Shoulder arthritis is an inflammatory process in the area of articulation of the head of the humerus with the articular cavity of the scapula. The course of arthritis is accompanied by pain of varying degrees of intensity, difficulty in movement, crepitation during movement, swelling in the joint area. Arthritis is diagnosed based on the results of shoulder joint radiography, ultrasound, MRI, arthroscopy, blood test and synovial fluid examination. Treatment involves taking anti-inflammatory, analgesic drugs, intra-articular injections, massage, physical therapy, physiotherapy.
ICD 10
M13.8 Other refined arthritics
Meaning
Shoulder arthritis is a group of diseases of the shoulder-thoracic (shoulder) joint of an inflammatory nature. The pathology of the shoulder joint is diverse and includes malformations (hypoplasia of the head of the humerus, congenital subluxation and dislocation of the humerus), damage to the elements of the joint (bruises, sprains, ruptures of ligaments and capsules, tendons and muscles, dislocations of the shoulder, fractures), diseases (arthritis, periarthritis, osteoarthritis, tumors, ankylosis, etc.). Among the various lesions of the shoulder joint, arthritis occupies one of the leading places, occurring mainly in middle-aged and older people. Arthritis can be an isolated pathology or a manifestation of systemic diseases, therefore it is considered both in the framework of traumatology and clinical rheumatology.
Causes
Shoulder joints can be affected by infectious, systemic, metabolic diseases, injuries:
- Post-traumatic arthritis develops as a result of shoulder injuries (cracks and fractures of the articular surfaces of bones, dislocation, rupture of the rotator cuff, etc.).
- Rheumatoid arthritis is based on autoimmune inflammation, accompanied by synovitis, formation of granulation tissue, destruction of cartilage, fibrous and bone ankylosis. The key factors triggering rheumatoid arthritis are unknown; the triggering role of infectious agents, congenital defect of cellular immunity, familial hereditary predisposition, etc. is being considered.
- Osteoarthritis is mainly a consequence of age-related degenerative processes that lead to the “wear” of articular cartilage.
- Non-infectious arthritis can also develop in patients with psoriasis and gout.
- Purulent arthritis can be caused by direct infection (for example, with wounds and shoulder injuries, medical and diagnostic punctures) or by lymphogenic or hematogenic penetration of pathogens from other septic foci (with axillary phlegmon, osteomyelitis of the humerus, purulent bursitis, etc.).
- Particular forms of infectious arthritis may be etiologically associated with extrapulmonary tuberculosis (tuberculosis of bones and joints), STIs (gonorrhea, syphilis).
The factors provoking the development or exacerbation of arthritis are often hypothermia, physical overload of the shoulder joint, hypokinesia, stress, etc.
Anatomy
The shoulder joint refers to spherical joints, which are an articulation of a cup-shaped depression (articular depression of the scapula) and a spherical head of the humerus. The shoulder joint provides a wide range of movements: flexion and extension, retraction and reduction, circular rotations of the upper limb. From the outside, the shoulder joint is surrounded by an elastic capsule, stabilized by a powerful beak-acromial ligament and surrounding muscles – deltoid, scapular, supra- and subacute, small and large round. Greater freedom of movement of the upper limb is largely provided by the structural features of the shoulder joint.
Classification
The course of shoulder arthritis can be acute or chronic. Depending on the causality, arthritis can have an infectious-inflammatory and non-infectious origin.
Infectious arthritis includes acute purulent arthritis, tuberculous arthritis, syphilitic arthritis, gonorrheal arthritis, etc.
Non-infectious arthritis is represented by gouty, rheumatoid, post-traumatic, psoriatic arthritis, osteoarthritis, etc.
Shoulder arthritis symptoms
The defining symptoms of arthritis are shoulder pain, limited mobility and swelling in the joint area. Depending on the severity of these and other signs, there are three degrees of shoulder arthritis.
First degree
In the early stages, pain in the shoulder joint is short and unstable; it usually occurs due to increased physical activity, and after its cessation it quickly subsides. A feature of rheumatoid arthritis is the symmetry of the lesion of the shoulder joints. At this stage, patients rarely seek medical help.
Second degree
The second degree is characterized by pain, both during exercise and at rest. Typically, the occurrence of pain attacks at night. There is a restriction of joint mobility; the patient can hardly lift his arm. When the joint moves in different planes, a crepitating crunch is heard. With the exacerbation of arthritis, the skin in the area of the shoulder joint becomes hyperemic, edematous, hot to the touch.
Third degree
Arthritis of the third degree is accompanied by sharp pain during palpation of the shoulder, joint deformation and complete loss of mobility in the joint. Pronounced degenerative changes in cartilage tissue can lead to disability.
Purulent arthritis
With purulent arthritis, fluctuating swelling of the joint is determined. A characteristic pose is that the diseased arm is bent at the elbow joint and brought to the trunk; the shoulder is slightly lowered and deflected anteriorly. In the case of a breakthrough of pus into the paraarticular tissues, deep congestion and phlegmons are formed. The general condition of the patient is severe, the temperature is elevated to 39-40 ° C. The outcome of the phlegmon of the articular bag in most cases is ankylosis of the shoulder joint. In severe cases, sepsis may develop.
Diagnostics
The appearance of the above signs requires face-to-face consultation with a rheumatologist, arthrologist or traumatologist. Primary physical examination includes examination, palpation, examination of active and passive movements of the shoulder girdle. To obtain a detailed characteristic of the pathological process, a complex of imaging studies is carried out:
- ultrasound;
- thermography;
- shoulder x-ray;
- contrast arthrography;
- MRI of the joint;
- scintigraphy.
In order to study the synovial fluid, a diagnostic puncture of the shoulder joint is performed. If it is necessary to obtain a biopsy, diagnostic arthroscopy of the shoulder joint is resorted to. To clarify the form of arthritis, the content of fibrinogen, rheumatoid factor, CRP, autoantibodies to joint tissues in blood plasma is studied.
Differential diagnosis
During differential diagnosis, shoulder arthritis should be distinguished from the painful shoulder syndrome associated with angina, myocardial infarction, pneumonia, lung cancer (Pancost syndrome), cholecystitis. Other possible diseases of the shoulder joint and periarticular tissues should also be excluded:
- tendinitis;
- bursitis;
- shoulder-scapular periarthritis;
- arthrosis, etc.
Treatment
The initial treatment of arthritis is always conservative. In the acute phase, a gentle regime is recommended, a change of activity to eliminate situations that provoke pain, in some cases – immobilization of the joint. Treatment may include:
- Drug therapy. It is aimed at reducing the level of inflammation, eliminating the cause of arthritis, restoring the functions of the shoulder joint and includes the appointment of NSAIDs, analgesics, hormonal drugs, chondroprotectors, vitamins, etc.
- Therapeutic blockades and punctures. Intra-articular administration of diprospan and other glucocorticoids, hyaluronic acid preparations, periarticular blockades are assumed. Conservative management of purulent arthritis includes antibiotic therapy, a series of therapeutic punctures with aspiration of pus, washing of the shoulder joint cavity with antiseptics and the introduction of proteolytic enzymes into the cavity (joint lavage).
- Physical therapy. Along with medical effects, physiotherapy (SMT, UHF, magnetotherapy, laser therapy), balneotherapy, physical therapy, massage, manual therapy, cryotherapy are used.
- Surgical methods. With a neglected and complicated course of arthritis, surgical treatment may be indicated: arthrotomy, resection of the shoulder joint, endoprosthetics (total arthroplasty or hemiartroplasty), etc.
Prognosis and prevention
In the absence of treatment, shoulder arthritis severely restricts or even excludes the mobility of the shoulder girdle and upper limb, seriously impairing the patient’s quality of life. In severe cases, the only way to treat is an expensive operation with a long period of rehabilitation, so it is extremely important to recognize the first signs of the disease in time and start therapy at an early stage. Prevention of arthritis is facilitated by the exclusion of increased physical exertion and injuries of the shoulder joint, timely therapy of concomitant diseases, rational nutrition.