Arthritis of the shoulder joint

Shoulder arthritis is an inflammatory condition that affects the joint in the shoulder area. Arthritis can come in different forms and types, but in most cases, it means that the joint joint becomes inflamed, causing pain, restricted movement and discomfort.

Some common symptoms of shoulder arthritis may include:

1. Pain: Patients may experience pain in the shoulder area, which can be acute or chronic in nature. The pain may increase with movement of the arm or shoulder.
2. Restriction of movement: Arthritis can lead to restriction in lifting the arm or performing twisting movements in the shoulder joint.
3. Swelling: Inflammation can cause swelling in the shoulder area.
4. Heat and redness: Some forms of arthritis may be accompanied by fever and redness in the area of the affected joint.

Shoulder arthritis can have various causes including rheumatoid arthritis, osteoarthritis, post-traumatic arthritis and other forms of arthritis. It can be caused by inflammation of the joint tissues, autoimmune reactions, or degenerative changes in the joint.

To accurately diagnose and treat shoulder arthritis, it is important to see a doctor. The doctor will perform a physical exam, and an X-ray or MRI may be needed to evaluate the condition of the joint. Treatment for arthritis may include physical therapy, pain management, medications, injections, or surgery, depending on the type and severity of the arthritis.

Causes of the shoulder arthritis

The following are some of the most common causes of shoulder arthritis:

1. Age: As we age, the cartilage tissue that covers the joint surfaces can undergo natural wear and tear and breakdown. This can lead to the development of osteoarthritis of the shoulder joint, which is one of the most common forms of arthritis.
2. Trauma: Trauma or injury to the shoulder, such as a fracture, sprain, or strained tendon, can trigger the development of post-traumatic arthritis.
3. Rheumatoid Arthritis: Rheumatoid arthritis is a chronic inflammatory disease that can affect a variety of joints, including the shoulder. It is caused by an autoimmune response and can destroy joints over time.
4. Other forms of arthritis: There are various other forms of arthritis such as psoriatic arthritis, gout and ankylosing spondylitis that can also affect the shoulder joint.
5. Infections: Sometimes shoulder arthritis can be caused by an infection, such as a bacterial or viral inflammation of the joint.
6. Hormonal and metabolic disorders: Some hormonal and metabolic disorders, such as thyroid and diabetes, can affect the joints and trigger the development of arthritis.
7. Genetic predisposition: Genetic factors can also play a role in the development of arthritis, especially if there is a family history of the disease.

Symptoms of the shoulder arthritis

Here are the common symptoms and signs of shoulder arthritis:

1. Pain: Pain is one of the main symptoms of shoulder arthritis. It can be sharp, dull, throbbing or burning, and it usually gets worse when you move your shoulder.
2. Limitation of movement: Patients with shoulder arthritis often experience limited range of motion in the shoulder. This can manifest as difficulty raising the arm up, bending or extending the shoulder, and rotating.
3. Joint stiffness: Morning joint stiffness is a common symptom. Patients may have difficulty trying to move in the morning or after resting for long periods of time.
4. Inflammationand swelling: Inflammation of the shoulder joint can cause swelling, redness and heating of the skin in the joint area.
5. Muscle weakness: Due to pain and restricted movement, the shoulder muscles may become weak and less strong.
6. Crunching and creaking in the joint: Some patients may experience crunching or creaking in the shoulder joint when they move.
7. Skin changes: In rare cases, shoulder arthritis can cause skin changes such as rashes or sores.
8. Symptoms of systemic inflammation: In the case of rheumatoid arthritis, systemic arthritis, or other systemic forms of arthritis, symptoms may include fever, fatigue, and weight loss.

Stages

Shoulder arthritis, like other types of arthritis, can have different degrees of severity that allow you to assess how severe the changes in the joint are. Assessing the severity of shoulder arthritis can help your doctor determine an appropriate treatment plan. A commonly accepted system for assessing the severity of arthritis is the ACR (American College of Rheumatology) classification, which uses four grades:

1. Grade I (minimal): In this degree of arthritis, there is little inflammation of the joint, often without visible deformity or restriction of mobility. The patient may experience mild pain and discomfort, but their impact on daily life is limited.
2. Grade II (moderate): In this degree of arthritis, the inflammation is more severe, the joint may be slightly deformed and the limitation of movement becomes more noticeable. The pain is more severe and may affect the performance of some routine tasks.
3. Grade III (severe): The joint is significantly inflamed and deformed. Pain becomes intense and the limitation of mobility is more significant. This degree of arthritis can severely limit the ability to perform everyday tasks.
4. Grade IV (extremely severe): In this degree of arthritis, the joint undergoes severe destruction and deformity. Pain is intense and constant, and mobility is almost completely lost. This condition can significantly limit the patient's life and requires serious intervention.

Classifying the degree of arthritis can help your doctor determine the best treatment, including medication, physical therapy, lifestyle changes, or surgery.

Forms

Shoulder arthritis can come in many forms and subtypes, including acute and chronic, inflammatory and non-inflammatory, and various etiologies. Here is a brief description of the main types of shoulder arthritis:

1. Acute: Acute arthritis can develop suddenly and lead to inflammation of the shoulder joint. It can be caused by infection, injury, or other factors.
2. Chronic: Chronic arthritis lasts for a long time and can be caused by various diseases such as rheumatoid arthritis or osteoarthritis.
3. Rheumatoid: Rheumatoid arthritis is a systemic autoimmune disease that affects multiple joints, including the shoulder joint. It leads to chronic inflammation, pain, and joint deformity.
4. Purulent: Purulent arthritis occurs when bacterial germs infect the joint. This condition requires immediate medical attention.
5. Psoriatic: Psoriatic arthritis is arthritis that develops in patients with psoriasis, a chronic skin disease. It can affect the shoulder joint and other joints.
6. Reactive: Reactive arthritis can develop after an infection in another part of the body and affect the shoulder joint, causing inflammation.
7. Post-traumatic: This type of arthritis develops after trauma or injury to the shoulder joint and can manifest as chronic inflammation and degeneration of the joint.

Diagnostics of the shoulder arthritis

Diagnosing shoulder arthritis involves several steps that will help your doctor determine the presence and type of arthritis, as well as its severity. Here are the main methods for diagnosing shoulder arthritis:

1. Medical History and Physical Examination:

   • Your doctor will begin by talking with you about your symptoms, medical history, and factors that could increase your risk of developing arthritis.
   • Physical examination includes assessing shoulder joint movement, looking for signs of inflammation (warmth, redness), evaluating painful points and limitations in movement.

2. Radiographs of the shoulder joint:

   • X-rays can be used to evaluate the structure and condition of the joint, detect signs of osteoarthritis (wear and tear on the joint), and determine if there are bone changes.

3. Magnetic resonance imaging (MRI):

   • MRI can provide more detailed information about the condition of joint tissues, including cartilage, tendons and soft tissues. It can help identify other forms of arthritis and assess the degree of inflammation.

4. Blood work:

   • Blood tests can help identify indicators of inflammation, such as C-reactive protein (CRP) and serum rheumatoid factor (RF) antibody levels, which may be associated with rheumatoid arthritis.

5. Ultrasonography (ultrasound):

   • Ultrasound can be used to assess the condition of the joint, including the presence of inflammation and joint effusion.

6. Joint aspiration (joint puncture):

   • If the diagnosis is unclear, joint aspiration may be performed to take a sample of joint fluid and then analyze it. This can help determine the type of arthritis and rule out infectious causes of pain.

Differential diagnosis

Differential diagnosis of shoulder arthritis involves identifying and distinguishing this condition from other possible causes of pain or inflammation in the shoulder joint. Here are some of the possible conditions and diagnostic methods that may be used:

1. Osteoarthritis (o steoarthritis): Osteoarthritis of the shoulder can mimic the symptoms of arthritis. Diagnosis may include X-rays to evaluate the joints and rule out signs of inflammation characteristic of arthritis.
2. Subacute/chronic synovitis: This is inflammation of the joint bag (synovial membrane) or joint sheaths. Synovial fluid tests and imaging studies (MRI or ultrasound) may be performed to evaluate the joint and synovial membrane.
3. Traumatic injury: Tra uma to the shoulder can cause symptoms similar to arthritis. X-rays and clinical examination can help determine if there is an injury or fracture.
4. Rheumatoid arthritis: This is a chronic systemic inflammatory disease that can affect the joints, including the shoulder. Diagnosis includes blood tests such as determination of rheumatoid factor and antibodies to cyclic citrullinated peptide (anti-CCP), radiography and MRI.
5. Other types of arthritis: There are many different types of arthritis, such as intra-articular arthritis, arthritis associated with other systemic diseases (e.g., systemic lupus erythematosus, ankylosing spondylitis, etc.), and others. Diagnosis may vary depending on the type of arthritis.
6. Infectious arthritis: If infectious arthritis is suspected, joint fluid tests may be performed to look for germs.
7. Tendinitis: Inflammation of the tendons in the shoulder joint can mimic the symptoms of arthritis. Ultrasound or MRI may be used to evaluate the condition of the tendons.

Osteoarthritis and shoulder arthritis are two different medical conditions that can affect the shoulder joint. They have different causes, symptoms, and treatment approaches.

1. Osteoarthritis of the shoulder joint (also known as osteoarthritis):

   • Cause: Osteoarthritis of the shoulder joint is a degenerative condition characterized by wear and tear of the articular cartilage as well as changes in the articular bone. This process can be related to age, increased stress on the joint, injury, or other factors.
   • Symptoms: Symptoms of shoulder osteoarthritis may include pain, creaking or popping when moving the joint, limitation in lifting the arm, and decreased shoulder function. Pain usually gets worse with movement and improves at rest.

2. Arthritis of the shoulder joint:

   • Cause: Arthritis of the shoulder joint is an inflammatory condition caused by various factors such as rheumatoid arthritis, viral or bacterial infections, systemic immune system disorders, and others. Arthritis is characterized by inflammation of the joint tissues.
   • Symptoms: Symptoms of arthritis include pain, inflammation, swelling and morning stiffness of the shoulder. Systemic symptoms such as fatigue and fever may also occur.

Treatment for osteoarthritis and arthritis of the shoulder can vary depending on the type and severity of the condition. Common treatment approaches include physical therapy, anti pain medications, lifestyle adjustments, muscle strengthening exercises and, in some cases, surgery.

Treatment of the shoulder arthritis

Treatment for shoulder arthritis can involve several steps and depends on the severity of the condition, its cause, and the patient's overall condition. The following are common steps and protocols for treating shoulder arthritis:

1. Diagnosis: The first step is to accurately diagnose the condition. The doctor performs an examination, gathers a medical history, and possibly performs tests such as X-rays, MRI or ultrasound to determine the type of arthritis and the extent of damage to the joint.

2. Medication treatment:

   • Anti-inflammatory drugs (NSAIDs): NSAIDs such as ibuprofen can help reduce inflammation and pain.
   • Pain medication: Pain medication may be required.
   • Injections: Corticosteroid or hyaluronic acid injections can help reduce inflammation and pain.
   • Disease-modulating medications: In the case of rheumatoid arthritis, your doctor may prescribe disease-modulating medications (biologic drugs).
3. Physical Therapy and Rehabilitation: Physical therapy can help strengthen shoulder muscles, improve joint mobility and reduce pain.
4. Lifestyle changes: It is important to lead an active and healthy lifestyle, pay attention to physical activity and proper nutrition.
5. Surgical Treatment: If conservative treatment fails to improve, the doctor may consider a surgical option such as arthroscopy, arthrodesis, joint revision, or shoulder replacement.
6. Supportive therapy: Managing arthritis may require regular visits to your doctor and adherence to joint care recommendations.

Medications for shoulder arthritis

Treatment of shoulder arthritis involves the use of various medications to reduce inflammation, relieve pain, slow disease progression and improve quality of life. Treatment tactics depend on the type of arthritis, its severity and individual characteristics of the patient. Below are the main groups of drugs that can be used for shoulder arthritis:

1. Nonsteroidal anti-inflammatory drugs (NSAIDs):

   • Examples are ibuprofen, diclofenac, naproxen, meloxicam, and others.
   • NSAIDs help reduce inflammation and relieve pain. They can be taken as tablets, creams, gels or injections.

2. Glucocorticosteroids (corticosteroids):

   • Examples: methylprednisolone, prednisolone.
   • Glucocorticosteroids can be injected directly into the joint to reduce inflammation and pain. This is often used in cases of severe symptoms.

3. Baseline antirheumatic drugs (BRDs):

   • Examples: methotrexate, hydroxychloroquine, sulfasalazine, and others.
   • BPPs are used to manage systemic forms of rheumatic diseases such as rheumatoid arthritis. They can slow disease progression and reduce inflammation.

4. Biologicals:

   • Examples: adalizumab, infliximab, etanercept, and others.
   • Biologic drugs are used for severe symptoms of arthritis and rheumatic diseases. They block certain inflammatory proteins, reducing inflammation and slowing joint destruction.

5. Analgesics and muscle relaxants:

   • Examples: paracetamol, codeine, trisycyclic antidepressants, etc.
   • These medications can be used to reduce pain and relieve muscle spasms that can accompany arthritis.

6. Additional Funds:

   • Vitamins and minerals such as vitamin D and calcium may be recommended to support joint health.
   • Physical therapy, exercise, relaxation, and lifestyle changes can also be an important part of treatment.

Ointments for shoulder arthritis

Various ointments and creams may be used for shoulder arthritis to relieve pain, reduce inflammation, and improve joint mobility. Your doctor may recommend a specific remedy based on your diagnosis and symptoms. Below are some of the possible ointments and creams that may be used:

1. NSAIDs (non-steroidal anti-inflammatory drugs):

   • Diclofenac (Voltaren, Diclofenac)
   • Ibuprofen (Ibuprofen, Advil)
   • Naproxen (Naproxen, Aleve)

2. Glucocorticosteroid ointments:

   • Hydrocortisone (Cortizone)
   • Prednisolone (Prednisolone)
   • Deoxymethasone (Topicort)

3. Salicylate ointments:

   • Methyl salicylate (Bengay, Icy Hot)
   • Menthol (Biofreeze, Flexall)

4. Camphor and menthol ointments:

   • Vikasol (Camphor-Phenol, Thera-Gesic)
   • Emersol (Salonpas)

5. Ointments with capsaicin:

   • Capsaicin (Capsaicin, Zostrix).

6. Ointments with chondroitin and glucosamine:

   • Chondroitin and glucosamine can be used for joints, including the shoulder joint. Examples include ArthriFlex, FlexaJoint, and others.

7. Gels with arnica and herbal ingredients:

   • Some natural gels may contain arnica, boswellia, angelica, and other herbal ingredients that can help relieve pain and inflammation.

8. Anesthetic ointments:

   • Ointments containing anesthetics can temporarily relieve pain. Examples include ointments containing lidocaine (Lidocaine) and benzocaine (Benzocaine).

Exercises for shoulder arthritis

Can help improve joint mobility, strengthen muscles and relieve pain. However, before beginning any set of exercises, it is important to consult with a doctor or physical therapist to make sure they are appropriate for your condition and will not cause additional harm. Here are a few exercises that may be helpful for shoulder arthritis:

1. Passive exercises to improve mobility:

   • While sitting or standing, assist the healthy hand in raising and lowering the large sore arm to improve shoulder mobility. Gradually increase the range of motion.
   • Gentle back and forth circular movements of the sore arm can help relieve joint stiffness.

2. Stretching exercises:

   • Constantly stretch your shoulder by straightening your arm and gently pulling it downward. Hold this position continuously for a few seconds and then return to the starting position. Repeat several times.
   • Shoulder stretch through the body: cross your large arm in front of your chest and gently pull it with your other arm. Hold the stretch for 20-30 seconds and repeat on the other side.

3. Strengthening the shoulder muscles:

   • Light exercises with an elastic band can help strengthen your shoulder muscles. For example, you can strap the band to a door handle and perform arm extension and arm flexion exercises with light resistance.
   • Exercises with dumbbells or your own body weight can also help strengthen muscles. For example, lift a dumbbell up in front of you and lower it while controlling the movement.

4. Active exercises to maintain mobility:

   • Rotating the arm at the shoulder joint can help maintain mobility. Make sure the movements are gentle and controlled.

5. Exercises to strengthen the muscles of the back and neck:

   • Strengthening your back and neck muscles can help maintain proper posture and reduce strain on your shoulders.

Folk remedies

Folk remedies can be used as an adjunct to mainstream medical treatment to relieve the symptoms of shoulder arthritis. However, it is important to remember that they cannot replace professional medical treatment and consultation with a doctor. Before using folk remedies, it is recommended that you consult your doctor to ensure that they are safe and do not interact with other medications or treatments. Here are some folk remedies that may help:

1. Mustard wrap: Mustard powders are mixed with water to form a thick mass that can be applied to the sore shoulder. The wrap is kept on for a few minutes (avoiding burning) and then washed off. This can help improve circulation and relieve pain.
2. Baking soda compresses: Baking soda can be used to make a compress. Dissolve 2-3 teaspoons of baking soda in 1 liter of warm water and soak a gauze compress with this solution. Apply it to the shoulder for a few minutes.
3. Lavender Oil Massage: A gentle shoulder massage using lavender oil can help relax muscles and improve circulation.
4. Warm compresses: Applying warm compresses to the sore area can help improve blood flow and relieve pain. Use a heating pad with warm water or a heating pad with salt.
5. Camphor Oil Application: Camphor oil can be massaged into the shoulder area to relieve pain and reduce inflammation.
6. Golden Hammer (turmeric): Curcuma, a spice that contains curcumin, has anti-inflammatory properties and may help reduce arthritis symptoms. It can be added to food or taken in capsule form (after consulting your doctor).
7. Green Tea: Green tea is rich in antioxidants that can help reduce inflammation and reduce pain.
8. Vitamin D and Calcium: Vitamin D and calcium play an important role in maintaining healthy bones and joints. Consider adding these vitamins to your diet if levels are low.

Literature

• Kotelnikov, G. P. Traumatology / edited by Kotelnikov G. P.., Mironov S. P. - Moscow : GEOTAR-Media, 2018.
• Pavel Evdokimenko: Arthritis. Getting rid of joint pain, World and Education, 2017.
• Frank Green / Shoulder treatment: exercises and medications, 2020