Osteosclerosis of bones: symptoms, causes and treatment of the disease

What is osteosclerosis?

Bone consists of a number of structural elements - osteons, which fold into trabeculae (bone crossbars). They are visible on an x-ray or cross-section with the naked eye.

Based on the position of the trabeculae, two types of bone substance are distinguished - spongy (bone beams are laid loosely, absorbs the load) and compact (dense structure, can withstand heavy weight).

Osteosclerosis is the growth of a dense, compact substance, with thickening and compaction of the areas where it is physiologically located and displacement of the spongy substance. At the same time, the bone becomes denser and less elastic, resists stress less well, and is susceptible to pathological fractures.

Development of osteosclerosis

Osteosclerosis of articular surfaces can also be physiological - it accompanies the growth and ossification of the skeleton in childhood and recovery from injuries.

General information

Osteosclerosis is a pathological condition caused by an increase in bone density and thickening of bone trabeculae (beams), a decrease in the volume of bone marrow cells as a result of excessive formation of bone components, as well as compact substance.
It develops under conditions of imbalance in the functional viability of osteoclasts and osteoblasts - when synthesis processes prevail over destruction processes. Osteosclerosis can be physiological - it is noted during the development of skeletal structures in growth zones, but it is pathological osteosclerosis that is dangerous, since it leads to a decrease in the elasticity of bone formations.

Schematic representation of normal bone and osteosclerosis

Osteosclerosis may be accompanied by benign dysplasia ( melorheostosis ), inhomogeneity and spotty ossification ( osteopoikilosis ), myelofibrosis, increased fragility and failure of bone marrow tissue as in osteopetrosis . Moreover, narrowing of the bone marrow canal and its complete obliteration due to thickening of the cortical layer is possible.

Osteosclerosis occurs in the form of genetic diseases, including marble disease , which develop in childhood, as well as in the form of adult osteomyelosclerosis, which is characteristic mainly of older people.

Types of osteosclerosis

There are several types of osteosclerosis depending on the causes and characteristics of the lesion:

• physiological (ossification of growth zones in children);
• pathological (all other cases);
• congenital (increased bone density, osteopetrosis - premature closure of growth zones);
• acquired (the result of injury, inflammation or tumor).

Also by type of localization and prevalence:

• uniform (affects the entire bone or a large area);
• spotted (affects several small areas);
• local or local (occupies an area of ​​bone tissue, may be associated with loads in a certain area);
• limited (occupies an entire area of ​​the bone);
• widespread (the process affects several bones);
• systemic - lesions are noted far from each other throughout the skeleton.

Osteoarthritis of the hands

Some types of pathology deserve special attention. Subchondral osteosclerosis develops with osteoarthritis, a joint disease that is accompanied by degradation of cartilage tissue.

Such osteosclerosis is considered a characteristic diagnostic sign. Damage to the spinal endplates is a diagnostic sign of osteochondrosis.

Foci of osteosclerosis in the bones

Pathological foci are visible on an x-ray in the form of lighter areas (on an x-ray – darkening) of denser bone tissue in the patient’s body without clear boundaries. Their shape and size may vary depending on the form of the disease.

Foci of osteosclerosis on an x-ray image

Pathogenesis

The mechanism of osteosclerosis is based on the opposite condition to osteoporosis , reflecting reparative processes in the bone - in the form of an increase in the bone-forming ability of osteoblasts. This nonspecific reaction in the form of an increase in bone mass occurs due to periosteal and endosteal ossification in response to various diseases, injuries and processes in the body. To stimulate true osteosclerosis, pathological processes are sufficient, the substrate of which is located in the spaces between the bone beams.

In addition to pathological changes in the bone—thickening of the trabeculae and compact substance—cancellous bone tissue also undergoes changes, taking on the appearance of a narrow-loop structure or a compact mass.

Diagnostics

Which doctor should I consult for osteosclerosis? If you have complaints, you should start with a therapist. Most likely, he will write out a referral to a surgeon or traumatologist. The treatment of the disease is carried out by an orthopedic doctor, who may request consultations with a surgeon, infectious disease specialist, traumatologist and oncologist, if necessary.

Radiography plays an important role in the diagnosis of osteosclerosis. The appearance of moderate foci of denser tissue on X-ray examination is a sufficient reason to begin treatment.

If necessary, a sample may be taken for a biopsy (for cancer testing). Densitometry helps determine the mineral density of bone tissue.

X-ray image of osteosclerosis

Degrees

Experts distinguish three degrees of OPS, each of which is characterized by specific symptoms and certain therapeutic tactics are used:

1. Osteoporosis of the shoulder joint 1st degree is described by minimal symptoms or its absolute absence. The patient experiences short-term pain only during prolonged or heavy exercise, which disappears after rest. X-rays can reveal subchondral sclerosis of the joint surface.
2. Deforming osteoarthritis (DAO) of the shoulder joint, grade 2, osteoporosis is accompanied by increasing pain, which can be eliminated with painkillers. The X-ray image shows a clear narrowing of the joint space, large-scale zones of cartilage destruction and osteophyte growth.
3. The third degree occurs with intense painful sensations that are permanent. The joint is practically immobile. The image shows the absolute destruction of cartilage tissue, a significant change in the shape of bone structures and many osteophytes.

Causes of osteosclerosis

Osteosclerosis can occur for several reasons, most often acquired:

• injury and recovery period after it;
• inflammation (osteomyelitis, arthrosis, arthritis);
• tumor process;
• intoxication.

Causes of osteosclerosis of bones

Among the congenital anomalies are disorders of phosphate metabolism, as well as genetic disorders that predispose to such diseases. Systemic connective tissue diseases are possible, which lead to the development of osteosclerosis.

Etiological factors

The main causative factors are divided into the following groups:

• Age indicator: persons over 60 years old. By this age, cartilage tissue almost completely loses fluid, which leads to a change in its structure.
• A hereditary factor that determines the structural features of cartilage tissue.
• Physical activity and joint trauma.
• Excess weight and other endocrine disorders.

The disease in orthopedics is divided into primary and secondary forms, depending on the action of etiofactors.

The primary form refers to a process that develops without a reliably identified cause. The secondary form has a clear reason for the development of the pathological process.

A number of emerging path processes in cartilage tissue are the same in all variants. Any factor leads to a condition where the cartilage matrix is ​​initially destroyed, thus depleting the joint of fluid, which leads to a loss of elasticity of the chondral tissue, creating additional conditions for the destruction of cartilage. Finally, the cartilage also loses other structural elements synthesized by chondrocytes. Degraded particles become antigens, and the body begins to synthesize antibodies and cytotoxic cells to them, which leads to an immune inflammatory process. This situation leads to the formation of a vicious circle that is difficult to break in the final stages of the disease.

Symptoms of osteosclerosis

The change in bone structure itself does not cause any characteristic symptoms. However, the patient notices decreased mobility in the joints, pain in the limbs or back.

But most often osteosclerosis is diagnosed with pathological fractures. This is the name for injuries that occur during normal, non-extreme loads for a given patient - walking, running, lifting light weights, morning exercises.

Causes of osteoarthritis of the hip joint

The hip joint is a large, articulated synovial joint, which is called the most powerful because it bears a greater range of loads. It is formed by the spherical head of the femur and the cup-shaped cavity of the pelvic bone (acetabulum), the surfaces of which are covered with smooth hyaline cartilage. Together they represent a hinge, where their musculoskeletal contact interaction occurs.

Every day, this unique mechanism performs the most important functions, which include maintaining the weight and position of the body in an upright state (standing, sitting), ensuring motor activity during movement (walking, running, jumping, etc.), and moving parts of the body relative to each other.

The forces passing through the hip joint apparatus are quite significant. For example, in the usual position of “standing on two lower limbs” the joint experiences a load of 1/3 of a person’s weight, while standing on one limb - 2.5 times higher than the body weight, when walking and running - a load of 2-6 times exceeds the person's original weight. Experts definitely attribute the fact of significant loads to one of the explanations for the high susceptibility of the joint to destabilization and wear, and, consequently, to the development of osteoarthritis. However, to say that the cause of the disease is the natural functional physiology of the joint is fundamentally incorrect; without an aggravating factor, the pathological process is impossible.

And another important point: for the hip joint to function well, it must have a sufficient range of movements with very good stability. And this, in turn, is possible provided there are strong ligamentous muscle groups that control movement and support functions in the joint, as well as a strong articular capsule that protects and holds the bone joint. The depth of insertion of the spherical element of the femur into the acetabular bed of the pelvis also plays a huge role. Failure of the designated structures and/or incorrect anatomical parameters can clearly lead to degeneration of the articular surfaces.

This is what the joint cavity looks like through an arthroscope.

All of the above is general introductory information, it is also important to know and understand. Of course, we will not leave readers without an answer to the burning question: what specific reasons cause such a complex diagnosis? Experts name the following root causes that most often lead to osteoarthritis of the hip joints:

• genetic defects in the development of the hip joint, characterized by congenital disorders of the development and growth of bone, cartilage, ligamentous, and muscle structures of the joint (dysplasia);
• old age, since against the background of age-related changes, cartilage hydration, muscle elasticity, blood circulation in joints, etc. decrease;
• systemic pathologies, where osteoarthritis is one of the consequences (gout, rheumatism, collagenosis, diabetes, complex types of allergies, etc.);
• various chondropathy leading to modifications of bone structures related to the joint;
• chronic arthritis (long-term inflammatory phenomena in the joint due to infection, autoimmune and metabolic disorders);
• avascular osteonecrosis of the femoral head (death of bone tissue) as a consequence of local circulatory disorders of traumatic or non-traumatic origin;
• hormonal imbalance, especially in women during menopause, when the level of estrogen, which protects joints, sharply decreases;
• obesity of any stage (excess weight is the worst enemy, since it significantly increases the load on the TB department and on the limbs in general);
• previous injuries localized to the pelvis and femur (fractures, dislocations, bruises, etc.), as well as a history of surgical manipulations on the hip region;
• orthopedic disorders, in particular valgus and varus deformities of the limbs, flat feet, spinal curvatures;
• a sedentary lifestyle, which causes a deficiency of muscle mass, ligament laxity, poor blood supply and limited supply of nutrients to the hip joint, which contributes to the onset and progression of osteoarthritis;
• constant overload of the hip region and lower extremities due to intense sports training, performing work while standing with heavy lifting, long monotonous poses (especially in static positions “standing” in one place, “sitting”), long walking forced by the nature of the activity.

It is impossible not to ignore the fact that smoking and alcohol abuse also have an adverse effect on the condition of the joint. Toxic products of nicotine and alcohol lead to a critical disruption of blood circulation around the musculoskeletal organ, to depletion and irreversible death of osteochondral tissues.

Treatment

Currently, osteosclerosis of any localization is preferably treated conservatively (that is, using medications and physical therapy techniques). The use of surgical methods is required only in severe cases of the disease, when other means have proven ineffective.

It is mandatory to prescribe a treatment regimen and diet - this increases the effectiveness of procedures and drug treatment. After the operation, a fairly long recovery period is recommended. Physical activity must be strictly dosed.

Drug treatment of osteosclerosis

Drug treatment of osteosclerosis is carried out strictly as prescribed by the doctor:

• Among medications for the treatment of osteosclerosis, the most important are chondroitin and glucosamine preparations (Chondrogard and others). They allow effective restoration of bone and cartilage tissue and support the growth of normal osteons and trabeculae.
• For osteosclerosis of the knee joint, medications are prescribed in the form of tablets or intra-articular injections. The course of treatment is up to six months.
• If other joints are affected, injections are not used due to the risk of damaging the ligaments.
• Additionally, general strengthening treatment, phosphorus and calcium preparations, and vitamin D may be prescribed, which improve the metabolism of minerals in the bones. It is possible to prescribe hormones that regulate bone mineralization.

Physical therapy and exercise

Physical activity is extremely important for the normal formation of trabeculae. A set of exercises is selected taking into account the localization of pathological changes and the nature of bone lesions.

For osteosclerosis of the lower extremities, the most effective exercise is considered to be an exercise bike, walking, running and squats. If the shoulder joints are affected - rotation, raising and lowering the arms.

Pull-ups and push-ups are not recommended. Affected elbows and hand joints require flexion, extension and rotation. A special restraint (knee pad, elbow pad) must be worn on the affected joint to limit mobility.

An approximate set of exercises for patients with osteosclerosis of the knee joint:

• Warm-up – raising on toes – 20 times, rotating the knee joint – 10 times in each direction.
• Squats – 20-30 times, more is possible if you are in good physical shape.
• Exercise bike - 30 minutes, or run 30 minutes.
• Stretching – bending over with straight knees.
• Completion – slow walking for 2-3 minutes.

You should check the set of exercises with your doctor - the same techniques are not suitable for all patients. If the spine is affected, you can perform some of the exercises while sitting or lying down.

Physiotherapy

Among the physical treatments for osteosclerosis, preference should be given to massage with warming oils and ointments. You can also use anti-inflammatory ointments and gels. This procedure should be carried out by a professional massage therapist to avoid the risk of accidental injury.

This is especially important when it comes to osteosclerosis of the spine - an insufficiently qualified massage therapist can cause pinched nerves or the appearance of a hernia.

In addition to massage, other types of physiotherapy are indicated:

• Warming procedures are also necessary that increase blood circulation and improve tissue nutrition - infrared irradiation, magnetic therapy.
• Electrophoresis is prescribed with chondroprotectors and painkillers , and less often with anti-inflammatory drugs.
• It is possible to use UHF and ultraviolet irradiation to increase blood circulation in diseased bones.

Physiotherapy methods are used as additional to the main treatment regimen.

Surgical intervention

Considered a last resort. It is prescribed in cases where other methods have proven ineffective, as well as for deformations and bone fractures. Operations for osteosclerosis can be divided into two types – therapeutic and restorative.

X-ray after surgery

Restorative traumatological operations are prescribed for severe spinal deformities and vertebral osteosclerosis, which cannot be restored in other ways, as well as for fractures and dislocations of bones and joints. This involves repositioning the fragments, restoring the normal structure and fixing it with the help of traumatological structures.

Therapeutic operations for osteosclerosis - transplantation of healthy bone tissue into the affected area. The method is effective, but is associated with risks for the patient, like any operation.

X-ray diagnosis of changes in the shoulder joint

A.V.Smirnov

Institute of Rheumatology, Russian Academy of Medical Sciences, Moscow

Pain in the shoulder joint is one of the most common reasons for which patients consult doctors of various specialties. Physicians must differentiate between damage to the shoulder joint itself or periarticular soft tissues and other extra-articular lesions that cause radiating pain in the shoulder joint. Such diseases include changes in the chest organs, neurological and vascular diseases, metastatic lesions of bones and soft tissues. The shoulder joints may be the site of initial manifestations of many systemic inflammatory rheumatic diseases. Pathological changes in the shoulder joints can be divided into diseases that affect the osteochondral structures of the joint, and diseases that manifest themselves as changes in the ligaments and periarticular soft tissues. The most common diseases of the shoulder joint include systemic inflammatory arthritis, arthrosis, aseptic necrosis of the humeral heads, septic arthritis, and subluxation of the shoulder joints. Diseases associated with damage to periarticular soft tissues include glenohumeral periarthritis (SLP), various types of tendonitis, including calcified tendinitis and bursitis, tears of the rotator cuff of the humerus, damage to the acromioclavicular and coracoclavicular joints.

X-ray diagnosis of PLP

X-ray diagnosis of PLP consists of signs of damage to the proximal humerus and periarticular soft tissues surrounding the shoulder joint. Radiological symptoms of damage to the humerus include osteosclerosis, unevenness and/or blurred bone contour, deformation, osteophytes at the sites of attachment of the ligaments to the greater tubercle (Fig. 1). Local, in the area of ​​the greater tubercle, or periarticular osteoporosis, single or multiple cyst-like clearings of bone tissue in the area of ​​the greater tuberosity and humeral head can complement the overall picture of bone damage. According to R.A. Zulkarneev [1], osteoporosis and cysts are combined in 75% of patients with PLP. Osteoporosis of the bone area adjacent to the greater tubercle refers to local pathological processes that characterize local changes in the area of ​​the greater tubercle. Periarticular osteoporosis of the humeral head or widespread osteoporosis of the humerus and scapula can be regarded as a manifestation of systemic changes in the skeleton associated with PLP or other diseases. These diseases include osteochondrosis of the cervical spine with signs of cervical radiculitis and damage to the autonomic nervous system and persistent limitation of mobility of the shoulder joint - “frozen shoulder”. Cyst-like clearings of bone tissue can vary in shape and size, with a sclerotic rim separating the cyst from the surrounding bone tissue. Cysts against the background of osteoporosis are most clearly defined.

The second type of pathological changes in PLP is the deposition of calcium salts into the soft tissues of the shoulder joint. Most often, calcifications are determined in the thickness of the supraspinatus tendon. On a radiograph, calcifications will be visible next to the greater tubercle or slightly above it (Fig. 2). When the infraspinatus tendon is affected, the shadow of the calcification is located slightly below the greater tubercle, and if it is outward from it, then we can talk about damage to the mucous membrane of the shoulder joint bursa. In addition to these main places where calcifications are detected, calcium salts are also deposited in the muscles, in the coracoacromial and coracoclavicular ligaments. Calcium salts are most often deposited in the thickness of the tendons of the external rotators of the shoulder. Calcifications can migrate in the thickness of the soft tissues of the shoulder from the tendons of the external rotators of the shoulder outward, towards the subacromial bursa or inward, into the cavity of the shoulder joint. A characteristic feature is the lack of parallelism between clinical symptoms and the X-ray picture of PLP. Large calcifications in soft tissues, detected on radiographs, can be asymptomatic, while small and mild calcifications occur with severe pain and a sharp limitation of mobility in the joint. Calcification can be bilateral, with pain and limitation of movement detected in only one joint. Calcifications in soft tissues have a variety of shapes and sizes. They can be in the form of fuzzy linear shadows or small rounded formations in the area of ​​the greater tubercle or reach large sizes (up to 3–4 cm in length and 1–2 cm in width), with clear, even or uneven contours, a homogeneous structure and high density , comparable to cortical bone density. Often calcium deposits do not represent a homogeneous mass, where both areas of increased and decreased density are combined.

Rice. 1. Patient Ya., 68 years old. Diagnosis: humeroscapular periatritis. Multiple osteophytes at the site of attachment of the ligaments to the greater tubercle of the humerus. Linear soft tissue calcification under the acromion process of the scapula. Linear calcification below the articular process of the scapula. Large cyst-like lucidity in the area of ​​the greater tubercle. Osteophytes on the edges of the articular surfaces in the acromioclavicular joint.

Rice. 2. Patient P., 45 years old. Diagnosis: humeroscapular periarthritis. “Stone” bursitis. In the soft tissues above the greater tubercle of the humeral head, an oval-shaped calcification of homogeneous bone density is determined.

Rice. 3. Patient V., 31 years old. Diagnosis: rheumatoid arthritis. The joint gap is sharply narrowed. Multiple cysts in the humeral head. Erosion of articular surfaces. Subchondral osteosclerosis. Subluxation of the humerus upward. Osteophytes on the edges of the articular surfaces.

Rice. 4. The same patient as in Fig. 3. Negative dynamics of radiological changes after 9 months.

Rice. 5. Patient K., 23 years old. Diagnosis: systemic lupus erythematosus. Aseptic necrosis of the left humeral head. The gap of the shoulder joint is not narrowed. Flattening and unevenness of the contour of the articular surface, a decrease in the volume of the humeral head. Severe subchondral osteosclerosis. Calcifications in soft tissues. Osteophytes on the edges of the articular surfaces.

Rice. 6. Patient N., 38 years old. Diagnosis: systemic lupus erythematosus. Aseptic necrosis of the left humeral head. The gap of the shoulder joint is not narrowed. The articular surface of the humeral head is uneven. Deformation of the humeral head. Subchondral osteosclerosis. Cyst-like restructuring of the bone structure. Calcifications in the soft tissues under the acromion process of the scapula.

When describing radiographs of the shoulder joints in patients with PLP, attention is paid mainly to bone changes in the area of ​​the greater tubercle and often do not notice pathological changes in the area of ​​the apex of the acromial process of the scapula, along the lower surface of which one can see bone lesions similar to tubercles: osteosclerosis, unevenness of the bone surface, osteophytes. It is proposed to consider these changes as a whole in PLP and use the terms “acromiotubercular arthrosis” or “arthrosis of the subacromial joint” [2].

X-ray manifestations of PLP are often combined with signs of deforming arthrosis of the acromioclavicular joint, the main symptoms of which are narrowing of the joint space, osteophytes at the edges of the articular surfaces, unevenness of the articular surfaces and subchondral osteosclerosis. Small calcifications in the soft tissue may be found in the area of ​​​​the upper or lower edge of the joint space.

The complex of x-ray examination for PLP must include x-ray of the cervical spine in two standard projections. Osteochondrosis of the cervical spine is often combined with PLP, but radiating pain in the shoulder joint is no less often found with the development of cervical plexitis. The absence of radiological changes in pain in the shoulder joints is a direct indication for examination of the cervical spine.

Standard AP X-rays of the shoulder joints may not detect calcareous shadows in the soft tissues, as calcifications may be located behind the greater tuberosity. In this case, it is necessary to perform a multi-view examination of the joint in the position of internal and external rotation of the shoulder joint. If you have a frozen shoulder, you can change the position of the X-ray tube relative to the shoulder joint. In the most complex cases of PLP, it is necessary to expand diagnostic methods, including computed tomography and magnetic resonance imaging of the shoulder joint.

X-ray diagnosis of arthritis of the shoulder joint Arthritis of the shoulder joint is quite often found in patients with rheumatic diseases. Arthritis of the shoulder joint most often develops in patients with rheumatoid arthritis (RA). A plain radiograph of the shoulder joint at the onset of the disease reveals periarticular osteoporosis, single or multiple cyst-like clearings of bone tissue located in the subchondral part of the humeral head and humeral process of the scapula or in the central parts of the humeral head (Fig. 3). Cyst-like clearings may alternate with areas of osteosclerosis. In later stages of shoulder arthritis, progressive destruction of the articular cartilage of the humeral head and articular process of the scapula leads to widespread and severe narrowing of the joint space (Fig. 4). This stage of arthritis is combined with the formation of large cyst-like clearings of bone tissue and the appearance of small subchondral osteosclerosis on the articulating surfaces of the bones. Erosion of the articular surfaces can be single or multiple, spreading throughout the entire articular surfaces of the humeral head and the articular surface of the humeral process of the scapula. Typical of RA is large erosion at the superior edge of the articular surface of the humeral head at the border with the greater tuberosity, which can cause a fracture with anterior displacement of the humerus. Further destruction of the bones and articular surfaces of the shoulder joint leads to the expansion and deepening of existing erosions and the appearance of new erosions over a significant area of ​​the bone surface. Against this background, pronounced bone deformations with subluxations and dislocations of the humeral heads appear.

Arthritis of the shoulder joint occurs without the formation of pronounced osteosclerotic changes in the area of ​​the articulating articular surfaces and without the formation of large osteophytes at the edges of the articular surfaces. Small osteophytes on the edges of the joints are detected in patients with long-term arthritis of the shoulder joints and indicate the development of secondary osteoarthritis in this joint.

RA of the shoulder joint is often combined with damage to the periarticular soft tissues. These include subacromial bursitis, tendonitis, and rotator cuff tears. Atrophy of the rotator cuff or their tears are often detected changes in long-term RA due to damage to the ligamentous apparatus of the shoulder joints by pannus. These changes on radiographs are manifested by a significant displacement of the humeral head relative to the articular process of the scapula, narrowing of the space between the upper part of the humeral head and the lower part of the acromial process of the scapula, osteosclerosis and the formation of cysts. These radiographic changes can also be found in patients with other inflammatory and non-inflammatory diseases, but the combination of anterior subluxation of the humeral head in relation to the articular process of the scapula and diffuse narrowing of the joint space of the shoulder joint is typical for RA. In some cases of shoulder RA, one or more synovial cysts may form in the surrounding soft tissues, which are better diagnosed by ultrasound examination of the joint or magnetic resonance imaging (MRI).

Along with damage to the shoulder joint, arthritis can be detected in the acromioclavicular joint, radiological changes in which will be similar to changes in the shoulder joint, while changes in these joints are interrelated. In RA, both unilateral and bilateral changes can be detected in the acromioclavicular joints. Soft tissue thickening at the anterior joint, periarticular osteoporosis, and erosions of the articular surfaces that first appear in the articular surface of the clavicle are early symptoms of arthritis. Subsequently, large erosions of the articular surface of the clavicle and, less often, in the acromion process of the scapula may appear. The eroded surface of the clavicle has uneven contours and can be evenly narrowed in the area of ​​the articular end. The articular surface of the acromion process is more often susceptible to osteolytic changes in the bones. Along the lower edge of the acromial process of the scapula, periostitis and unevenness of the bone contour can be detected, which is the influence of the inflamed synovial membrane in the subacromial (subdeltoid) mucous membrane of the bursa. Changes in the synovial membrane in the joints and their inversions can be detected with MRI and arthrography of the shoulder joint. Arthritis in the acromioclavicular joint can be accompanied by rupture of the ligaments, capsule and subluxation in the joint, while the joint space widens.

In RA, erosions may be found along the inferior surface of the distal clavicle. Typically, these changes are detected 2–4 cm from the articular surface of the clavicle and are associated with changes in the area of ​​the coracoid process of the scapula.

The shoulder joint is the second most important peripheral joint, most often involved in the pathological process in ankylosing spondylitis (AS) [3]. Bilateral damage to the shoulder joints is also a common manifestation of AS. The main radiological symptoms of arthritis of the shoulder joint in AS are bone porosis, narrowing of the joint space, erosion of the articular surfaces of the articulating bones, and tears of the rotator cuff. Multiple destructive changes in the articular surface of the humeral head, especially in the upper outer part, in combination with periarticular changes and slight upward subluxation of the humerus lead to the appearance of the “hatchet” symptom of the proximal humerus. Atrophy or tear of the rotator cuff leads to superior subluxation of the humerus.

Lesions of the acromioclavicular joints in ankylosing spondylitis (BD) are often bilateral and are similar in their pathological manifestations to changes in RA. In BD, resorption of the distal end of the clavicle may be detected. Damage to the coracoclavicular joint is associated with enthesopathy at the site of attachment of the ligament, inflammation in the synovial bursa, or damage to the joint itself. A distinctive property of radiological changes in BD is a combination of erosive and proliferative changes in the joints and places of attachment of ligaments, which makes it possible to carry out a differential diagnosis with other inflammatory and non-inflammatory diseases and make the correct diagnosis.

X-ray diagnosis of arthrosis of the shoulder joint The shoulder joint is not a typical joint for the development of primary osteoarthritis (OA). The presence of radiological symptoms of arthrosis in the joint indicates the secondary nature of the changes, which are primarily the result of traumatic injuries both in the osteochondral part of the joint and in cases of damage to periarticular soft tissues (microtraumatization of tissues during prolonged heavy physical load on the joint, some occupational diseases, sports injury, posterior subluxation of the humerus), after surgical interventions, as well as inflammatory and non-inflammatory changes in the shoulder joint. The latter include RA, BD, a group of microcrystalline arthritis, ochronosis, dysplasia of the bones of the shoulder joint, changes in certain neurological and hematological diseases. The main radiological symptoms of OA include osteophytes at the edges of the articular surfaces, slight narrowing of the joint space, single cyst-like clearings of bone tissue with a sclerotic rim, and osteosclerosis of the subchondral bones to varying degrees. Thinning of the articular cartilage primarily occurs in the central part of the humeral head, at the point of greatest contact with the articular surface of the scapula. Cyst-like clearings of bone tissue are found in the subchondral part of the articulating surfaces of bones. Marginal osteophytes are most often found on the lower edge of the articular surface of the humeral head. Intra-articular inclusions are not typical for OA of the shoulder joints. Degenerative changes in the shoulder joint may be associated with a subacromial spur or osteophyte.

Shoulder OA develops when the rotator cuff of the shoulder is torn. The main radiological symptoms are upward displacement of the humeral head relative to the articular surface of the articular process of the scapula, while the distance between the humeral head and the acromial process of the scapula decreases, osteosclerosis and cystic clearing of the bone tissue of the articulating surfaces of the bones develop.

OA of the acromioclavicular joint is most often found in older people and can be the cause of vague shoulder pain. X-ray changes are characterized by narrowing of the joint space, compaction of bone tissue in the subchondral bones, and the formation of osteophytes at the edges of the articular surfaces of the clavicle and acromion process of the scapula. Bone hypertrophy, downward displacement of the acromial end of the scapula, bone proliferation on the upper edge of the acromion, and involvement of the ligaments surrounding the acromioclavicular joint in the pathological process may also be detected.

X-ray diagnosis of aseptic necrosis (osteonecrosis) of the humeral head Osteonecrosis mainly develops in the humeral head and is a consequence of various diseases. The most common cause of avascular necrosis (AN) of the humeral head is avascular necrosis of the bone due to a fracture in the area of ​​the anatomical neck of the humeral head [4]. A fracture of the humerus in this area ruptures the intraosseous vessels and vessels of the capsule of the shoulder joint, which supply the humeral head, which is the cause of the development of AN.

Another cause of AN is therapy with glucocorticoid hormones (GCs), which are taken for a long time and in large doses by patients with systemic lupus erythematosus, dermatomyositis and some other diseases. The mechanism of development of AN during the use of GCs remains not fully understood to date. At the same time, hypotheses are considered regarding the relationship of AN with vasculitis, which is characteristic of many rheumatic diseases [5–7], as well as with osteoporosis, which accompanies chronic inflammation and GC intake, leading to bone microfractures, which leads to vascular compression and microcirculation impairment. The congenital predisposition to the development of osteonecrosis in this group of patients is also discussed. In some cases, AN appears early, at the very beginning of taking GC, although symptoms of the disease may appear in more distant periods of the disease. The pathogenesis of AN during GC intake, according to R. Ficat and J. Arect [8], is explained by an increased content of free fatty acids, which thrombose intraosseous vessels against the background of systemic vasculitis associated with the underlying disease. Blockage of the supply vessels increases intraosseous pressure in the humeral head, leading first to ischemia of the bone area and subsequently to AN of the humeral head.

The stages of AN are resorption, sequestration, repair, sclerosis and remodeling of the humeral head. In the initial stage of AN, radiological changes in bone tissue may be absent, so early diagnosis of pathological changes requires the use of MRI. If there is a history of risk factors for the development of AN (for example, trauma), timely identified symptoms of AN contribute to an earlier start of therapeutic measures aimed at eliminating the causes and the choice of the correct treatment tactics for patients.

The initial radiological manifestations of AN of the humeral head at the stage of bone tissue resorption should be considered an increase in radiolucency and rarefaction of the trabecular bone structure in the subchondral bone with the formation of either a linear zone of clearing of bone tissue running along the articular surface of the humeral head, or this may be an area of ​​cyst-like clearing of bone tissue or multiple small cysts, alternating with small areas of compaction of bone tissue of a round or linear shape, as in the first case, located subchondral. At this stage of the disease, the humeral head can retain its round, spherical shape, clear, even contours of the articular surface and the normal width of the joint space.

At the stage of sequestration in the AN zone, a necrotic area of ​​bone and a zone of preserved healthy bone tissue are clearly visualized on an x-ray of the shoulder joint. The area of ​​necrosis is defined as a round, oval or irregularly shaped dense shadow. It is often localized in the central part of the humeral head. The focus of necrosis may be surrounded by a linear zone of clearing. At the base of the necrosis zone, an area of ​​osteosclerosis is found, which is a compensatory reaction of the bone, delimiting the affected area from healthy bone [9]. The joint space at this stage of the disease can be widened to the greatest extent over the area of ​​necrosis. The articular surface of the humeral head loses its regular rounded shape, becomes flattened, and the humeral head as a whole becomes deformed (Fig. 5, 6).

Subsequently, as the resorption of necrotic bone tissue increases, reparative processes on the part of healthy bone tissue begin to increase. X-ray changes at this stage are characterized by the appearance of secondary deforming arthrosis of the shoulder joint in the form of the formation of osteophytes on the edges of the articular surfaces of the humeral head and the articular process of the scapula, narrowing of the joint space throughout, non-growth of osteosclerotic changes in the humeral head, pronounced deformation changes in the bones, in some cases, subluxation of the humerus bones up.

The stages of AN of the humeral head are similar in their radiological manifestations to the changes found in AN of the femoral head in patients with rheumatic diseases. Radiological stages of AN of the femoral heads can be used to describe AN of the humeral heads [10].

Computed tomography and MRI Standard computed tomography (CT) or in combination with arthrography is one of the main diagnostic methods for assessing the musculoskeletal system of the shoulder joint. CT is the method of choice for various traumatic injuries of the shoulder joint; it allows one to evaluate bone, cartilage and soft tissue post-traumatic changes, and determines loose bodies in the joint cavity M. Rafii et al. [11] report high accuracy (up to 95%) in identifying injuries to the proximal humerus, articular surfaces of the humeral head, and articular process of the scapula. CT is also a unique diagnostic tool for the study of subluxations, dislocations and for determining the thickness of the rotator cuff of the humerus, which is necessary for decisions regarding surgical intervention on the shoulder joint.

MRI is a unique research method that allows for complete visualization of all joint structures and includes assessment of bone tissue and bone marrow, articular cartilage, menisci, joint synovium and intra-articular fluid, intra-articular ligaments, adipose tissue, joint capsule, periarticular muscles and ligaments.

MRI is used to examine the structure of the periarticular soft tissues to diagnose partial or complete tears of the rotator cuff of the shoulder joint, synovitis, damage to the articular cartilage and cartilaginous labrum of the scapula, as well as in subluxations or dislocations of the humeral head [12, 13]. In RA, MRI is a more sensitive diagnostic method than direct radiography of the shoulder joint in detecting soft tissue changes and bony changes in the humeral head and articular process of the scapula.

References 1. Zulkarneev R.A. “Painful shoulder”, glenohumeral periarthritis and “shoulder-hand” syndrome. Kazan: Kazan University, 1979; 309 p. 2. Tretyakova G.A. Author's abstract. diss. ...cand. honey. Sci. L., 1967. 3. Resnick D. Radiology 1977; 110: 523. 4. Neer CS. In: Rockwoods C. and Green D. (eds). Fractures. Philadelphia, JBLippincott Company, 1975. 5. Olyunin Yu.A. Ischemic bone necrosis. Rheumatic diseases. Ed. V.A.Nasonova, N.V.Bunchuk. M.: Medicine, 1997. 6. Klippel J, Dieppe P. Rheumatology 1997; 2:6–8. 7. Stinberg M, Stinberg D. Osteonecrosis. Textbook of Rheumatology. 1993; P. 1628–50. 8. Ficat RP, Arlet J. Ischemia and Necrosis of the Bone. Baltimore, Williams and Wilkins, 1980. 9. Mikhailova N.M., Malova M.N. Idiopathic aseptic necrosis of the femoral head in adults. M.: Medicine, 1982; 134 p. 10. Smirnov A.V. Consilium medicum 2003; 5 (8): 442–6. 11. Rafii M, Minkoff J, Bonano J et al. Am J Sport Med 1988; 16 (4): 352. 12. Zlatkin M, Reicher M, Kellerhouse L et al. J Comput Assist Tomogr 1988; 12 (6): 995. 13. Seeger L, Gold R, Bassett L. Radiology 1988; 168(3):696.

Source: https://www.consilium-medicum.com

Traditional home remedies

Folk remedies are not effective enough, however, many patients prefer to use them.

Among the most popular are:

• cinquefoil (it is included in many ointments for joints and bones);
• propolis tincture;
• dead bees infused with alcohol;
• snake poison;
• a mixture of Vishnevsky ointment and heparin ointment.

Vishnevsky ointment

Heparin ointment

Propolis tincture

The effectiveness of such means is questionable. However, cinquefoil and snake venom are used as components of medicinal ointments.

Below are some recipes:

• Calamus roots, 250g, are infused in 3 liters of cold water and added to the bath.
• Alcohol-based honey ointment - applied under a compress for 10-15 minutes.
• A mixture of lingonberry leaves, sweet clover herb , St. John's wort and flax seeds in equal proportions is infused in water for 2 hours, and the affected areas are treated three times a day. The same mixture can be infused with alcohol and used as compresses for 10-15 minutes daily.
• An elegant solution for cat owners - the warmth of an animal sitting on a sore area is comparable to physical therapy. In addition, the purring of a cat increases the production of endorphins.

Sanatorium treatment

Sanatorium treatment of osteosclerosis involves walking and exercise in the fresh air, proper nutrition, and a therapeutic regimen. It is advisable to go to sea and mud sanatoriums, where there are unique natural factors that improve the condition of bones and joints.

Sanatorium treatment of osteosclerosis

Patients with chronic bone damage are recommended to go to sanatoriums 2 times a year, preferably in spring and autumn. If the patient does not have such an opportunity, it is necessary to find it at least once a year.

A ticket to a sanatorium is prescribed by the attending physician; if necessary, a certificate of incapacity for work can be issued for this time.

Prognosis for arthrosis of the hip joint

With successful lifelong treatment, pain due to arthrosis of the hip joint may be completely absent or rarely bother the patient. The prospects for this therapy depend on the patient’s compliance with the rheumatologist’s rules and his personal self-discipline. Please note that the most accurate prognosis for the disease can only be made by the attending physician.

With timely and regular treatment

If chronic diseases do not contribute to the progression of the disease and treatment of hip arthrosis began at stage 1 or 2, hip replacement can be avoided. Disability and loss of ability to work, if the doctor's recommendations are followed, shifts by 20 years, and sometimes the patient retains an almost unlimited range of motion in the joint until old age. The best prognosis is possible with the so-called. benign arthrosis - when the wear of cartilage depends on external factors (professional activity, sanitary violations). In this case, it is worth excluding them and undergoing a course of restorative therapy to slow down further degeneration of the joint.

Timely surgical treatment of grade 3 osteoarthritis of the hip joint will help avoid joint immobility, consequences for the entire musculoskeletal system and many years of pain. In the absence of contraindications, prosthetics will help you return to your former activity.

When self-medicating

When choosing a treatment method for arthrosis of the hip joint, the doctor takes into account the age, constitution, physical fitness of the patient, his state of health, specific symptoms of the disease and its stage. In this case, the narrowing of the lumen of the joint space, the presence of osteophytes, the rate of progression of arthrosis, the quality of synovial fluid and other indicators are examined.

Self-treatment of osteoarthritis of the hip joint with traditional methods does not take into account these individual indicators and, instead of the desired result, can lead to severe exacerbation, metabolic disorders and worsening the stage of the disease. But the worst thing is the time spent on the illusion that such a serious chronic disease as arthrosis of the hip joint can be cured only with traditional methods. Avoid taking anti-inflammatory drugs without a doctor's prescription - this can cause serious problems with the digestive and endocrine systems!

No treatment

Left untreated, arthrosis of the hip joint progresses on average 2-4 times faster. A deterioration in the quality of life and the onset of disability in this case is possible already at a relatively young age - about 45-50 years. Patients' sleep deteriorates, physical activity decreases, and psycho-emotional disorders are observed. The pain prevents them from getting out of bed in the morning, walking with their grandchildren, or going to work.

Nutrition and diet

Diet is not the main treatment. However, some dietary adjustments are required. First of all, you should think about the amount of food - you should not overeat, food should completely cover a person’s energy needs, but not exceed them.

When the bones of the lower extremities and spine are affected, it is very important to normalize weight if there is excess weight.

Required and permitted products:

• milk and dairy products, preferably low-fat;
• dietary meat and offal – liver, heart;
• fresh fruits - apples, grapes, pears, bananas;
• cereals, primarily buckwheat and pearl barley.

These products contain calcium, which is necessary for the construction of normal bone tissue, supporting healthy regeneration processes and trabecular formation. Foods that should be limited are bread and pastries, especially white ones, sweets, alcohol and fatty foods.

Consequences and prognosis

When talking about the consequences, the cause of the pathology should be taken into account. If we are talking about physiological osteosclerosis, then there is nothing to be afraid of - this process must end in a timely manner, in accordance with the age norm. If this does not happen, treatment and diet are prescribed.

Post-traumatic osteosclerosis is part of the recovery process. This is normal. After fractures, trabeculae form chaotically, and in order to give them the desired direction, a measured load is required. If the exercises are performed in a timely manner, the prognosis is favorable.

If we are talking about pathological osteosclerosis, then the following complications are possible:

• pathological bone fractures;
• inflammatory process in cartilage and joints;
• destruction of bone tissue;
• osteomyelitis.

In severe stages of the disease, a deferment or complete exemption from military conscription is given. Disability is granted for complications of the disease.

Treatment of the disease: conservative and surgical methods

Today, not a single conservative method, unfortunately, is capable of either completely stopping or reversing the pathological process of this disease. Conservatively, it is only possible to slow down the rate of progression of degenerative pathogenesis. Medication and physiotherapeutic methods, which are used in a non-invasive approach, are designed for symptomatic treatment and prevention of the accelerated rate of tissue destruction of the hip joints. In the final stages, it is useless to treat a pathologically changed joint conservatively.

Prevention of osteosclerosis

It is impossible to completely avoid osteosclerosis, so we can only talk about maintaining a fairly high quality of life:

• You should strictly follow your doctor's recommendations regarding treatment , diet and exercise. It is also possible to reduce the rate of progression of the disease in a chronic course.
• It is necessary to eat foods containing calcium and phosphorus compounds , primarily dairy products and fruits.
• If necessary, take vitamin complexes containing these substances in the required volume.
• To avoid post-traumatic osteosclerosis, it is necessary to perform a set of exercises aimed at developing the limb.