Shoulder periarthritis is an inflammatory and degenerative changes in the periarticular soft tissues involved in the functioning of the shoulder joint. Disease manifests itself as aching pains that increase with movement, tension of the periarticular muscles, swelling and compaction of tissues in the shoulder area. Ultrasound and X-ray examination, thermography, MRI, and laboratory tests play an essential role in the diagnosis of shoulder periarthritis. Methods of immobilization, drug therapy (NSAIDs, corticosteroids), novocaine blockades, physiotherapy, massage, gymnastics are used in the treatment of shoulder-grabbing periarthritis.
Meaning
Shoulder periarthritis (periarthrosis) is a disease of the soft tissues surrounding the shoulder joint (muscles, ligaments, tendons, synovial bags), characterized by their dystrophic changes followed by reactive inflammation. Inflammatory and degenerative soft tissue diseases of various localization in rheumatology and traumatology account for a quarter of all extra-articular lesions of the musculoskeletal system. Among them, pathology occurs most often; periarthritis of the wrist, elbow, hip, knee, ankle, joints, and foot joints are somewhat less common. About 10% of the population, to one degree or another, face manifestations of shoulder periarthritis. More often, the disease is diagnosed among women over the age of 55.
Causes
When considering the etiology and pathogenesis of diseases of the periarticular soft tissues of the upper limb (periarthritis, epicondylitis, styloiditis), two main points of view dominate. The first of them explains disease by neurodystrophic changes in tendon fibers that develop as a result of osteochondrosis of the cervical spine, cervical spondylosis or displacement of the intervertebral joints. This leads to infringement of the nerves of the brachial plexus, reflex vasospasm, circulatory disorders in the shoulder joint, dystrophy and reactive inflammation of the tendon fibers of the shoulder.
The second theory connects the origin of shoulder periarthritis with mechanical injuries of soft tissues that occur during cyclic or simultaneous extreme physical exertion (stereotypical movements in the shoulder joint, impact on the shoulder, falling on an outstretched arm, dislocation, etc.). Macro- and microtrauma, accompanied by tears of tendon fibers, hemorrhages or rupture of the rotator cuff of the shoulder, cause swelling periarticular tissues and circulatory disorders in the limb.
In addition, diseases (myocardial infarction, angina pectoris, pulmonary tuberculosis, diabetes mellitus, TBI, Parkinson’s disease), as well as some operations (mastectomy) that disrupt microcirculation in the shoulder joint area can lead to the development of shoulder periarthritis. The contributing factors are prolonged cooling, congenital connective tissue dysplasia, arthropathy.
Necrosis foci form in tissues with insufficient vascularization, which are further scarred and calcified, as well as aseptic inflammation. These changes are confirmed by a pathomorphological study of the material obtained in patients with shoulder-graft periarthritis.
Classification
Due to the variety of causes that cause shoulder joint dysfunction, shoulder periarthritis is not distinguished in an independent nosology. According to ICD-10, periarticular lesions of the shoulder joint area are commonly referred to as: biceps tendinitis, calcifying tendinitis, adhesive capsulitis, subacromial syndrome (impingement syndrome), shoulder rotator compression syndrome, shoulder joint bursitis, etc.
Nevertheless, in clinical practice, the term “shoulder-grabbing periarthritis” has a wide use. At the same time , the following forms of periarthritis of this localization are distinguished:
- simple (“painful shoulder”)
- acute
- chronic (“frozen shoulder”, “blocked shoulder”, ankylosing periarthritis)
In most cases, the pathology is unilateral in nature; bilateral shoulder periarthritis develops less often.
Symptoms
As a rule, with the traumatic genesis of shoulder periarthritis, from the moment of injury to the appearance of the first symptoms, it takes from 3 to 10 days. Therefore, patients cannot always accurately indicate the factors that provoked the disease.
A simple form of shoulder periarthritis proceeds most easily and favorably. The main complaints are associated with mild pain in the shoulder area, which occur only with exertion or certain movements. Pronounced pain accompanies rotational movements, attempts to overcome resistance. The limitation of the mobility of the upper limb is expressed in the impossibility of lifting the arm high up, placing it behind the back, etc. Simple shoulder periarthritis responds well to therapy; sometimes it can disappear spontaneously within 3-4 weeks.
If the stage of painful shoulder is accompanied by additional overload or injury of the limb, then acute shoulder periarthritis may develop with a high degree of probability. This form manifests itself with a sudden increasing pain in the shoulder with irradiation in the arm and neck. Typically, an increase in pain syndrome at night. Especially painful are attempts to move the arm through the side, pull back and rotate in the shoulder joint. To relieve pain, the patient is forced to bend his arm at the elbow and press it to his chest. A slight swelling is detected in the area of the anterior surface of the shoulder. In the acute form of shoulder periarthritis, general well-being usually suffers: subfebrility develops, insomnia occurs, performance decreases. The duration of the acute period is several weeks, then in half of the cases the disease takes a chronic course.
In the chronic form of shoulder periarthritis, patients are mainly concerned about moderate shoulder pain, discomfort during movement, and shoulder aches at night. Periodically, with sharp or rotational movements of the hand, shooting pain may occur. Chronic shoulder periarthritis can last up to several years and lead to the development of ankylosing periarthritis – “frozen shoulder” syndrome. At this stage, the periarticular tissues become dense to the touch, and the shoulder becomes immobilized. At the same time, any attempt by the patient to raise his hand up or bring it behind his back is accompanied by sharp, unbearable pain. Movements in the shoulder joint are severely limited; it is practically impossible to lift the arm forward and up, to the side, rotation around the axis, etc. The “blocked shoulder” syndrome develops in 30% of patients and is the final, most unfavorable stage of shoulder periarthritis.
Diagnostics
With complaints of pain in the shoulder girdle and associated movement restrictions, patients can contact a district therapist, surgeon, neurologist, rheumatologist, traumatologist, orthopedist. At the initial reception, anamnesis is collected, external examination, assessment of the motor activity of the shoulder joint (the possibility of performing active and passive movements), palpation of periarticular tissues.
To clarify the causes of the dysfunction of the upper limb, radiography of the shoulder joint and cervical spine, ultrasound, MRI of the shoulder joint is performed. Usually, radiological changes are determined already with a far-reaching chronic form of shoulder periarthritis. As a rule, they are characterized by periarticular deposits of calcium microcrystals (calculous bursitis); with ankylosing periarthritis – signs of osteoporosis of the humerus head. Acute shoulder periarthritis is characterized by changes in the blood – an increase in ESR and CRP.
Invasive diagnostic methods (arthrography, arthroscopy) are justified when deciding on surgical treatment. During differential diagnosis, shoulder arthritis, arthrosis, subclavian artery thrombosis, Pancost syndrome in lung cancer should be excluded.
Treatment
The main purpose of therapeutic measures for shoulder periarthritis is the relief of pain syndrome, prevention or elimination of muscle contractures. In the acute stage, a gentle motor regime is necessary, unloading of the upper limb with a soft supportive bandage or plaster splint. To relieve acute pain and local inflammation, nonsteroidal anti-inflammatory drugs are used, novocaine blockades are carried out in the shoulder area, dimexide applications, periarticular administration of corticosteroids. Additionally, muscle relaxants, angioprotectors, metabolic and chondroprotective drugs are prescribed.
Mandatory components of the therapy of acute and chronic shoulder periarthritis are physical therapy, physiotherapy (electrophoresis, microcurrent therapy, magnetotherapy, ultrasound, laser therapy, cryotherapy), massage, sulfide and radon baths. Shock wave therapy, hirudotherapy, acupuncture, stone therapy, and post-isometric relaxation have proven effectiveness. If the cause of shoulder periarthritis was the displacement of the intervertebral joints, manual therapy is recommended to restore normal joint relationships. Surgical treatment of advanced forms of shoulder periarthritis consists in performing arthroscopic subacromial decompression.
Prognosis and prevention
The initial stages of shoulder periarthritis usually respond well to standard conservative therapy; mobility of the shoulder joint is fully restored. A prolonged course of chronic periarthritis can lead to permanent disability of a person, loss of household and professional skills. With the development of the “blocked shoulder” syndrome, it is possible to partially restore mobility in the shoulder joint only by surgical intervention. Measures for the prevention of shoulder periarthritis are reduced to the prevention of micro- and macro-injuries of the shoulder area, timely treatment of spinal diseases. Hypothermia, excessive and stereotypical loads on the shoulder girdle should be excluded.
