgeon, neurologist, rheumatologist, orthopedist).

An external examination and history taking is complemented by an assessment of the motor activity of the shoulder joint. Also, palpate the area where the inflammatory process occurs. To clarify the diagnosis and determine the cause of this disease, the patient is referred for an X-ray examination. It is necessary to examine the diseased joint and cervical spine. In addition, ultrasound and magnetic resonance imaging may be needed.

Diagnostic measures involve a blood test. In the presence of an acute form of the disease, an increased erythrocyte sedimentation rate and c-reactive protein are detected. Other forms of glenohumeral periarthritis are not detected by blood tests.

If surgical intervention is necessary, the patient may be referred for an invasive diagnostic procedure (arthrography, arthroscopy). It should be borne in mind that such a disease can easily be confused with another pathology that manifests itself with similar symptoms. this means that it is advisable to carry out a differential diagnosis of arthritis, arthrosis, thrombosis of the artery located under the collarbone.

Symptoms

Symptoms associated with the disease glenohumeral periarthritis tend to develop gradually over a period of time (often after recent injury, surgery and/or immobilization). Patients typically experience a dull ache that may intensify and become sharp with certain movements and activities. The pain is usually located deep in the shoulder, but can sometimes be felt in the shoulder, upper back and neck. Patients may also experience stiffness in the shoulder, neck, and back.

The pain associated with this condition can worsen with any movement of the shoulder and with activities that place pressure on the shoulder. These are activities such as: raising your arms up, lifting weights, pulling or pushing movements, being in a position lying on the affected side, placing your hand behind your back. Patients with glenohumeral periarthritis often experience pain at night or after waking up in the morning. As the disease progresses and moves from the painful stage to the frozen shoulder phase, the pain may decrease significantly.

In addition to pain, patients typically experience noticeable stiffness and a significant reduction in the shoulder's range of motion. As a rule, with periarthritis, all movements in the shoulder are limited, but the most reduction in volume is noticeable during rotation and elevation of the arm. This may manifest as difficulty raising your arm or placing your arm behind your back. As this condition progresses from the "frozen" phase to the "unfreeze" phase, the range of motion gradually increases, with a subsequent decrease in joint stiffness. Patients may also develop muscle atrophy in the affected arm, as a decrease in range of motion causes some of the muscles to not work at full strength and this leads to their atrophy. Although glenohumeral periarthritis usually affects only one side, some patients may have bilateral involvement.

The development of glenohumeral periarthritis can be divided into three phases, each of which can last several months:

• Pain - In this first phase of glenohumeral periarthritis, the shoulder becomes painful and most movements are painful. There may also be stiffness in the shoulder.
• “Freezing” is the second stage of this disease and is characterized by severe loss of movement in the shoulder, coinciding with scarring of the shoulder capsule. Patients usually have difficulty raising their arms or placing their arms behind their back. Pain may noticeably decrease during this phase.
• "Unfreezing" - In this final phase, the shoulder spontaneously begins to "loosen" and movement in the shoulder is gradually restored.

Herbal medicine for periarthritis

For scapulohumeral periarthritis, as a treatment with folk remedies, herbal medicine is an excellent addition to medications - the use of herbal infusions. This method consists of preparing decoctions and infusions for drinking or compresses.

There are a huge number of healthy recipes made from natural ingredients. The only contraindication is intolerance to the ingredients of the medicine. Traditional medicine perfectly complements the overall effectiveness of treatment, helps slow the progression of the disease and is often recommended by a doctor.

Before using traditional medicine, you should consult a doctor.

Recipes for medicinal preparations

Among the variety of decoctions and infusions of traditional medicine, you can pay attention to the following options:

1. Decoction of willow bark: to 2 parts of the main component add 1 part each of stinging nettle, tricolor violet and silver birch leaves. Next 4 tbsp. spoons of the crushed mixture are poured into 1 liter of boiling water. The semi-finished decoction should be left to brew overnight and then boil the drink in the morning for no more than 5 minutes and let sit for half an hour. It is recommended to use strained 100 ml 4-5 times a day.
2. Infusion of St. John's wort: brew 1 tbsp in 200 ml of boiling water. spoon of dry herb and infuse. After half an hour, the infusion is ready for use. Recommended dose – 2 tsp. 4–5 times a day.
3. A decoction of currant leaves: a few black currant leaves (2 parts) are mixed with lingonberry, raspberry leaves, and brown rose hips in a proportion of 1 part of all ingredients. The collection of herbs in crushed form (4 tablespoons) is brewed with boiling water (1 liter), left overnight, then boiled for no more than 5 minutes. The broth is allowed to sit for half an hour, filtered and drunk 80 ml up to 5 times a day.

Decoction of black currant leaves

Rubbing

Herbal compositions for rubbing have a good decongestant, local anesthetic and anti-inflammatory effect:

1. Infusion of calendula flowers.
2. Herbal infusions in a combination of mint, buds and leaves of birch, plantain, chamomile, plantain root and burdock, coriander.
3. Pepper infusion.

An infusion of calendula flowers is used for rubbing.
The proper rubbing technique involves smooth, measured movements. To improve warming, you can wrap the sore joint with a warm scarf or cover it with a blanket. Doctors recommend repeating the procedure no more than three times a day until the painful spasms stop completely.

Compresses

Compressotherapy will help provide additional assistance with the development of joint pathology and relieve swelling. Among the compresses that are recommended to effectively relieve inflammation, the following are the most effective:

1. Compress made from grated horseradish root.
2. Chamomile compress based on sweet clover and marshmallow.

You can make compresses from grated horseradish root.
It is recommended to do compresses all night, removing them only after cooling. To preserve the effect of the warm composition for as long as possible, you can wrap the sore spot with film. Treatment methods can be used daily, and the duration of the course depends on the condition of the joint tissues and the doctor’s prescription.

Honey

A honey compress is often used to combat inflammation in the body. A small layer is spread on the skin of the affected area and adjacent areas. Cover with cellophane and wrap in warm wool fabric. It is better to apply the compress at night, remove it in the morning, wipe the skin with a warm damp cloth and wipe dry.

If allergies occur, you can dilute the concentration of honey by combining it with flour or potato starch. This will reduce the effects of an allergic nature and preserve the medicinal properties of the component.

Recipes with salt

The use of salt helps relieve swelling and strengthen joints due to sodium chloride. You can use table and sea salt. In addition to the main substance, sea salt contains essential microelements:

1. Magnesium – prevents the destruction of nerve cells.
2. Calcium is responsible for bone strength.
3. Manganese – increases protective properties.
4. Iron – improves nutrition of joints.
5. Selenium – destroys tumor cells.

Sea salt in a compress will help relieve swelling
. To prepare the salt dressing:

1. 150 g of salt are dissolved in 1 liter of water.
2. A clean gauze cloth is immersed in a saline solution for 4 hours, which is later heated.
3. The soaked fabric is taken out, wrung out and applied to the sore shoulder.
4. The gauze compress is wrapped on top with a cloth made of warm material.

The effectiveness of treatment is achieved after 10–14 days.

Diagnostics

As a rule, to make a diagnosis of glenohumeral periarthritis, an examination by a doctor and the patient performing certain functional tests are sometimes sufficient. Additional research methods such as ultrasound or MRI make it possible to visualize the altered connective tissue of the joint capsule and confirm the doctor’s preliminary diagnosis. In addition, laboratory tests are advisable to exclude possible other diseases. The most informative diagnostic method is MRI, which allows you to clearly visualize not only the joint capsule, but also morphological changes in all tissues of the joint.

SYMPTOMS OF PERIARTHRITIS

• Pain that feels like it is in the joint itself: limits movement, does not bother you at rest. Rotations are especially difficult. Burning pain appears in some positions of the limb.
• Mild swelling of the tissues over the affected joint; in acute periarthritis, a local increase in temperature is felt.
• Muscle spasm around the source of pain is noticeable.
• Sometimes the sensitivity of the areas around the joint disappears.
• In severe forms of post-traumatic periarthritis, fluid often accumulates around the joint - serous exudate.

Treatment

The goal of treating glenohumeral periarthritis is to reduce pain and maintain mobility in the shoulder. However, recovery of full shoulder function may take a long time, and symptoms may persist for several years.

Conservative treatment

Drug treatment. The most widely used drugs are NSAIDs, such as ibuprofen, voltaren, movalis, etc. For severe pain, prescription analgesics (for example, containing codeine) can also be used. Intra-articular injections of steroids can quickly relieve the inflammatory process and reduce pain during periarthritis. But frequent steroid injections are not recommended as they may cause damage to the shoulder tissue.

Transcutaneous electrical neurostimulation can significantly reduce pain.

Physiotherapy. There are many physiotherapeutic procedures that can improve blood circulation in a damaged joint capsule, reduce inflammation and reduce pain.

Exercise therapy. A carefully chosen exercise program can prevent and even relieve shoulder stiffness.

Shoulder manipulation under anesthesia allows you to increase range of motion.

Surgical treatment and periarthritis

Indicated in cases where conservative treatment is not effective. The operations are performed using arthroscopic techniques, during which excision (removal) of scar tissue and adhesions or osteophytes is performed. Given the minimally invasive nature of such surgical techniques, the patient after arthroscopic surgery is discharged on the same day.

Therapeutic baths

To improve the general condition of joints, ligaments and cartilage, you can perform procedures based on herbal baths. An example of a remedy for periarthritis is hay dust. It’s easy to prepare a bath solution:

1. Bring 500 g of hay dust to a boil in 10 liters of water over medium heat.
2. Immediately after boiling, the solution is removed from the heat and left for 40 minutes.
3. Pour the filtered infusion into a heated bath (37–38 degrees) and take it for 20 minutes.
4. Baths with hay dust are recommended to be carried out daily for 7 days.

Prognosis and prevention

In most cases, glenohumeral periarthritis heals within a few months. In severe cases, symptoms may last for 18 months or longer. Typically, the painful stage of glenohumeral periarthritis lasts 2 to 6 months. The frozen phase is approximately 4 -12 months, while the defrosting phase can last another 4 - 18 months. In some cases, patients may experience some restrictions in movement after completing all three stages. However, in most cases the prognosis for glenohumeral periarthritis is good. Prevention of this disease is timely consultation with a doctor if shoulder pain occurs (especially after an injury) and systematic physical activity, which minimizes the risk of such conditions and helps maintain mobility and flexibility in the shoulder joint.

Causes of the disease

Humeroscapular periarthritis is a collective term, behind which there are different official diagnoses, since the causes of the disease can vary greatly. Most often diagnosed: calcific tendinitis; shoulder bursitis, biceps tendonitis, subacromial syndrome, adhesive capsulitis and some others. However, in clinical practice it is more convenient to combine them all according to the location of the affected area, due to the similarity of diagnosis and treatment.

The reasons for its occurrence are:

• Neurodystrophic changes in tendon fibers, which are usually associated with diseases of the spine. Inflammatory and degenerative processes in the tendons, circulatory failure in the shoulder joint, pinched nerves, reflex vascular spasms are usually the result of mixing of intervertebral discs, spondylosis, osteochondrosis and other pathologies of the cervical spine.
• The disease can develop as a result of mechanical damage (bruises, dislocations, fractures, sports and work injuries), excessive loads, systematic traumatic effects on the shoulder joint, ligaments, tendons and soft tissues of the shoulder.
• The cause of the disease can also be various pathologies of internal organs, chronic and infectious diseases. For example, the development of the disease is facilitated by the presence of diabetes mellitus, damage to the cardiovascular system, heart attack, angina pectoris, and tuberculosis in the patient.

Pharmacological drugs

Drug treatment of periarthritis of the shoulder joint is to improve the patient’s well-being and prevent the spread of the inflammatory process to healthy tissue. To quickly relieve severe, piercing pain, the appearance of which is characteristic of the acute form of the pathology, drug blockades are carried out. Two groups of drugs are commonly used:

• anesthetics Novocaine, Lidocaine;
• glucocorticosteroids Diprospan, Flosteron, Kenalog, Hydrocortisone, Dexamethasone.

The best therapeutic effect is obtained by combining them with subsequent periarticular administration. Hormonal drugs are toxic to bone tissue and internal organs, therefore, if possible, they are replaced with non-steroidal anti-inflammatory drugs. NSAIDs in the form of injection solutions for intramuscular administration (Diclofenac, Ortofen, Ketorolac) are used to relieve acute pain and inflammation. Tablet forms (Nise, Ketorol, Nurofen, Celecoxib) are included in treatment regimens to eliminate pain of moderate intensity. And ointments and gels help get rid of mild discomfort - Voltaren, Fastum, Dolgit, Indomethacin, Artrosilene.

To resolve swelling, compresses with dimexide, medical bile, and magnesium sulfate are used.

How does periarthritis manifest?

Joint pain with periarthritis does not appear immediately. If the onset of the disease was caused by an injury, pain may occur after a couple of days. Initially, the pain is mild, intensifying with movement in the joint.

As the inflammatory process develops, if left untreated, periarthritis can become acute. It is characterized by severe pain that radiates beyond the boundaries of the joint. For example, with humeroscapular periarthritis, pain can radiate to the arm and neck, and with knee periarthritis, pain can radiate to the hip area.

Local pain during periarthritis intensifies with pressure and may be accompanied by swelling and swelling in the joint area.

Clinical picture

The leading symptom of periarthritis is shoulder pain. Its intensity depends on the stage of the pathology, the degree of inflammatory-degenerative damage to connective tissue structures. Periarthritis is characterized by the constant presence of painful sensations, the severity of which increases significantly with lifting heavy objects or increasing physical activity. The pain does not subside even at night and in the early morning hours. They become “gnawing”, aching, pressing, and radiate to the forearms. In the morning, a person feels sleep-deprived and exhausted. Periarthritis is often accompanied by pain in the cervical spine, regardless of whether osteochondrosis was the cause of its development.

The constant feeling of pain and the expectation of its intensification lead to a deterioration in psycho-emotional and physical condition. There are problems with falling asleep, neurological disorders, apathy, weakness, and fatigue appear. In an acute inflammatory process, the clinical picture is supplemented by symptoms of general intoxication of the body:

• body temperature rises to subfebrile levels (37-37.9°);
• headaches, dizziness, and dyspeptic disorders occur.

The disease may disappear without medical intervention after several months or years. But during its course, numerous complications develop that remain after recovery. One of them is contracture, or limitation of the range of passive and active movements. Often surgery is required to eliminate it.

Folk remedies for internal use

To treat periarthritis of the shoulder joint, folk remedies are used in the form of infusions and aromatic teas from medicinal plants. They have a strengthening, tonic effect, increase local and systemic immunity, and mobilize the body to fight pathology. It should be borne in mind that drinking tea with oregano and lemon balm relaxes, causes drowsiness, and reduces concentration and attention.

Traditional healers advise preparing medicinal drinks based on large-leaf green tea. The tea leaves contain a high concentration of almost all microelements necessary for the restoration of tissues damaged by inflammation. It contains a lot of bioflavonoids that stimulate blood circulation and microcirculation, and phytoncides that increase the body's resistance to infectious agents. How to prepare healing tea:

• rinse the ceramic teapot with boiling water, add 0.5 teaspoon of green tea, a pinch of grated ginger root, a teaspoon of dry plant material;
• brew with 2 glasses of hot water (temperature about 95-97°C), leave for 15 minutes;
• strain, drink instead of regular tea with honey, jam, preserves.

Large leaf tea.

St. John's wort, elecampane, yarrow, fireweed, and cinquefoil are used as herbal raw materials in the treatment of ligaments, tendons, and muscles. They are also used to prepare stronger infusions. Pour a tablespoon of a mixture of dry herbs into a glass of boiling water and keep it covered for 2 hours. Strain, take 0.3 cups after meals 3-4 times a day. With exacerbation of shoulder periarthritis, the quality of sleep decreases due to pain, weakness and psycho-emotional instability occur. Therefore, it is advisable to drink tea with oregano, lemon balm, mint or thyme at dinner.

Before treatment, it is necessary to establish the cause of the pathology. Inflammation of the shoulder joint occurs more often due to excessive physical activity that exceeds the strength of the muscles and tendons. But often the disease is provoked by endocrine disorders (diabetes mellitus, thyrotoxicosis). In such cases, simultaneous treatment of shoulder periarthritis and the underlying disease is carried out.

Consequences of periarthritis:

• The walls of the periarticular bursa become encapsulated, and calcifications appear in the tissues. Because of this, the mobility of the limb is limited. Even if there is no significant pain, the joint is still not able to move in the same range of motion.
• Due to the restriction of movement, joint tissues change pathologically, tighten, and lose elasticity - these are contractures.
• The nutrition of tissues not only around the joint is disrupted. Bones and ligaments become fragile, and the risk of osteoporosis and arthrosis increases.