Symptoms and treatment of glenohumeral periarthritis (ICD 10 code M75)

A disease such as glenohumeral periarthrosis is a degenerative process with thinning and destruction of tissues - capsules, ligaments, tendons that surround the joint. Periarthrosis, with structural changes in tissues, in contrast to periarthritis - an inflammatory process, is characterized by complications in the form of deformations, in the absence of proper treatment. Rapidly developing periarthritis can develop into glenohumeral periarthrosis, the cause of which will be the initial inflammation.

With this disease, a person experiences pain that intensifies when pressing on the affected area, difficulty sleeping, and the disease leads to great inconvenience in everyday life. With periarthrosis, there is a significant limitation in the motor ability of the arm on the affected side, difficulties arise when lifting it, and it is difficult to place the arm behind the back, as this causes a significant increase in pain.

It is quite possible to successfully treat an ailment such as periarthrosis, but timely seeking medical help will be a very important point. The doctor, having studied the symptoms, will select the correct treatment package for glenohumeral periarthrosis. Traditional therapy for the disease can be supplemented with traditional methods, with a preliminary discussion of these methods with the treating doctor.

Periarthrosis is treated by neurologists, orthopedists or rheumatologists, when pathology develops as one of the symptoms of rheumatic lesions. Surgery is resorted to in cases where conservative treatment of the disease does not bring results, for example, with extensive growth of fibrous tissue in the joint capsule.

General information

The term periarthritis (periarthrosis) means changes in the tissues that surround the joint.
Any joint has periarticular tissues - these are ligaments, muscle tendons, tendon sheaths, bursae, fascia and aponeuroses. Based on this, periarthritis of the knee, shoulder and ankle joint is possible, and changes in the tissues can be inflammatory, dystrophic or mixed. The shoulder joint suffers more often than others and pain in the shoulder is a manifestation of periarthritis, which is associated with various mechanisms of occurrence. The syndrome of glenohumeral periarthrosis includes all periarticular lesions in this area. A common cause of shoulder pain is damage to the tendons of the shoulder muscles, which are degenerative and inflammatory in nature. Therefore, damage to the muscles around the joint is distinguished (partial or complete ruptures, muscle degeneration, calcification, inflammation), damage to the joint capsule, and the acromial clavicular joint. The diagnosis of “scapulohumeral periarthritis” hides various diseases of the musculoskeletal structures of the joint, as well as the joints of the neck. This may be capsulitis , shoulder tendinosis acromiocleidoclavicular arthrosis , or radicular syndrome .

This variety of forms of periarthritis of the shoulder is associated with the characteristics of the periarticular apparatus of the joint, which carries out various movements: flexion, extension, rotation, circular motion, abduction and adduction. Thus, the range of motion in the shoulder is greater than the range of motion in other joints. Despite the fact that there is no ICD-10 code for glenohumeral periarthritis (this diagnosis is excluded), the term “humeral periarthritis” or “frozen shoulder” syndrome is used in practice. It occurs in 20% of patients aged 40 to 65 years in men and women.

Etiology of glenohumeral periarthritis

It is worth noting that this disease is quite common and both men and women are susceptible to it. The factors that stimulate its appearance are quite diverse:

• joint injuries (strong blows, falls on the shoulder or outstretched arm);
• intense and/or prolonged physical activity;
• diseases of the spine, poor posture;
• some surgical interventions (for example, breast removal).

Pathogenesis

In the pathogenesis of this pathology, inflammatory and degenerative-dystrophic processes, as well as metabolic and not yet studied immune mechanisms, are important. The main role in the pathogenesis is played by muscles and the development of myofascial dysfunction. Inflammatory and degenerative changes in the muscles cause their hypertonicity. With acute muscle overstrain or chronic exercise, the muscles are damaged with the release of Ca2+ ions, which maintains contracture of muscle fibers. An area of ​​reduced blood flow and contracted muscles is formed, which feels like a tight band. Most often, compactions occur at the junction of muscles and tendons.

With hypertonicity, muscle shortening occurs, with the formation of trigger points, dysfunction of the joint due to a change in the position of the scapula (it is raised and shifted by the shortened muscles - subscapularis and supraspinatus). Due to shortening of the muscles of the cervicobrachial and scapular region, the articular capsule tightly covers the head of the humerus. All these changes limit active mobility in the shoulder joint and contribute to pain. As a result, an abnormal glenohumeral rhythm is formed - an attempt to flex and abduct the shoulder causes a pronounced elevation and displacement of the scapula. An important role in pathogenesis is also played by impaired blood supply. The tendons of the supraspinatus, infraspinatus and subscapularis muscles are poorly supplied with blood. As a result of ischemia, enzymes are released and collagen fibers are torn, which ultimately causes tendinitis . If myofascial dysfunction develops in these muscles, the ischemia worsens. of necrosis appear in the tissues , which subsequently undergo scarring, calcification and aseptic inflammation.

There are also neurological mechanisms of glenohumeral periarthritis - damage to the roots of the cervical spine ( reflex cervicobrachialgia ), nerves in the area of ​​the joint capsule and brachial plexus. There is also a connection between periarthritis of the shoulder and damage to internal organs - diseases of the pleura, lungs, gall bladder, as well as strokes and myocardial infarction .

our treatment

If you have received standard treatment and are not satisfied with the results, we are pleased to offer our comprehensive approach aimed at restoring the tissues around the shoulder joint and the function of the arm.

Using a series of special microinjections, we eliminate triggers, relieve residual tension in the muscles, resolve scar tissue around the shoulder joint capsule and ensure the restoration of normal metabolic processes in the periarticular tissues.

This method of treating periarthrosis has been developed and used by doctors at our center for two decades.

To relieve the load on the shoulder joint during treatment, we use kinesiological taping, which ensures normal blood flow and lymphatic drainage, and the tape itself plays the role of an external ligament.

If the cause of the development of periarthrosis is cervical osteochondrosis, then the osteochondrosis is treated first, and then the periarthrosis.

The course of treatment includes osteopathy sessions aimed at forming the correct stereotypes of hand movement.

Reflexology and magnetic therapy are used as auxiliary methods.

The pain decreases after the first procedures, and after 1 - 1.5 months the manifestations of periarthrosis are completely eliminated.

Classification

Scapulohumeral periarthritis includes the following types of lesions:

• supraspinatus muscle (rupture, tear, tenomyositis , entensopathy - periarthritis of the shoulder joint is associated with this pathology in most cases);
• rotator cuff muscles;
• subscapularis muscle (its distal parts);
• inflammation of the biceps tendon ( tendinitis );
• teres minor and infraspinatus muscles;
• acromioclavicular joint;
• enthesopathy of the subscapularis muscle;
• subacromial bursitis;
• shoulder-hand syndrome;
• capsulitis of the shoulder joint.

Forms of periarthritis:

• simple;
• acute;
• chronic (“locked or frozen shoulder”).

Periarthritis is divided into:

• primary;
• secondary.

Primary periarthritis of the shoulder develops with prolonged muscle tension or disturbances in the motor pattern. Secondary occurs in various diseases: arthrosis , arthritis , developmental abnormalities, spondyloarthritis , joint hypermobility , connective tissue dysplasia , diabetes mellitus , hypothyroidism , calcium metabolism disorders, oncopathology or vascular disorders.

Why are the periarticular tissues of the shoulder joint often affected? This is one of the complex joints and the high incidence of damage to periarticular tissues is due to the anatomy, biomechanics of the joint and high loads. The shoulder joint does not have strong intra-articular ligaments that strengthen the joint, and the joint capsule is thin. Joint stability depends on the muscles that provide movement. The appearance of pain during degenerative processes of the tendons is associated with the addition of inflammation (tendinitis).

The duration of glenohumeral periarthritis depends on the course. The duration can be several weeks or several years (recurrent course). The disease can begin slowly and progress gradually, or it can progress quickly, leading early to dysfunction, tendon dystrophy and muscle wasting. A long-term course is observed with bilateral damage to the joints - the second joint is affected due to mechanical overload when performing the function of the first joint.

Cervicoscapular periarthritis is considered a complication of osteochondrosis . Vertebrogenic radiculopathy of the C4-C6 roots is characterized by pain not only in the neck, but also in the shoulder girdle, as well as in the scapula. In this case, the pain is associated with damage to the cervical spine. MRI of the cervical spine, which reveals osteophytes, arthrosis of the facet joints, calcification of the ligaments, and intervertebral hernias, allows for a correct diagnosis.

As stated above, there may be inflammation of the tissues surrounding any joint. The tissues of the knee and hip joint are also affected, but somewhat less frequently. This is due to the fact that the hip and knee joints have strong external ligaments and intra-articular ligaments that support the joints well.

Periarthritis of the knee and hip is most often secondary, that is, it develops against the background of arthrosis and arthritis . Thus, with osteoarthritis, the pathological process involves all structures of the joint - ligaments, capsules, synovial bursa and periarticular muscles. Also, mechanical pain of the knee joint develops with excessive load, intensifies in the evening and significantly decreases or disappears after resting at night.

In the area of ​​the knee joint, tissue damage is represented by bursitis, enthesopathies (inflammation at the site of attachment of the tendon to the bone) and tenosynovitis (inflammation of the tendon and tendon sheath). Prepatellar bursitis (the term “parquet floorer’s knee” is often used) is caused by repeated trauma or stress (prolonged kneeling).

It is manifested by edema, swelling, pain, redness of the skin and a local increase in temperature. If the skin is damaged, infection can occur. When the prepatellar bursa becomes infected, there is a sharp, twitching pain and swelling, and redness of the skin. The contents of the bag contain pus. Recurrence of bursitis is avoided by eliminating the causative factor and protecting the joint with an orthosis.

The patellar ligament, which bears a large load, is often affected (it connects the quadriceps and lower leg and is involved in the extension of the joint). Damage to the patellar ligament occurs during stress and trauma in the form of enthesopathy . The ligament is damaged at the junction with the tibia (the term “footballer’s knee” is used) and the edge of the patella (the so-called “jumper’s knee”). “Jumper's knee” (patellar ligament ligamentitis) occurs when the joint is mechanically overloaded. The pain may be sudden or chronic. “Jumper’s knee” is observed in tennis players, track and field athletes, basketball players, and volleyball players and is associated with long jumps. Symptoms include pain below the patella, worse when sitting, swelling, and limited mobility.

In the hip area, pain syndromes are associated with damage to the femoral tendons, ligamentous structures and muscles.

Iliopsoas tendonitis causes pain in the upper thigh that makes walking difficult, as well as limited extension associated with back and groin pain.
When the hip joint is fully extended, painful clicking sounds occur and sometimes there is pain in the abdominal cavity. With this lesion, there is pinching of the femoral nerve ( Bernhardt-Roth neuralgia ), manifested by numbness of the outer thigh and paresthesia.
A common cause of hip pain is enthesitis of the greater trochanter, which complicates osteoarthritis at 40-60 years of age, but enthesitis can occur without coxarthrosis . Patients experience pain radiating along the outer thigh.

A typical complaint is the inability to lie and sleep on the side where the ligament is affected and pain when abducting the hip. enthesopathy of the abductor muscles occurs , and the presence of constant pain in the hip joint indicates trochanteric bursitis .

What is glenohumeral periarthrosis?

Humeral periarthrosis (PHP) is a disease associated with inflammatory and degenerative damage to the structures responsible for the functioning of the shoulder joint. The pathological process covers the joint, extends to the cervical spine and nerve plexuses. The progression of the disease causes persistent pain, leading to deformation and gradual destruction of the joint.

When identifying a disease, the clinic uses advanced diagnostic techniques, including proprietary developments, which make it possible to quickly recognize specific symptoms of the disease.

Causes

The causes of damage to periarticular tissues are:

• Excessive load on the muscles of the shoulder girdle or prolonged stereotypic movements in the joint.
• Loads are usually associated with sports or professional activities.
• Chronic microtraumatization of periarticular tissues (overstretching and partial tears of ligaments).
• Long-term immobilization (plastering or orthoses).
• Injuries. Post-traumatic periarthritis differs depending on age: up to 40 years of age, patients more often have dislocations /subluxations, and after 40 years of age, post-traumatic periarthritis is associated with a rupture of the rotator cuff. Sports injuries are especially common. Joint instability is associated with baseball, tennis, and hockey. Damage to the acromioclavicular joint occurs in weightlifting, powerlifting and other training that involves lifting weights. Weakness in the joint indicates osteoarthritis of the shoulder joint or rotator cuff pathology.
• Shoulder arthroplasty.
• Brachial plexus neuropathy.
• Pathology of the cervical spine. With vertebrogenic radiculopathy associated with osteochondrosis and hernias, reflex-dystrophic changes develop in the ligaments, muscles and joint capsule. With glenohumeral periarthrosis, patients are found to have damage to the C5-C6 discs and pain in the spine radiates to the shoulder joint.
• Features of the structure of the ligamentous apparatus and joint (changes in the alignment of the head of the humerus or weakness of the shoulder rotators).

Prolonged cooling and congenital structural features of the joint can be cited as contributing factors.

Treatment methods

• Drug treatment of the disease using non-steroidal anti-inflammatory drugs is used to reduce the inflammatory process and to eliminate symptoms of a disease such as periarthrosis. If such treatment is ineffective and symptoms persist, intra-articular corticosteroids may be prescribed.
• Physiotherapeutic procedures - electrophoresis, electroanalgesia, magnetic therapy, laser therapy.
• Healing mud
• Hydrotherapy procedures
• Acupuncture
• Hirudotherapy
• Massage is prescribed to relieve pain and muscle tension and improve blood circulation.
• Manual therapy
• Kinesiotherapy
• Therapeutic exercise is an integral part of therapeutic treatment for weakened muscles and ligaments, and without it, drug treatment will not have a good result, since the muscular-ligamentous system needs stress.

Exercises for the rehabilitation of periarticular tissues:

• The patient stands straight, feet shoulder-width apart. Lowering your shoulders and hanging your arms, bends forward, remaining in this position for several seconds and then returning to the starting position. The physical therapy exercise must be repeated five to ten times. It relaxes tense muscles in the shoulder girdle.
• The patient stands, holding the back of the chair with his healthy hand, tilting the body forward, straightening and lowering the affected limb, and then begins to swing it like a pendulum forward and backward ten to twenty times. Such movements relieve muscle tension, increase the range of motion of the affected limb, without being a large load on the affected area.

After relieving a severe inflammatory process, you can use hot compresses to improve blood circulation and flow to the affected area.

Surgery

Surgical intervention is resorted to when conservative treatment of glenohumeral periarthrosis does not bring the expected result. Surgery may also be prescribed for extensive growth of fibrous tissue in the joint capsule.

Symptoms of periarthritis

The main symptoms of glenohumeral periarthritis are pain in the periarticular tissues and limitation of movements. The pain appears gradually and is most often localized along the anterolateral surface of the joint, shoulder girdle, neck and scapula. The patient tries to avoid movements that cause pain in the joint and spare the arm. This results in limited range of motion. Gradually, the pain becomes constant, the pain intensifies and becomes shooting. Patients experience difficulties in everyday life - they have difficulty dressing, combing their hair, and cleaning the house. Because of the pain, sleep is disturbed; patients cannot sleep on the affected side. A detailed picture is formed two to three months from the beginning of the process, which forces you to seek medical help.

Periarthritis of the shoulder joint is characterized by a particular pain syndrome - pain occurs when abducting the arm, lifting it up, putting the arm behind the back, when rotating and flexing the elbow joint. The junctions of tendons and ligaments with bone are called entheses. Enthesopathies of the supraspinatus and subscapularis muscles are the most common forms of periarthrosis. And the pathology of the supraspinatus muscle determines the clinical picture of glenohumeral periarthritis.

The patient experiences only pendulum-like movements of the shoulder without pain. Characterized by morning stiffness and unilateral lesions. Most often, the pain intensifies at night, when the weather changes and when lying on the painful side. “Sensitive” disorders are not typical.

Symptoms of glenohumeral periarthrosis, such as range of motion and pain, may vary. The greatest restriction of movement is observed in osteoarthritis and adhesive capsulitis . Night pain is more typical for rotator cuff lesions and capsulitis. If numbness and tingling appear in the arm, if the pain radiates to the elbow joint, then pathology of the cervical spine can be suspected. Pain in the shoulder when trying to bring the hand to the stomach indicates a process in the subscapularis muscle. Subacromial bursitis is also a common variant of periarthritis.

The patient experiences pain when abducting and flexing the shoulder; he cannot lie on the painful side. Combing and dressing with bursitis is painful and difficult. The pain may radiate down the arm. The range of motion in the joint is sharply limited due to pain. The patient may remember the overexertion that preceded the onset of pain, but often the cause cannot be identified.

Periarthritis of the knee joint

The main symptom is intermittent or constant pain in the knee area, which occurs with flexion and extension, walking and changing body position in bed. The important thing is that pain is absent at rest, but occurs only with active and passive movements. When walking, the feeling of muscle tension increases. Sometimes swelling appears in the area of ​​the internal condyle and examination of this area is painful.

There are no radiological signs of changes in the joint. If left untreated, pain and swelling become constant and more severe. In the chronic course of damage to the ligamentous apparatus, dysfunction and significant limitation of joint mobility develop.

Periarthritis of the ankle joint

Damage to the periarticular tissues of the ankle joint is less common. The ligamentous apparatus is damaged in overweight individuals and track and field athletes. Main complaints of patients:

• aching pain in the joint and arch of the foot, aggravated by movement;
• muscle tension;
• soft tissue swelling.

The pain causes discomfort when walking and standing for long periods of time.

Disease prevention

The best methods for preventing glenohumeral periarthritis are massage and special physical exercises. Let's give a few examples of the latter.

1. In a sitting position, bend your arms at the elbows, place them on your waist and move your shoulders back and forth.
2. In the same position, make circular movements with the stoves - smoothly and slowly.
3. In a sitting position, they put their hands behind their backs, trying to reach the fingers of one hand with the other and clasp them into a “lock”.

If you still experience pain in the shoulder girdle, make an appointment at the shock wave therapy clinic “Medical Center Health”. Express diagnostics, experienced specialists, individual treatment regimens, UVT course - by contacting this clinic, you will receive an effective solution to your problem.

Tests and diagnostics

Diagnosis begins with identifying the symptoms, the patient’s occupation and types of daily activities. Next, the doctor evaluates the localization of pain, based on palpation and special tests, and also determines the factors that increase the pain.

X-ray studies for glenohumeral periarthritis provide little information. Osteoporosis of the bone head, periostitis , bone remodeling, and calcifications in bursae or soft tissues are detected X-ray examination is mostly carried out to exclude diseases of the shoulder and acromioclavicular joints (meaning arthrosis, arthritis or consequences of injury).

If pathology of the cervical spine is suspected, radiography of this area is performed, which reveals a decrease in the height of the discs, subchondral sclerosis , osteophytes , hernias and protrusions .

Ultrasound examination of tissues in this area. The study evaluates the shape of the head of the humerus, the structure of the articular cartilage, the joint capsule, the presence of osteophytes, as well as the presence of fluid in the periarticular bursae. Ultrasound evaluates the ligamentous-muscular system: changes in the rotator cuff tendons, changes in the sites of entheses, the presence of fibrosis and calcifications in the ligaments and muscles.

Magnetic resonance imaging is the optimal diagnostic method for rotator cuff pathology.

Computed tomography is an important method for identifying pathologies of bone structures, such as arthritis , arthrosis , comminuted fractures , bone tumors and bone metastases

Arthrography is important in diagnosing shoulder instability.

cost of treatment

The cost of treatment in our center is calculated individually, depending on the severity of the disease, its duration and the presence of complications.

Each patient is prescribed comprehensive sequential treatment in the form of a course of individually selected procedures.

In addition to the procedures, the treatment course includes a free follow-up appointment.

Initial and repeat appointments, as well as medications prescribed by a doctor, are paid separately. The cost of the initial appointment is 3,000 rubles.

A 10% discount is provided for a one-time payment for a treatment course.

Forecast

The initial stages of periarthritis respond well to conservative treatment. Long-term treatment and temporary transfer to light labor are provided. After complex treatment, joint mobility is completely restored. With a long course of chronic periarthritis, persistent limitation of function, loss of professional activity and disability are possible. If a “locked shoulder” develops, only surgery can partially restore mobility in the joint.

In rotator cuff syndrome, the presence of symptoms for more than three months is associated with a poor prognosis. It worsens with age 55 years and a hooked acromion. Only a third of patients experience complete recovery; 54% remain with clinical signs. To prevent exacerbations of rotator cuff syndrome, patients are advised to avoid stress on the shoulder girdle, excessive tension, and vibration.

Capsulitis is difficult to predict . The pain limits active and passive movements in all directions and frozen shoulder develops. Subsequently, contracture and immobility of the joint develops.

Classification of glenohumeral periarthritis

In medicine, glenohumeral periarthritis does not have an independent nosology, because there are many causes of dysfunction of the shoulder joint. According to the International Classification of Diseases, 10th revision, the following diseases can cause lesions of the shoulder joint:

• Adhesive capsulitis.
• Biceps tendonitis.
• Subacromial syndrome.
• Calcific tendinitis.
• Compartment syndrome and bursitis of the shoulder joint.

There are 3 forms of pathology: simple, acute, chronic. In rare cases, bilateral glenohumeral periarthritis has been observed.

List of sources

• Bunchuk N.V. Diseases of extra-articular soft tissues. In a manual of internal medicine. Rheumatic diseases / Ed. V. A. Nasonova, N.V. Bunchuk. – M.: Medicine, 1997. – P. 411428
• Povoroznyuk V.V. Shoulder pain: a multidisciplinary approach / “Health of Ukraine 21 stories” 2021, No. 11-12 (432-433).
• Khitrov N. A Variants of periarthritis of the shoulder joint: differential diagnosis, course, treatment / Acute and emergency conditions in a doctor’s practice. - 2012. - No. 4–5. - With. 44-50.
• Belenky A. G. Pathology of the shoulder joint. Humeroscapular periarthritis. Farewell to the term: from approximation to specific nosological forms // Consilium medicum. – 2004. – T. 6, No. 2. – pp. 15–20.
• Zulkarneev R.A. “Painful shoulder”, glenohumeral periarthritis and “shoulder-hand” syndrome. – Kazan: Kazan University Publishing House, 1979. – 310 p.

Diagnostics

During the examination, the doctor pays attention to: the symmetry of the shoulder girdle and shoulder joints; expressiveness of the muscles of the shoulder girdle; presence of bony protrusions. When palpated, there is pain in the area of ​​the affected joint, above the shoulder blade, along the outer surface of the shoulder. There is pain in both bone protrusions and joints and muscles. X-ray examination of the shoulder joint in various projections is of great diagnostic importance. The picture is taken at rest, with the arm rotated inward or outward, and with the shoulder abducted. A CT scan is performed in case of bone pathology detected during radiography. Modern technologies make it possible to obtain a 3D image of the joint. Ultrasound is an informative and inexpensive method for diagnosing pathologies of the shoulder joint. MRI allows you to simultaneously examine bones, muscles, tendons, ligaments, joint capsule, and cartilaginous lip.