What happens in the joint
The shoulder is the most mobile joint in the body, and its stability is provided not so much by bones as by the rotator cuff muscles and ligaments. When the cuff is damaged or the shape of the articular surfaces changes after a fracture, the load is distributed incorrectly and the cartilage wears out faster. It loses its smoothness, becomes thinner, and the joint space narrows. The body tries to stabilize the joint by growing bone growths around the edges, but they only limit movement. The capsule thickens and shrinks, causing rotation to be lost—moving the arm behind the back is usually the first to suffer.
- Primary arthrosis without obvious cause
- Post-traumatic after fractures and dislocations
- Arthrosis secondary to rotator cuff tear
- Secondary in rheumatic diseases
- Arthrosis of the acromioclavicular joint
Causes and risk factors
As we age, cartilage naturally loses water and elasticity, which is why arthrosis is more common after age fifty. Past injuries play a significant role: fracture of the humeral head, repeated dislocations, and a torn rotator cuff left without treatment. Wear and tear is accelerated by heavy physical labor, working with arms raised above the head, the professions of a painter, plasterer, loader, as well as sports with throwing movements. Contributions include systemic joint diseases, gout, long-term use of glucocorticoids and impaired blood supply to the head of the humerus.
- Age-related changes in cartilage
- Previous fractures and dislocations of the shoulder
- Rotator cuff tear
- Working with your hands up and working hard
- Throwing sports
- Rheumatoid arthritis and gout
- Aseptic necrosis of the humeral head
Symptoms
The pain is usually deep, aching, felt deep in the shoulder and radiates to the upper third of the arm. At first, it appears only with exertion and certain movements, then night pain occurs, especially if a person sleeps on the affected side. Characterized by a crunching sound and a feeling of friction when rotated by hand. The range of movements gradually decreases: it is difficult to fasten a bra, take a wallet out of the back pocket, or reach the top shelf. The limitation develops slowly, over months and years, so the person has time to adapt and applies late.
- Deep aching pain in the shoulder
- Increased pain with exertion and at night
- Crunching and friction when rotating
- Difficulty placing your hand behind your back
- Limitation of arm lifting
- Weakness of the arm and muscle atrophy over a long period of time
Diagnostics
The doctor examines the shoulder, assesses the range of active and passive movements, and performs special tests to distinguish arthrosis from rotator cuff damage, tendon inflammation, and adhesive capsulitis, in which the shoulder “freezes.” X-ray in two projections remains the main method: it shows narrowing of the joint space, bone growths, and changes in the head. Ultrasound is good at assessing tendons and the presence of fluid; MRI is needed if a cuff tear is suspected and before surgery. Blood tests are prescribed to rule out inflammatory joint diseases.
- Shoulder examination and functional tests
- X-ray of the shoulder joint in two projections
- Ultrasound of the rotator cuff tendons
- MRI if a rupture is suspected or before surgery
- Complete blood count, ESR, C-reactive protein
- Uric acid for suspected gout
Treatment
The basis is movement: special gymnastics maintains the volume of rotation and strengthens the muscles that stabilize the shoulder. Complete rest is harmful; it quickly leads to permanent limitation. To reduce pain, non-steroidal anti-inflammatory drugs are used in a short course, local remedies, and physiotherapy. In case of severe exacerbation, the doctor may perform an injection into the joint; Such procedures cannot be repeated often. It is useful to adjust the load: do not carry weights on the painful side, avoid prolonged work with raised arms. In cases of severe arthrosis and severe pain, shoulder arthroplasty is discussed.
- Daily therapeutic exercises
- Short course non-steroidal anti-inflammatory drugs
- Local painkillers
- Physiotherapy and shock wave therapy
- Injections into the joint according to indications
- Correction of household and work loads
- Weight control and general physical activity
- Endoprosthetics for severe damage