Shoulder periarthritis.

Scapulohumeral periarthritis is a pathology of inflammatory nature and affects structures located near the shoulder joint. The particle "peri" means that the inflammatory focus includes the joint and surrounding tissues and structures.

Some components of the humerocephalic joint are not affected, which cannot be said about the joint capsule, ligaments and surrounding tendons. They form the pathological focus and are subject to structural and functional changes.

In order to choose the right treatment and cope with periarthritis, it is necessary to identify the cause that became the provoking factor for damage to the joint components.

One of the most common causes is considered to be osteochondrosis of the spine in the cervical region. As a result of changes in the configuration of the discs between the vertebrae, the nerve fibers that innervate the joint are affected. The main clinical manifestation of this pathology is pain syndrome in the shoulder joint.

Shoulder-scapular periarthritis is a consequence of disorders of the innervation of the shoulder and scapula area. Dystrophic changes are observed in the tissues surrounding the joint, slowly destroying its structures.

ICD 10 code

In the tenth revision of the ICD, scapulohumeral periarthritis was not included in the list of nosological units and is not an official diagnosis. Adhesive capsulitis of the shoulder is under code M75.0 - this is the closest designation of the joint pathology.

Previously, scapulohumeral periarthritis meant damage to the joint and adjacent tissues, the cause of which was not acute trauma.

Later, the concept of brachiocephalic periarthritis began to include various forms of manifestation that could clinically indicate the cause of its development.

To indicate the degree of joint damage, only descriptions of its functioning and the presence of additional clinical symptoms, such as pain syndrome or swelling, were used. The ICD did not single out scapulohumeral periarthritis as a separate nosological unit.

To specify the pathology of the joint, it was necessary to differentiate the signs of the disease for the formation of separate groups. Thus, the new classification of periarticular injuries included: tenditis of various muscles, tendon ruptures, calcifying tendinitis and retractile capsulitis.

Causes of scapulohumeral periarthritis

Among all the causes, the most common is shoulder trauma, which includes not only a dislocation or fracture, but also prolonged excessive strain on the shoulder, a blow or a fall on it.

After the causes of scapulohumeral periarthritis have taken effect, it may take from several hours to months before the first clinical symptoms of the pathology appear. On average, this period is approximately 10 days.

In addition to the traumatic factor, it is worth highlighting the influence of degenerative processes in the spine (cervical region). As a result, there is a disruption in the nutrition of the joint and surrounding tissues.

Thus, under the influence of numerous factors, a pain syndrome begins, the intensity of which increases every day. The pain is especially felt when performing any movements, for example, rotations or raising the arm, but in some cases the pain syndrome is present at rest.

In addition, it is necessary to highlight the probability of an increase in local temperature and the appearance of hyperemia of the affected area. In the future, the general body temperature may increase to subfebrile numbers.

Some causes of scapulohumeral periarthritis can provoke the development of an ankylosing form of pathology, when the joint acquires a dense consistency, as a result of which motor activity in it is sharply limited.

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Symptoms of scapulohumeral periarthritis

Depending on the stage and severity of clinical symptoms of the disease, the pathology can be cured on its own or become chronic with the development of complications.

Symptoms of mild scapulohumeral periarthritis may only cause minor pain, or rather discomfort when performing shoulder movements.

In cases where the injured shoulder is constantly subjected to excessive long-term loads, a full-fledged treatment stage cannot be carried out, as a result of which the disease becomes chronic.

Symptoms of scapulohumeral periarthritis in the chronic form are characterized by a moderate degree of pain syndrome, the intensity of which increases sharply with active movements.

The most unfavorable outcome of a chronic course is “frozen shoulder,” when the joint loses its functionality and becomes dense to the touch.

In addition to pain, the acute period of scapulohumeral periarthritis includes an increase in local and sometimes general temperature. Due to the increase in inflammatory reaction, the shoulder increases in volume due to swelling.

Acute scapulohumeral periarthritis

The defeat of the shoulder-scapular joint suggests the presence of such clinical symptoms as pain syndrome, which is characterized by a sudden onset and is not associated with physical activity. The pain is more pronounced at night.

Acute scapulohumeral periarthritis also manifests itself as pain in the neck and arm, which intensifies when the arm is moved back. Sometimes a decrease in pain intensity is noted when the arm is passively raised upward, when relief can be felt at a certain level.

When palpating the shoulder and shoulder blade, an increase in pain is noted. In order to reduce pain, a person presses his arm to the body to reduce its mobility. As a result, stiffness of the joint occurs, which requires long-term development. If physical exercises with the arm are not performed for a long time, then a "frozen shoulder" may develop. In this case, further functionality of the joint is limited only to raising the arm as much as possible to the level of the shoulder in a straightened state.

Acute scapulohumeral periarthritis can cause an increase in the volume of the joint with increasing swelling, reddening of the skin in the area of the affected joint, and further disturbances in the innervation of the hand are possible.

Bilateral scapulohumeral periarthritis

The pathology is unilateral in most cases. This is observed in some diseases, increased load on one of the shoulder joints or as a result of traumatic injury. However, sometimes both joints are affected and bilateral scapulohumeral periarthritis develops.

The intensity of clinical manifestations can increase quickly or over several days or months, depending on the cause of occurrence.

The pain syndrome is localized in the shoulder area and spreads to the upper back, neck and arm. Increased intensity is observed when performing movements involving the shoulder joint or the arm as a whole.

Bilateral scapulohumeral periarthritis has conventionally three stages of development. At the first stage, there is an increase in pain, swelling and the appearance of a limitation of joint activity.

Further, as the pathological process progresses, there is a marked decrease in the motor capacity of the scapulohumeral joint, when scarring of the capsule is observed. In parallel to this, the pain syndrome gradually subsides.

In the absence of the necessary treatment, the next phase occurs, which is characterized by a complete lack of movement in the joint. However, if complex therapy is started, a significant improvement in the condition is noted, since the disease responds well to treatment.

Left-sided scapulohumeral periarthritis

The causes of the development of an inflammatory reaction in the shoulder-scapular joint are excessive physical activity, when microtraumatization of tissues and structures of the joint occurs. In addition, diseases of internal organs can cause a violation of blood circulation and innervation in the affected joint.

Left-sided scapulohumeral periarthritis may occur against the background of a previous myocardial infarction, when there is a disturbance in blood circulation in the heart area, which has a negative impact on the joint and surrounding tissues and organs.

As a result of damage to blood vessels, tissues and other structures of the scapulohumeral joint, the permeability of the vascular wall increases and the liquid part of the blood leaks into the tissues. As a result, the swelling of the affected joint increases.

This is also facilitated by inflammatory mediators that affect the vessel wall. The skin becomes hyperemic in the shoulder area, and later, as innervation and blood circulation in the arm are disrupted, the skin may turn blue.

Left-sided scapulohumeral periarthritis may be acute or characterized by a chronic course. During a long-term inflammatory process, muscle atrophy and a decrease in the motor activity of the shoulder and arm occur.

Right-sided scapulohumeral periarthritis

Most often, right-sided scapulohumeral periarthritis is caused by trauma, degenerative processes or liver pathology. When the rotator cuff is damaged, severe pain syndrome appears, which can be constant or wave-like.

The pain extends to the entire shoulder joint area and intensifies with motor activity, especially when abducting the arm. At this stage, the use of painkillers does not bring a full effect.

Right-sided scapulohumeral periarthritis also limits the motor activity of the shoulder and arm. As the disease progresses, the volume of active movements gradually decreases, and then passive ones.

The joint on the right side is more often affected, as it is subject to more intense loads. To prevent its inflammation, it is necessary to warm up before the upcoming intense motor activity.

Diagnosis of scapulohumeral periarthritis

When you see a doctor with typical complaints of joint pain and limited mobility, the specialist first conducts an objective examination for the presence of bone protrusions, muscle atrophy and joint symmetry.

Further diagnostics of scapulohumeral periarthritis consists of palpating the shoulder and the scapular region. In order to assess the motor activity of the joint, it is necessary to perform abduction of the arm, rotation, lifting and extension.

By performing passive movements, muscle tone and tension can be determined. The degree of loss of joint function is assessed in a complex manner.

Diagnosis of scapulohumeral periarthritis also involves conducting an X-ray examination, which will reveal traumatic or degenerative damage to the joint. When determining bone pathology, it is necessary to use computed tomography with a 3D effect.

Thus, a three-dimensional image provides a complete picture of the location of joint structures, muscle or tendon damage. The most popular research method today is ultrasound diagnostics.

The advantages of this method are non-invasiveness, absence of pain and special preparation. In addition, magnetic resonance imaging and arthroscopy can be used.

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Treatment of scapulohumeral periarthritis

At the initial stage, this disease responds quite well to drug therapy. However, in addition to drugs, it is necessary to use physiotherapy procedures and physical exercises. They are necessary for the complete restoration of the lost function of the joint.

Treatment of scapulohumeral periarthritis involves determining the cause of the disease and eliminating it, after which it is necessary to combat its clinical manifestations.

Of course, at the stage of "frozen shoulder", when the joint's functionality is almost completely lost, it is very difficult to restore a healthy structure. In most cases, it is almost impossible to achieve 100%.

Of the medications, it is rational to use non-steroidal anti-inflammatory drugs, which are able to reduce the activity of the inflammatory reaction and reduce the severity of clinical symptoms of the pathology.

Also, treatment of scapulohumeral periarthritis involves the use of compresses, hormonal injections, leeches and physiotherapy procedures.

Physical exercises are also important, helping to develop the joint and restore full motor activity.

What kind of doctor treats scapulohumeral periarthritis?

Shoulder-scapular periarthritis is a group of inflammatory diseases that affect the joint capsule, ligaments, tendons and muscles. Due to the fact that cartilage and bones are not involved in the process, the disease is amenable to therapeutic intervention.

Clinical manifestations of the disease are generally not different, but the cause of occurrence, localization, degree of activity and duration of the inflammatory reaction can divide the pathology into several separate nosological forms, for example, if the capsule is damaged, capsulitis should be considered.

Self-treatment does not always have the desired effect, so you should not engage in self-treatment for a long time to avoid the development of a chronic course and complications. When the first signs appear, you should contact a specialist for diagnosis and determination of effective therapeutic directions.

When pain syndrome appears in the area of the shoulder-scapular joint, it is necessary to conduct laboratory and instrumental diagnostics, with the help of which the pathology is revealed. For this purpose, you can contact a therapist - rheumatologist, traumatologist, neurologist or orthopedist.

A set of exercises for scapulohumeral periarthritis

An important part of physical restoration of joint activity is post-isometric relaxation. Its meaning lies in short-term (up to 10 seconds) performance of isometric muscle work with minimal effort, after which passive stretching is necessary for the same amount of time.

This complex should be repeated up to 5 times, after which muscle relaxation and a decrease in the severity of pain syndrome are observed.

A set of exercises for scapulohumeral periarthritis must be selected individually, taking into account the degree of joint damage and the presence of concomitant pathology.

To achieve the desired result, it is necessary to maintain the load, since excessive stress on the joint can negatively affect the healing process.

A set of exercises for scapulohumeral periarthritis consists of clenching and relaxing the muscles of the hand, circular and sideways movements of the hand, palmar rotations down and up, and touching the opposite shoulder joint with the fingers.

In addition, it is necessary to fully engage the arm. Thus, it should be moved away with a simultaneous rotation of the wrist, raise the arm, perform jerks, movements around the elbow and shoulder joint.

The number of repetitions is determined individually, but generally fluctuates around 5-10 times. It is recommended to do therapeutic physical training every day for half an hour to restore the functioning of the shoulder-scapular joint.

Folk treatment of scapulohumeral periarthritis

An additional component of drug therapy can be folk treatment of scapulohumeral periarthritis. It helps with a mild degree of pathology or in the chronic stage. In combination with drugs, physiotherapy procedures and physical activity, folk methods speed up the recovery process.

Traditional treatment of scapulohumeral periarthritis involves the use of medicinal plants, from which tinctures, decoctions, ointments and solutions for compresses are obtained.

Thus, nettle is used for medicinal purposes. To prepare it, pour 1 dessert spoon of dry leaves with boiling water and heat it up using a water bath for a quarter of an hour. It is recommended to take the tincture one tablespoon three times a day.

Another recipe involves making a tincture of St. John's wort. To do this, pour 15 g of the herb (chopped) with a glass of boiling water and leave it to brew for half an hour. Take a tablespoon three times a day.

You can also use currants for internal use, calendula for rubbing the affected joint, or horseradish root for compresses.

Physiotherapy for scapulohumeral periarthritis

Treatment of joint pathology includes several areas, one of which is physiotherapy for scapulohumeral periarthritis. It occupies an important position, especially at the stage of restoring functional activity.

For this purpose, the shock wave method is widely used, which promotes the activation of regenerative processes in damaged tissues and structures, and also increases local blood circulation, which reduces the severity of the inflammatory reaction.

Ultrasound radiation of high or low frequencies is necessary to reduce the intensity of the pain syndrome. With the help of vibrations, an impulse is transmitted to the affected areas of the joint, including the vessels, which relax and increase the blood supply to this area.

Activation of blood circulation leads to acceleration of tissue recovery processes. Physiotherapy for scapulohumeral periarthritis can also be performed using transcutaneous electrical stimulation, which has the ability to reduce the severity of symptoms of the inflammatory reaction and pain syndrome.

The therapeutic effects are based on the intermittent conduction of pain impulses from the joint capsule to the nerve fibers.

In order to reduce the severity of pain, increase immune protection and activate regenerative processes, it is necessary to use magnetic therapy and laser therapy. In addition, do not forget about irradiation with a quartz lamp, acupuncture, electrophoresis and point massage.

Exercise therapy for glenohumeral periarthritis

One of the main tasks in the treatment of scapulohumeral periarthritis is considered to be the restoration of full joint mobility and the elimination of clinical manifestations of the disease.

Exercise therapy for scapulohumeral periarthritis takes a leading place at the stage of minor inflammation, when the period of joint development begins.

Thanks to physical exercises, it becomes possible to reduce the intensity of pain, improve the elasticity of the shoulder joint capsule, increase the motor activity of the scapulohumeral joint and strengthen the muscles around it.

Depending on the stage of the pathological process, the extent of loss of functional abilities and the severity of clinical symptoms, the specialist selects an individual set of physical exercises for each person.

Physical therapy for scapulohumeral periarthritis must be used regularly, without skipping sessions, since the duration of the disease and the volume of restored functionality of the joint depend on them.

In addition, you should engage in physical exercise after the acute period of the disease and after completing a course of physiotherapy procedures.

As for the exercises themselves, they must be performed in a certain order, without changing the sequence every day. Also, the load should be gradually increased, since the joint will gradually develop and require additional efforts for further restoration of functionality.

Massage for scapulohumeral periarthritis

Massage is used to treat musculoskeletal pathology in case of scapulohumeral periarthritis. The acute period of the disease is characterized by severe pain syndrome, which prevents the motor activity of the arm and shoulder.

At this stage, it is not recommended to use massage, since the inflammatory reaction is acute. In the future, as the severity of symptoms decreases, it is recommended to use massage for scapulohumeral periarthritis.

In most cases, the scapulohumeral joint is affected unilaterally, but there are cases of bilateral damage. In chronic cases, relapses are observed mainly in the cold season.

Massage should be applied after several weeks, when the joint immobilization period ends. Massage should be applied to the collar area, deltoid and pectoralis major muscles, as well as the scapulohumeral joint and shoulder.

Massage is used to reduce the intensity of pain syndrome, prevent the formation of dense scar tissue and the development of bursitis. In addition, kneading of these areas is necessary to prevent the occurrence of atrophy and the progression of the inflammatory reaction.

However, the most important goal of massage is to restore the functional activity of the shoulder joint and return a person to a full life.

Medicines for glenohumeral periarthritis

The treatment of scapulohumeral periarthritis involves physical exercises, massage, physiotherapy procedures, and medications for scapulohumeral periarthritis. In a more advanced case, surgical treatment is required.

In order to stop the inflammatory process, as well as its regression, it is necessary to use anti-inflammatory drugs. They are needed to reduce the severity of clinical symptoms of the pathology.

Thus, anti-inflammatory drugs can reduce swelling, hyperemia of local localization and intensity of pain syndrome. The greatest effectiveness of drugs is noted at the initial stage of the disease, when the first symptoms appear.

Anti-inflammatory medications for scapulohumeral periarthritis can be taken in tablet form, as well as in the form of ointments and creams. In severe forms of the pathology, the addition of hormonal drugs is required. They are used intra-articularly by injection.

In addition to medications, it is necessary to provide rest to the affected joint, but in the future, a certain set of physical exercises should be gradually performed, with the help of which the joint restores its functionality.

Prevention of scapulohumeral periarthritis

In order to avoid this pathology, it is necessary to know that there is a prevention of scapulohumeral periarthritis. It consists of several rules, adhering to which, you can reduce the likelihood of the disease to a minimum.

First, you should stick to measured physical activity. This consists of daily short exercises, thanks to which the joint is developed and is ready to withstand more serious loads throughout the day.

Secondly, you need to stick to a healthy diet and give preference to products that contain a significant amount of fiber, calcium and a minimum salt content. In addition, it is recommended to limit the consumption of fried, smoked and fatty foods.

Prevention of scapulohumeral periarthritis also includes maintaining correct posture while walking, sitting at a desk, and working at a computer. During physical activity, do not overload the shoulder girdle and spine, especially in the cervical region.

It is recommended to avoid drafts and direct exposure of the cold factor to the shoulder-scapular joint and neck. As a result of prolonged hypothermia, the development of an inflammatory process is observed. In general, it is necessary to prevent inflammation from occurring, and if it does appear, treat it promptly.

Prognosis of scapulohumeral periarthritis

Like any other disease, scapulohumeral periarthritis is most successfully treated at the first stage of the pathological process. The longer the disease remains without the necessary therapy, the more difficult it is to return the joint to its previous functionality.

The prognosis for scapulohumeral periarthritis is favorable. If treatment was started in time, then one can expect a quick and full recovery of lost working capacity.

Thus, the shoulder-scapular joint acquires good functional capacity, pain syndrome, swelling and hyperemia of the affected area disappear.

Thanks to modern approaches to treatment, a person will soon regain full activity. However, if self-treatment attempts are made over a long period of time, the chances of full restoration of joint functionality gradually decrease.

In this case, the disease progresses and the severity of clinical symptoms increases. When the process becomes chronic, even with the use of drug therapy it is not always possible to return the joint to its previous healthy state.

The prognosis of scapulohumeral periarthritis is considered unfavorable when a "frozen shoulder" is observed, characterized by joint stiffness and almost complete immobilization. In this case, scapulohumeral periarthritis requires surgical intervention, which does not give high chances for recovery.