Arthrosis of the shoulder joint - symptoms, prognosis, diagnosis and treatment of the disease

Arthrosis (deforming osteoarthritis) of the shoulder joint is the destruction of articular tissue, accompanied by pain and a reduction in the range of motion in the joint. The shoulder joint is unique in that its motor activity occurs in three planes at once. The consequence of such mobility is not only high functionality, but also vulnerability to premature wear and development of various diseases, including arthrosis of the shoulder joint.

Arthrosis of the shoulder joint, although not a direct threat to the patient’s life, critically reduces its quality. Loss of function of one or both hands entails such unfavorable consequences as professional failure, decreased social activity, and a whole range of family and everyday problems.

Arthrosis of the shoulder joint affects about 10% of people over 55 years of age, but in recent years there has been a steady trend toward “rejuvenation” of the patient population. The development of the disease is divided into three degrees, with the last 3rd degree being the basis for determining disability group III.

Causes of arthrosis of the shoulder joint

Deforming osteoarthritis of the shoulder joint is based on profound morphological and functional changes in the cartilage covering the articular surface of the bone: it loses its smoothness, firmness, and elasticity. As a result, the movement of the moving surfaces of the joint relative to each other is difficult, which entails constant injury to the cartilage tissue. Over time, more and more foci of dense connective tissue appear in the joint capsule and the membrane lining the joint cavity, which is why the cartilage loses its shock-absorbing properties. Receiving more and more load, the bone becomes deformed, the configuration of the joint is disrupted, and the disease progresses until a complete loss of joint mobility. Most often, this disease is secondary in nature, i.e. develops as a result of exposure to one or more negative factors on the shoulder joint. If it is impossible to determine the cause of the disease, they speak of primary arthrosis.

Primary arthrosis

Degeneration of articular cartilage due to biological aging of the body is a natural phenomenon. However, with primary deforming osteoarthritis, this process can develop at a much earlier age and be much more aggressive. The diagnosis of “primary arthrosis of the shoulder joint” actually means that the doctor has admitted his own powerlessness, when all possible causes have not been confirmed, and the disease, nevertheless, continues to manifest itself. However, there is nothing reprehensible in this: despite the obvious successes of recent decades, medicine remains more of a descriptive than a truly scientific discipline. In relation to primary arthrosis, this literally means the following: you can describe what happens to the joint, but you cannot reliably explain why this happens.

Secondary arthrosis

Typical causes of the development of secondary arthrosis of the shoulder joint:

injuries (intra-articular fractures, bone displacement in a joint, closed tissue damage without significant disruption of their structure). Mechanical damage to the joint triggers a chain of inflammatory reactions, under the influence of which the structure of the cartilage changes and the disease develops;
the presence of diabetes mellitus as a concomitant disease. As a result of impaired glucose utilization, blood vessels are affected, incl. intraosseous and subcartilaginous, which entails inhibition of metabolism in cartilage tissue and causes its destruction.

In more rare cases, the cause of the development of deforming osteoarthritis of the shoulder joint is congenital malformations of the humerus, calcium metabolism disorders, autoimmune pathologies, diseases associated with abnormal joint mobility and weakness or underdevelopment of the ligamentous apparatus, frequent joint hemorrhages in hemophilia.

Etiology and pathogenesis

Osteoarthritis is one of the most dangerous forms of arthrosis. It affects the joint, as well as its cartilaginous joints and periarticular capsules. In this condition, the cartilage becomes so thin that the underlying bone may become exposed.

Damage to the shoulder joint

Causes of the disease:

sedentary lifestyle;
poor nutrition;
lifting weights;
abuse of bad habits;
metabolic disorders (metabolism).

The following causes are typical for the occurrence of osteoarthritis:

Lack of physical activity.
Incorrect posture.

It is noteworthy that increased physical activity can also be a cause of the development of this disease. This disease often occurs in athletes.

Symptoms of arthrosis of the shoulder joint

At the first stages of its development, arthrosis is characterized by latency. Unlike arthritis, the key symptom of which is inflammation, deforming osteoarthritis is not characterized by hyperemia and increased temperature of the skin in the affected area. However, despite the absence of visible signs of the disease, serious pathological changes occur in the body: the composition of the fluid filling the joint cavity changes, the periarticular muscles weaken, and the structure of the articular cartilage is disrupted. Subjectively, the progression of deforming osteoarthritis can be judged by the crunching and pain of the joint, which occurs not only after physical exertion, as was the case at the initial stage, but also at rest. The reflex and neurotrophic mechanisms of regulation of the muscles that produce movements in the shoulder joint are disrupted. In the absence of adequate therapeutic measures, signs appear that increasingly clearly indicate an inevitably approaching disability:

coarsening of the joint capsule;
failure, shortening of joint ligaments;
chronic pain;
progressive decrease in range of motion of the affected limb;
decreased contractility of the periarticular muscles;
irreversible destruction of the joint.

Degrees of arthrosis of the shoulder joint

Arthrosis of the shoulder joint is protracted and requires regular medical monitoring. In this regard, several staging options for this disease have been developed, of which the Kellgren-Lawrence classification is considered the most utilitarian in the medical community. It is based on three clinical criteria: the width of the joint space (the space between the articular cartilages), the presence and size of pathological growths on the surface of the bone tissue (so-called osteophytes) and bone deformation. But the simplest, understandable even to a non-specialist and not requiring fluoroscopy is the clinical classification of the degrees of arthrosis of the shoulder joint, which is based on the symptoms of the disease:

arthrosis of the shoulder joint 1st degree (initial arthrosis of the shoulder joint). It is characterized by a slight crunching of the joint when moving and slight pain when trying to move the arm to the extreme position;
arthrosis of the shoulder joint 2 degrees. Pain begins to be felt when raising the arm from shoulder level and above, as well as at rest after intense and/or prolonged physical activity. The range of motion in the shoulder girdle becomes noticeably limited;
arthrosis of the shoulder joint 3rd degree. Pain syndrome manifests itself with any, even minor, movement in the joint. The range of motion of the shoulder is significantly limited.

Surgery

Surgery for osteoarthritis of the shoulder is advisable when conservative methods have failed. It is also used in cases of initially advanced disease (when the patient came too late). Total or partial joint replacement is usually practiced.

Artificial elements can restore motor activity and relieve symptoms for a maximum of two decades. But then they will have to be replaced with a new prosthesis. In addition, the cost of such operations is not small. Therefore, it is better not to bring it to surgery.

It is important for people at risk to take preventive measures. This includes a special diet (more foods containing collagen, vitamins and minerals) and a drinking regimen (at least 2 liters of clean water per day).

Also, as a preventive measure, you need to lead a healthy lifestyle. At an older age, it is good to take chondroprotectors and special dietary supplements that will keep the joint in working condition and prevent the development of osteoarthritis.

Diagnosis of arthrosis of the shoulder joint

The diagnosis is made based on physical examination and x-ray examination. The leading method of instrumental diagnosis of arthrosis is radiography. When conducting this study, the degree of dystrophic changes in bone, cartilage and soft tissue structures, marginal growths on the surface of the bones, narrowing of the space between the surfaces of the joint, changes in the shape and structure of bone tissue, and the formation of cysts are determined. In controversial situations (this usually happens at the initial stage of development of the disease), to clarify the diagnosis and obtain additional clinical data, the patient may be prescribed a CT or MRI of the shoulder joint. If the doctor assumes the secondary nature of the disease, he can refer the patient to the appropriate specialized specialist - a surgeon, immunologist, endocrinologist, etc. When carrying out diagnostic measures, it is important to exclude diseases with similar symptoms: gout, arthritis (rheumatoid, psoriatic), arthropathy (reactive, pyrophosphate).

Diagnostics

The symptomatic manifestations of DOA PS in the early stages are similar to the clinical picture of other diseases affecting the joints, which makes its diagnosis difficult.

Laboratory and instrumental diagnostic tests will help clarify the diagnosis:

Primary medical examination.
Radiography.
Ultrasound and magnetic resonance imaging.
Diagnosis using a micro-probe (arthroscopy).
Biochemical and clinical blood test.
Densitometry to detect osteoporosis.

On the radiograph in the initial period of the disease, blurred contours of the affected epiphysis are noted, then foci of clearing and thickening of the bone. The head is flattened, osteophytes are visible on the surface, and diffuse sclerosis of the cartilage is determined. Fragmentation of the ossification nucleus is noticeable. X-ray examination also shows a sharp narrowing of the joint space. Late diagnosis and incorrect therapy delay the recovery process for many years, and also increases the risk of developing complete immobility of the PS.

In a municipal clinic, the patient usually takes an x-ray

Prognosis and possible complications for deforming osteoarthritis of the shoulder joint

Due to the specific nature of this disease, the development of certain complications of deforming osteoarthritis of the shoulder joint is only a matter of time. The most typical complications of arthrosis include:

deformation of the articular surfaces (abrasion, the appearance of cracks, roughness, and, over time, painful ulcers). Clinical manifestations – pain in the joint during movement and at rest;
pronounced deterioration in the functional characteristics of the joint (displacement of the shoulder axis, frequent subluxation of the joint, its jamming at a certain point);
necrosis of the bone tissue of the head of the humerus. Develops in the absence of adequate treatment (neglect) of the disease;
complete immobility in the joint (ankylosis). The final stage of the disease, which is the complete overgrowth of the joint with bone tissue, as a result of which it simply ceases to exist.

As for the prognosis of the possible outcome of the disease, there are two news: bad and good. The bad news is that arthrosis is incurable and the patient's condition can only get worse. The good news is that the progression of this disease can be slowed down by “preserving” it at a certain stage of development. The success of this measure depends on two key factors: the age of the patient (the earlier the disease manifests itself, the less favorable the prognosis) and the nature of the pathological process (with an aggressive course, the likelihood of complications is higher).

You can influence the rate of progression of arthrosis by stopping the inflammatory process (with the help of NSAIDs and corticosteroids), improving the trophism and functional state of cartilage (with the help of chondroprotectors) and by making lifestyle adjustments (limiting the load on the joints, reducing body weight).

What causes the disease?

Among the factors that favorably influence the appearance and further development of the disease are the following:

Deposition of calcium salts causing the formation of osteophytes.
Aseptic necrosis of the capitate eminence of the humerus suffered in childhood.
Congenital disorders of skeletal development.
Complications after malunion of fractures.

In addition, there are a number of reasons that can provoke the occurrence of this disease:

It is worth noting that the clear cause of the pathological condition is still unknown

Endocrine and metabolic disorders.
Hormonal changes.
Intense mechanical load.
Inadequate functioning of the immune system.
Genetic predisposition.
Wrong diet.
A sharp increase in body weight.
Complications caused by infectious diseases.

Deforming osteoarthritis of the left shoulder joint occurs as often as the right one, sometimes the disease affects both joints. Due to the mild clinical picture, deformation of the shoulder joint occurs gradually. Sometimes the first symptoms appear after a long time has passed since the onset of osteoarthritis.

Treatment of arthrosis of the shoulder joint

A distinctive feature of the treatment of arthrosis of the shoulder joint is its complex nature (combining several therapeutic approaches, methods and techniques) and duration (in fact, lifelong). Considering that the disease undergoes several stages in its development, the treatment process can be divided into stages. Initial stage measures (at the first symptoms of arthrosis) include:

consulting the patient about the characteristics of the disease and possible measures to curb its progression;
therapeutic exercises aimed at developing periarticular muscles;
frequent water procedures (bathing, swimming) the purpose of which is to relieve stress from the joint and create conditions for its recovery;
getting rid of fat deposits to minimize the load on the joint.

For moderately severe clinical symptoms, the goal of treatment is:

reducing the load on the joint by fixing it with orthopedic medical devices;
pain relief with topical NSAIDs and corticosteroids;
inhibition of cartilage destruction with the help of chondroprotectors.

At advanced stages of the disease use:

long courses of oral NSAIDs;
intra-articular injections of corticosteroids;
non-narcotic analgesics;
surgery to replace the shoulder joint with an implant.

What treatment is needed?

Before starting treatment, it is necessary to carefully examine the patient to establish the form and degree of the disease in order to judge the success of the treatment measures taken. The general principle of treatment for DOA is immobilization of the affected limb and shoulder joint.

At the initial stage of the disease it is recommended:

unloading the limb;
relief from physical activity;
carrying out thermal procedures;
irradiation with ultraviolet rays;
paraffin applications;
mud therapy;
physiotherapeutic procedures;
healing folk remedies (infusions, rubbing, baths, compresses, ointments).

The main treatment method for stage 2 arthrosis of the shoulder joint is conservative therapy. It includes:

Non-drug treatment – physical unloading of the shoulder, gentle treatment for the limb, weight optimization, massage, exercise therapy, joint traction, mud therapy.
Treatment with medications - analgesics, anti-inflammatory, hormonal, protectors of collagen production, antibacterial, vasodilators, muscle relaxants.
Treatment with healing folk methods.

Surgical intervention. The ineffectiveness of the therapeutic measures taken and the continued progression of the disease are indications for surgical treatment. Persistent forms of deformation are subject to surgical correction.

If a deformity of the shoulder joint is detected, treatment is prescribed by a medical specialist.

Features of exercise therapy

Physiotherapy exercises for DOA are important due to the ability to slow down the process of deformational changes through exercise. The main task of exercise therapy is to restore muscle tone in order to reduce the immediate load on the PS. It must be remembered that PS overload increases the destructive effects of the disease.

Features of performing exercises for DOA of the shoulder joint:

preliminary preparation of muscles for exercise;
systematic exercise;
weight should not exceed 5 kg;
smooth execution of exercises;

It is allowed to perform gymnastics during the period of remission, when no manifestations of the disease are observed. The training regimen and set of exercises should be developed by the doctor, based on the medical history and current clinical picture.

Drug therapy

Today, medicine has in its arsenal many effective means to reduce symptoms and prevent further development of this disease:

Analgesic drugs. The manifestations of pain are relieved in a short time (“Analgin”, “Ketanov”).
Non-steroidal anti-inflammatory drugs - NSAIDs. They have an analgesic, anti-inflammatory and anti-fever effect (Nimid, Ibuprofen, Diclofenac).
Steroid hormones. Intra-articular administration of these drugs is indicated for prolonged progression of the disease; they have anti-allergic, anti-edematous, anti-inflammatory effects (Kenalog, Depo-Medrol).

The list of medications for DOA is prescribed by a medical specialist who has examined all the patient’s tests
Chondroprotectors. Promotes the production of collagen, which is part of synovial fluid, cartilage tissue, bones (“Glucosamine hydrochloride”, “Dona”, “Arthra”).
Muscle relaxants. Reduce muscle tension with the development of muscle contracture and spasms (Baclofen, Sirdalud).
Vasodilators. They increase blood flow, thereby restoring the enrichment of damaged paraarticular tissues with oxygen, nutrients and minerals (Cinnarizine, Actovegin).
Products that have a local warming, irritating and analgesic effect (ointments, gels, compresses).

The choice of medications depends on the severity of the disease and the reactive abilities of the patient’s body. All of the above medications and their dosage regimen are prescribed by the attending physician.

Physiotherapy for the shoulder joint with DOA

Along with treatment with medications, it is important to create a gentle regimen and use physiotherapeutic measures:

Corrective gymnastics.
Infrared irradiation.
Magnetic therapy.
Treatment with mud.
Irradiation with ultraviolet rays.
Cryotherapy.
UHF.
Iontophoresis.
Massage.

The first movements after immobilization should be passive and gentle. Physiotherapeutic treatment and physical therapy improve blood microcirculation and prevent muscle atrophy after prolonged limb sparing.

Ultrasound, magnetic therapy, therapeutic baths and mud will help slow down the development of DOA.

Surgical treatment

In cases where other treatment methods have failed, surgical removal of deformities and the source of inflammation provides a lasting recovery.

Surgical intervention consists of:

Plastic resection of deformed areas of bone tissue.
Arthroscopy.
Endoprosthetics (replacement of a damaged or deformed joint with a new one).
Artodesis (operation to completely immobilize the diseased joint).
Corrective osteotomy (removal of deformed areas).

After surgery, a long period is required to restore the functions lost by the bone joint.

Nutrition features and mode

An important aspect in achieving positive dynamics is adherence to an optimal daily routine, with the exception of excessive stress and proper nutrition.

To quickly recover and prevent relapses, you need to follow simple rules:

Give up bad habits (alcohol, tobacco).
Limit table salt consumption to 5 grams.
Increase the content in your diet of foods rich in calcium, potassium, iron, B vitamins, vitamins C, E, P, D.
Consume meat and fish broths and dishes containing gelatin.
Reduce the amount of animal fats and carbohydrates in the diet.

In order for the treatment to be as effective as possible, the patient must adhere to a diet.
In addition to the products that make up the dishes, the method of cooking them is important. So, if possible, it is advisable to exclude fried, pickled and smoked foods.

Folk remedies

Alternative medicine contains many recipes that can alleviate suffering and slow down the further development of the disease.

After consultation with an arthrologist and herbal therapist, you can use the following traditional methods of treatment:

applications with burdock leaves;
decoction and tincture of dandelion flowers;
pine baths;
wrap with liquid honey;
propolis ointment;
comfrey infusion;
tea with thyme.

Before using herbal components, it is recommended to exclude individual intolerance and the possibility of developing an allergic reaction.

Treatment with drugs

For the treatment of deforming osteoarthritis, the first choice drugs are:

non-steroidal anti-inflammatory drugs (NSAIDs);
glucorticosteroids;
non-narcotic analgesics;
chondroprotectors.

The mechanism of action of NSAIDs (diclofenac, ibuprofen, nimesulide, meloxicam, celecoxib, etc.) is based on suppressing the activity of the cyclooxygenase enzyme, which is involved in the synthesis of mediators of pain and inflammatory reactions. These drugs can be used both locally (in the form of external dosage forms) and systemically (in the form of tablets and injection solutions). If for most diseases the duration of taking NSAIDs is limited to 5-7 days, then for deforming osteoarthritis in the acute phase of the disease, the classical treatment regimen involves a course of medication lasting 2-3 weeks, and sometimes several months. As the duration of treatment increases, the risk of developing side effects also increases (in the case of NSAIDs, the mucous membrane of the digestive tract is the first to suffer, which is associated with a partial loss of selectivity of NSAIDs with prolonged use in submaximal and maximum doses).

Glucocorticosteroids have a more pronounced anti-inflammatory effect than NSAIDs, because block several links in the development of the inflammatory reaction at once. For arthrosis of the shoulder joint, these medications are prescribed only externally (for exceptions, see below). In the form of ointments for arthrosis, preparations containing dexamethasone, hydrocortisone, prednisolone, and betamethasone as active ingredients are used. The duration of treatment with external glucocorticosteroids should not exceed 7-10 days to avoid thinning and atrophy of the skin. At advanced stages of the disease, intra-articular injections of glucocorticosteroids are used to relieve pain for several months. The disadvantages of this method of administration include a high risk of infection in the joint with the subsequent development of purulent inflammation.

Non-narcotic analgesics (paracetamol, analgin, etc.) are used starting from stage 2 of the disease. Their main function is to relieve pain of medium and high intensity.

Chondroprotectors (glucosamine, chondroitin, hyaluronic acid) are preparations based on the structural components of cartilage. The purpose of their use is to stimulate the regeneration of damaged cartilage tissue, slow down its destruction, and activate trophic processes. Disadvantages include the need for long-term use and relative high cost.

The effectiveness of NSAIDs, glucocorticosteroids and non-narcotic analgesics is not disputed, as is their negative impact on the body. The task (elimination of pain and inflammation) will be completed, but the price is too expensive: NSAIDs cause ulceration of the gastrointestinal mucosa, intestinal bleeding, and disrupt reparative processes in cartilage tissue. Glucocorticosteroids help reduce bone mineral density (primarily we are talking about tablets and injections, but external forms with their frequent and long-term use can cause systemic side effects). Chondroprotectors are effective only with long-term use, which many cannot afford. To reduce the risk of side effects and minimize the pharmacological load on the body, taking natural-based medications seems to be the best option. An example of such a product is the herbal complex KHORDA'LIGHT.

The herbal medicine CHORDA'LIGHT has a powerful anti-inflammatory potential, naturally blocking the development of the inflammatory reaction and relieving joint pain. No drug can completely cure arthrosis, no matter how effective it is. CHORDA'LIGHT is no exception here, but its ability to prevent complications, prevent exacerbation of the disease and improve the quality of life of patients is beyond doubt. The undeniable advantages of the drug are excellent compatibility with other pharmacological and physiotherapeutic agents for the treatment of deforming osteoarthritis, as well as the almost complete absence of side effects.

A drug of similar properties is TODICLARK (There is also a weaker analogue - TODIKAMP) - an extract of green black walnut fruits in purified kerosene. Its feature is the ability to reduce the intensity of pain in arthrosis by 3-4 points on a visual analogue scale, without provoking the development of undesirable side reactions from the gastrointestinal tract, liver, kidneys, and hematopoietic system. TODICLARK can be used either orally or topically by applying it to the affected joint.

CURCUMIN PLUS deserves special mention, providing effective pain relief, localizing the inflammatory focus and limiting the affected area. The active ingredient of the drug curcumin is a pronounced natural antioxidant that neutralizes the damaging effects of free radicals - one of the main “culprits” of inflammatory reactions in the joints.

Maclura ointment (you can also use applications from it) based on orange maclura (also known as Adam's apple) also helps with joint pain. Regular use of the ointment stimulates blood circulation in the area of the affected joint, increases its mobility, and relieves pain. What is important is that the achieved effect is persistent and can be maintained for 2-3 months after the end of a three-month course of use of the drug.

Diagnosis and treatment of pathology

There is a simple test to suspect the onset of osteoarthritis. In a standing position, you need to move your hands behind your back, as if trying to tie the ribbons of a kitchen apron on your lower back. If this causes shoulder pain, there may be a problem.

But still, only a professional doctor can make an accurate diagnosis. After conducting a visual examination and conversation with the patient, he will direct the latter to an examination, which includes the following methods:

X-ray	The main method for diagnosing osteoarthritis, which allows you to see joint deformation in a photo taken using the device.
Lab tests	Tests of blood and synovial fluid filling the joint.
MRI	Used in isolated, rare cases.

X-ray helps identify pathology

Laboratory tests will help clarify the diagnosis

The Magnetic Resonance Therapy method is used in particularly difficult cases

The information obtained during the study will allow us to determine the stage of the disease. Based on it, the doctor chooses treatment tactics. It can be conservative and operative. The more advanced the disease, the more radical measures are taken.

Drug therapy

Treatment of osteoarthritis is based on drug therapy.

It involves taking the following medications:

non-steroids that reduce inflammation and relieve pain;
chondoprotectors that improve the quality of the structure of articular cartilage;
muscle relaxants that relieve muscle spasms and normalize motor activity of the joint;
drugs that activate blood circulation;
hormonal corticosteroids, appropriate in case of severe inflammation (they are administered by injection).

When using medications, the patient’s guideline should be not only the instructions included with them, but also (necessarily!) the doctor’s recommendations. Self-medication is strictly prohibited.

Various topical ointments and gels are widely used in the treatment of osteoarthritis. In combination with other drugs, as well as physiotherapeutic methods, including laser, cold and massage, they give good results.

Gymnastics and traditional treatment

Shoulder arthrosis involves moderate stress on the affected area. It is possible and necessary to do therapeutic exercises, but this must be done carefully (see How to do it correctly and which exercises are suitable for the shoulder joint with arthrosis).

It is advisable to perform the exercises under the guidance of a specialist. The video in this article introduces one of the most effective complexes. These exercises will help improve blood flow, tone muscles, and stimulate regeneration of the affected joint.

There are many folk remedies that can alleviate the condition of a patient with osteoarthritis. These include ointments, compresses, rubs, and decoctions of herbs and other natural ingredients for oral administration (see Alternative therapy: how to use herbs for joints).

Here are some effective recipes:

Mix 50 g of rendered pork fat with 3 g of bee propolis and rub the shoulder with this ointment daily after gymnastic exercises, course of treatment is 21 days, 1 week break and repeat if necessary;
apply a cabbage leaf to the affected area overnight, wrapping your shoulder in plastic wrap and something warm on top (this will relieve pain), perform the procedure for two weeks and repeat after 7 days;
Pour boiling water over a tablespoon of lingonberry berries, and when the liquid has cooled to room temperature, strain the infusion and drink a little at a time, spreading it out over the whole day, a course of a month, then a 30-day break and repeat.

Pork fat with propolis will help relieve pain and swelling of the shoulder

Cabbage leaves will relieve swelling and inflammation of the joints

An infusion of lingonberry berries will help improve immunity and start the processes of restoration of joint tissues

It is best to consult your physician before using any prescription. This will help you avoid unpleasant “surprises” and get the maximum benefit from “traditional treatment”.

Surgical treatment

Puncture of the capsule (puncture) of the shoulder joint is a gentle, minimally invasive method designed to remove inflammatory exudate from the joint cavity and inject the drug.

Arthroscopy is a high-tech surgical procedure that is performed under video camera control. The operation does not require an incision: all manipulations are performed through several miniature punctures required for the introduction of medical instruments and a video camera. Arthroscopy is minimally invasive and does not require long recovery.

Endoprosthetics is an extreme method of combating arthrosis of the shoulder joint, which is used at the last stage of the disease, when the head of the humerus is almost completely destroyed. This intervention, which involves replacing a joint with a bioprosthesis made of titanium or high-strength polymers, allows one to cope with arthrosis, but, like any radical method, it has its own risks and requires long postoperative recovery.

Mechanism of occurrence

The mechanism of occurrence of DOA PS is the same and does not depend on the causes that caused the development of the disease. Initial pathological changes occur in cartilage tissues. Such changes lead to a decrease in the density and thickness of cartilage, followed by its fragmentation. Reduced shock-absorbing functions of cartilage. Later, damage to the heads of the humerus is observed, caused by functional overload of this bone and the articulation as a whole. The head thickens, defects and areas of sclerotic cartilage form on its surface. Then the areas of compaction and loosening of the bone disappear, deformation and thickening of the head of the epiphysis remain, and growths form along the edges of the articular surface. The visual articular contour becomes unclear. Disturbances also occur in other PS tissues. So, in the later stages, the functioning of the tendons is disrupted, and muscle atrophy develops, caused by a gentle treatment of the limb.

Dystrophic changes in the cartilage and bone tissue of the joint will occur slowly but inexorably

Treatment at home

Treatment of arthrosis at home should pursue three main goals: reducing inflammation, reducing body weight and limiting activities that involve the shoulder girdle. And if the patient achieves the first goal with the help of a doctor, then the other two are entirely within his personal competence.

Losing body weight is an important element of the overall set of measures aimed at unloading the affected joint. At the same time, there is no need to rush to extremes and exhaust yourself with the most severe diets: the optimal is considered to be a loss of 2-3 kg per month until the body mass index recommended for arthrosis is reached (weight in kg divided by the square of height in meters) from 18.5 to 20. To achieve this goal, it is enough to make a few adjustments to your diet:

reduce the share of foods rich in saturated fats and “fast” carbohydrates;
increase fluid consumption to 3 - 4 liters per day in hot weather and 1.5 - 2 liters in cold seasons;
adhere to a fractional meal plan (5-6 times a day, but in small portions);
Consume fruits and vegetables daily (optimally at every meal);
drink a glass of water before eating;
do not eat after 20.00

Diet correction should be supported by increased mobility: walking for at least 1 hour daily.

Limiting activities that involve the shoulder girdle involves reducing the force load on the joint while maintaining sufficient motor load. For example, when lifting weights, if it is possible to distribute the load between the two shoulder joints, you must definitely use it.

Folk remedies

The treatment of arthrosis with folk remedies must be approached in a balanced, rational manner, without relying entirely on information gleaned from dubious newspapers about a healthy lifestyle and conversations with neighbors. Blindly following incompetent, unscientific recommendations, no matter how convincing and categorical they are expressed, can only do harm, contributing to the transition of the disease to a more advanced stage. And advanced arthrosis will then be very difficult to treat “from scratch”. Therefore, before starting to use this or that folk remedy, you should consult your doctor. Here we will also list several medicinal plants, the use of which for deforming osteoarthritis has stood the test of time and has repeatedly proven its effectiveness:

White cabbage;
Birch buds;
St. John's wort;
corn silk;
burdock (large, small, felt);
field dandelion;
black radish;
horseradish;
creeping thyme.

These plants and their parts are used in a wide variety of forms (decoctions, infusions, lotions, ointments). The dose and duration of use is determined individually, experimentally. Treatment begins with minimal doses. In case of a weak therapeutic response, provided the treatment is well tolerated, the dose can be increased. It is not recommended to use a preparation from one plant for more than a month. It is necessary to periodically consult a doctor to monitor the results of treatment.

Gymnastics for arthrosis of the shoulder joint

The importance of gymnastics for arthrosis of the shoulder joint is difficult to overestimate. The presence of a strong muscle frame reduces the load on the shoulder joint, which is one of the conditions for ensuring proper control of the disease. In this case, the load should be moderate, and the weights used should be within the permissible five-kilogram limit: otherwise, destructive processes can form in the joint.

The optimal frequency of physical exercise for arthrosis of the shoulder joint is at least three times a week. Each gymnastics session should begin with a thorough warm-up followed by muscle stretching. Low-speed running or jumping rope can be used as warm-up exercises. The duration of the warm-up should be on average 10 - 15 minutes, then proceed to performing stretching exercises. The main condition that must be observed when stretching is the exclusion of sudden movements and a strict sequence from simple movements to more complex ones.

Gymnastics Evdokimenko

P. V. Evdokimenko is a famous Russian rheumatologist specializing in the treatment of diseases of the spine and joints. He developed his own system of exercises aimed at treating arthrosis of the shoulder joint. Gymnastic complexes are used based on the age and individual characteristics of the patient, as well as the stage of the disease. According to many patients with arthrosis, it was Evdokimenko’s gymnastics that helped them avoid surgery and slow down the progression of the disease. General principles of the system:

sequence from simple movements to more complex ones. At the initial stage, priority is given to the simplest static exercises to strengthen the muscle corset;
smoothness and regularity of exercises;
be careful when doing stretching exercises (pain is evidence that you overdid it);
regularity of gymnastics sessions. Ideally, they should be carried out daily.

A feature of gymnastics according to Evdokimenko is the complete rejection of additional weights: the complexes use mainly isometric exercises, which involve consistent tension and relaxation of muscles. In the acute phase of the disease, gymnastics is limited to exercises on the hands, forearms and back without actively engaging the shoulder joint. A more clear idea of the Evdokimenko system can be obtained from many videos posted on the Internet and on the doctor’s personal website.

Exercise therapy from Bubnovsky

Professor S. M. Bubnovsky developed his own original method of rehabilitation of people with diseases of the musculoskeletal system. He confirmed its effectiveness from his own experience, literally raising himself to his feet after a severe disaster. Exercise therapy for arthrosis of the shoulder joint from Bubnovsky involves a harmonious combination of exercises with medication and physiotherapy. You need to do gymnastics according to Bubnovsky during the period of relief (remission), after the acute phase of the disease has stopped. Before including the Bubnovsky method for arthrosis of the shoulder joint in the treatment regimen, you should seek medical advice. In the presence of concomitant pathologies that do not allow the use of physical activity, the exercise therapy complex for arthrosis of the shoulder joint from Bubnovsky is contraindicated. The appearance of pain during exercise is an indicator that the exercise is performed incorrectly or is contraindicated for the patient. In such cases, you should consult your doctor. You should not count on a tangible effect from Bubnovsky’s gymnastics for arthrosis of the shoulder joint if you systematically skip classes: to get positive results, you should exercise daily. It is recommended to end each session with a light massage session in the area of the affected shoulder.

Massage for arthrosis of the shoulder joint

Professional massage performed by an experienced specialist can significantly improve the condition of a patient with deforming osteoarthritis of the shoulder joint. At the same time, any manual techniques, as well as exercise therapy, should be used during periods of remission of the disease, because in its acute phase, the risk of joint damage increases. With the help of massage, when performed correctly, you can:

reduce pain intensity;
stimulate blood supply to the affected joint, thereby improving its supply of oxygen and vital nutrients;
promote cartilage restoration;
increase the mobility of the affected limb;
prevent the formation of new osteophytes;
strengthen the muscle-tendon frame that supports the shoulder joint.

Massage for arthrosis of the shoulder joint is based on several techniques: point pressure, percussion, rubbing, stroking, circular kneading. It should be noted once again that specialists should be involved in performing this procedure, and not relatives, friends or neighbors who have watched a couple of videos on the Internet: despite all the apparent ease of its implementation, a positive result depends primarily on the competence and experience of the performer. To obtain a pronounced therapeutic response, the course of massage must be long.

Preventive actions

The set of preventive measures includes:

Maintaining optimal weight.
Compliance with diet and rest.
Timely treatment of injuries and infectious diseases.
Elimination of hypothermia.
Preventing overload of the bone joint.
Annual preventive examination.

It is completely impossible to completely cure deforming arthrosis of the left shoulder joint, as well as the right one. It is better to start treatment with conservative measures. If there is no effect from conservative treatment, surgical intervention is indicated. The prognosis for conservative therapy in the early stages and surgical intervention in the later stages is good.

Is it possible to cure deforming arthrosis of the shoulder joint?

The answer to this question has already been given in previous chapters and, unfortunately, it is negative: deforming osteoarthritis is a one-way ticket. However, this is not a reason to doomedly let everything take its course: as already noted, the development of the disease can be quite successfully stopped.

As the body biologically ages, the load on the articular cartilage increases (mainly due to an increase in body weight), but the level of its provision with nutrients remains the same. In conditions of deficiency of plastic substances, cartilage begins to deteriorate, which becomes noticeable at the age of 50 - 60 years. This is a natural process from which no person is immune. If the destruction of cartilage occurs at a faster pace than measured by nature, then the situation becomes pathological and requires therapeutic intervention. With a long-term and persistent imbalance between the needs of cartilage for nutrients and its supply with them, the disease begins to develop without any provoking external factors. The consequence of impaired trophism of articular cartilage is the loss of its key functional characteristics - elasticity and smoothness, which in turn leads to the formation of microcracks, small and then large cysts, and degeneration of cartilage tissue. It is impossible to completely stop this cascade of pathological processes, but it is quite possible to influence its individual links, thereby slowing down the progression of the disease. Improvement in cartilage trophism is achieved through long-term (optimally constant) use of chondroprotectors, and to relieve inflammation that aggravates the course of the disease, NSAIDs, glucocorticosteroids, and phytocomplexes are used (see chapter “Treatment with Drugs”).

Diet

The patient's diet should be rich in vitamins, minerals and nutrients. Therefore, you need to eat foods enriched with all this. You cannot follow any diets from the Internet or from friends; it is better to ask your doctor to create an individual nutrition plan.

The patient's diet should be balanced

Prevention of arthrosis of the shoulder joint

Prevention of arthrosis can be primary or secondary. In the first case, its goal is to prevent the development of the disease, in the second - to slow down the progression and prevent complications of an existing disease.

Primary prevention includes the following measures:

daily walking and/or jogging for at least 1 hour;
alternate dousing with cold and hot water to increase the tone of the periarticular muscles;
exclusion of everyday situations in which there is a high risk of injury to the shoulder girdle;
performing a set of gymnastic exercises (according to Evdokimenko, Bubnovsky, etc.);
visiting the pool at least once a week;
regular medical monitoring of concomitant pathologies;
minimizing physical stress on the damaged joint.

Secondary prevention does not differ in the variety of methods used and involves timely treatment of arthritis and regular use of chondroprotectors.

Which doctor should I contact for deforming arthrosis of the shoulder joint?

Arthrosis of the shoulder joint is a polyetiological disease, therefore, given the large number of its possible secondary causes, doctors of different specialties can be involved in the therapeutic process. In the vast majority of cases, a patient with deforming osteoarthritis of the shoulder joint gets an appointment with a therapist at a local clinic. At this stage, the stage of the disease is established, treatment is prescribed and, if necessary, a referral to a specialized specialist is issued depending on the cause of secondary arthrosis and the presence of concomitant pathologies. In addition to therapists, the treatment of arthrosis is carried out by rheumatologists (for concurrent rheumatoid arthritis), physiotherapists (since physical procedures are widely used in the treatment of arthrosis), orthopedists (if the patient has certain developmental defects of the musculoskeletal system), radiologists (for monitoring the progression of the disease), traumatologists (to monitor complications of the disease), surgeons (if it is necessary to perform endoprosthetic surgery), neurologists and vertebrologists (for concomitant pathologies of the spinal column).

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