Shoulder periarthritis

Shoulder periarthritis is an inflammatory lesion of the periarticular tissues. Let's consider the main causes of the disease, symptoms, diagnostic methods. As well as effective treatment methods, prevention and general prognosis for recovery.

As a rule, middle-aged and elderly people, both men and women, suffer from this pathology. Inflammation of the shoulder tendons and shoulder joint capsule is diagnosed very often. The disease can be provoked by injuries, falls on the shoulder or outstretched arms. In some cases, even mammary gland removal surgeries and internal organ diseases lead to the development of shoulder periarthritis.

Any disturbances in the joint structure lead to periarthritis and other bone diseases. Frequent injuries lead to changes in blood vessels and dysfunction of joints, which entails the formation of calcifications that complicate the mobility of the limbs, cause painful sensations and significantly reduce the quality of life.

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Causes of Shoulder Periarthritis

The causes of shoulder periarthritis are varied, but they all cause inflammation of the shoulder tissues, damage to the tendons, joint capsule and muscles. Periarthritis does not cause destruction of the joint, unlike arthritis or arthrosis. The causes of periarthritis can be hidden inside the body or arise from various acute diseases.

Let's look at the main causes of shoulder joint inflammation:

• Injuries and increased stress on the shoulders.
• Falls on an outstretched arm or shoulder.
• Unusual activity.
• Consequences of cardiovascular diseases.
• Pathologies of the lungs and endocrine system.
• Disorders of cerebral circulation and development of connective tissue.
• Hormonal imbalances and diabetes.
• Condition after operations (for example, after removal of mammary glands).
• Spondylosis.
• Osteochondrosis and osteoarthritis of the cervical and shoulder segments.

Regular hypothermia, stress, nervous disorders and high humidity worsen the course of shoulder periarthritis. But most often the disease appears due to injuries, blows and falls.

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Periarthritis of the shoulder joint

Periarthritis of the shoulder joint has four stages, each of which has certain signs and symptoms. The main sign indicating an inflammatory process is pain and discomfort. Only a doctor can accurately diagnose the disease after X-ray and a number of other studies.

• Simple shoulder periarthritis

This is the mildest form of the disease, the first sign is mild pain in the shoulder. Discomfort occurs when trying to raise the arm, touch the spine or put the arm behind the back. Joint mobility is limited, so it is difficult to perform simple actions. But if the affected area is not disturbed, the pain subsides. To diagnose this form of periarthritis, the doctor can conduct an experiment. The patient must try to raise the arm under resistance. If painful sensations occur during the exercise, this indicates simple periarthritis.

• Acute periarthritis

It occurs when simple periarthritis is left without medical care and begins to progress. The symptoms are as follows: the mobility of the hand is limited even more, when trying to raise or move the hand to the side, a sharp pain occurs, which increases over time. Discomfort worsens in the morning and evening, an increase in body temperature is possible, and signs of an inflammatory process in blood tests.

• Chronic periarthritis of the shoulder joint

This form of inflammation indicates the progression of periarthritis. Chronic inflammation of the shoulder joint is treated for a long time and is difficult. The main signs of the chronic stage: pain in the shoulder area in the morning and evening, sharp shooting pains with awkward shoulder movements, decreased discomfort compared to the acute stage. Due to night pain, sleep may deteriorate. Since the internal tissues of the shoulder joint are severely depleted, rare shooting pains appear. At this stage, periarthritis will not go away on its own, so urgent medical care is required.

• Ankylosing (adhesive capsulitis) periarthritis

This form of the disease has no treatment. Since pathological processes in the shoulder lead to complete fusion of the bone in the joint, which blocks any movement. Painful sensations are dull in nature, but completely deprive the ability to work. In rare cases, any attempts to move the joint cause severe pain.

Depending on the form of periarthritis, the symptoms of the disease and the characteristics of the patient's body, appropriate treatment is selected. The sooner therapy is started, the greater the chances of maintaining full mobility and functioning of the shoulder joint.

Symptoms of Shoulder Periarthritis

Symptoms of shoulder periarthritis depend on the form of the disease and the stage of its development. If the patient has scapulohumeral periarthritis, then painful sensations appear in the shoulder joint and persist for a long period of time. Pain that occurs when moving the arms is also a symptom of a certain form of the disease. Let's consider the main symptoms that occur at different stages and with different forms of periarthritis.

1. Simple periarthritis:
   • Minor discomfort and pain in the shoulder with certain arm movements.
   • Limitation of joint movement when trying to put your hand behind your back, touch your spine, or stretch it up.
2. Acute shoulder periarthritis:
   • Sudden, increasing pain that radiates to the arm and neck.
   • When trying to rotate the arm around the axis or to the side, sharp pains appear, which intensify at night. The easiest way to keep the affected limb is to bend it at the elbow and press it to the chest.
   • A slight swelling and redness of the skin appears on the front surface of the shoulder.
   • Slight increase in temperature, insomnia, general malaise.
3. Chronic form of periarthritis:
   • The pain is moderate and worsens at night and in the morning.
   • If you make unsuccessful arm movements, severe pain occurs in the sore shoulder.
   • There is a feeling of pain in the shoulders, which causes insomnia.

All symptoms of the above-described forms of shoulder periarthritis are progressive. For example, chronic inflammation can last from a couple of months to several years. But in 30% of patients, periarthritis without medical treatment takes more serious clinical forms:

• Duplay syndrome (frozen shoulder)

Due to degenerative changes in the rotator cuff, restrictions of any movements are clearly expressed. Such symptoms can last for 2-7 months, which entails a rupture of the muscle tendons. The progressive inflammatory process affects the joint bags, which leads to a decrease in the intra-articular fluid in the joint cavity.

• Pseudoparalysis syndrome

A sharp limitation or complete inability to perform active movements in the shoulder. The duration of the syndrome is no more than a month, if the symptoms last longer, this indicates a joint contracture. The pathology appears due to damage to the rotator cuff, in which the head of the shoulder is stabilized.

• Paralytic Shoulder Syndrome

The patient loses the ability to perform any movements in the joint. Due to traumatic damage to several structures of the shoulder joint at the same time, the general course of periarthritis is significantly aggravated.

• Impingement syndrome

Pain occurs in various positions of the limb and develops due to transosseous damage to the cuff.

• Tunnel syndrome

Discomfort occurs with sudden movements. Pathology develops due to external compression of the supraspinatus muscle by the clavicle or adjacent tissues.

Scapulohumeral periarthritis

Scapulohumeral periarthritis is an inflammation of the tendons of the shoulder and the capsule of the shoulder joint. The peculiarity of this pathology is that the internal structures of the joint and cartilage are not damaged. This fact distinguishes periarthritis from arthritis or arthrosis of the shoulder joint. According to medical statistics, every fifth person in the world suffers from scapulohumeral periarthritis. Both women and men are equally susceptible to the disease.

The causes of the pathology are different, these can be injuries, falls on an outstretched arm, excessive physical activity or blows to the shoulder area. That is, an unusual load on the joint or its overload leads to periarthritis. It is necessary to take into account the fact that between the cause of the inflammatory process and the appearance of the first symptoms there is a certain time interval, which can last 1-2 weeks.

In some cases, diseases of internal organs lead to the development of scapulohumeral periarthritis. Often, people who have had a myocardial infarction begin to have pain in the left shoulder, which indicates the development of periarthritis. Liver pathologies, injuries and any diseases of the cervical spine also provoke the disease.

Cervical-brachial periarthritis

Cervical-brachial periarthritis usually occurs due to diseases of the cervical spine. The disease is accompanied by degenerative changes in the intervertebral discs, pain and symptoms that can easily be mistaken for other pathologies. Periarthritis can occur against the background of cervical osteochondrosis, as a result of pinching of the nerve bundle in the shoulder. In this case, not only periarthritis is subject to treatment, but also the primary disease, that is, osteochondrosis.

Cervical-brachial periarthritis, like other forms of this pathology, is accompanied by pain syndrome and discomfort. Unpleasant sensations arise for no apparent reason and very often at night. Sharp pain radiates to the neck and arm, gradually increases and radiates to the spine. At the same time, if you raise your arm up, the pain subsides. In especially severe cases, cyanosis and slight swelling appear on the hand. In addition, an increase in temperature and pain when trying to palpate the paravertebral points of the cervical spine are possible.

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Diagnosis of shoulder periarthritis

Diagnosis of shoulder periarthritis is the first thing a doctor does when a patient complains of pain in the shoulder area. To determine the cause of the ailments, anamnesis is collected. The main clinical picture of periarthritis is pain in the shoulder joint when abducting the arm and local soreness in the places where the tendons and bones connect. The doctor conducts an external examination of the limb, motor tests and palpation. This is followed by instrumental diagnostic methods that allow you to differentiate periarthritis from a number of other pathologies of the joints and bones of the shoulder.

Let's consider step by step the entire process of diagnosing periarthritis of the shoulder joint:

• Initial examination

At this stage of diagnostics, the doctor pays attention to the severity of the muscular system of the shoulder girdle and shoulder girdle. Very often, with periarthritis in the suprascapular region, minor muscle atrophy is observed. When palpating the diseased joint, pain appears.

• The next stage of the examination is determining the range of motion. The patient needs to do arm abduction, flexion, extension, outward and inward rotation, i.e. active movements. If discomfort or painful sensations appear during the exercises, this may indicate periarthritis.
• In addition, passive movements are studied. This is due to the fact that a sharp decrease in active movements occurs with Duplay syndrome, that is, a "frozen" shoulder.

As a rule, if a patient under 40 years of age comes with suspicions of shoulder periarthritis, then the cause of the pathology is injuries, sprains, blows. If the patient is over 40 years old, then the disease occurs against the background of pathological changes in the body.

• X-ray diagnostics

X-rays are of great diagnostic importance. For a more accurate study of the cause of pain, three images are taken: at rest, with the arm rotated inward or outward, and with the shoulder abducted. The main X-ray signs of shoulder periarthritis look like bone defects or an uneven structure in the area of the humeral head. During the diagnostic process, the doctor may inject a contrast agent into the joint cavity. This allows for the detection of cuff damage, since in this case the substance penetrates beyond the joint.

• Computer tomography

This diagnostic method is used for bone pathologies detected by X-ray. Modern technologies make it possible to visualize the image of the joint condition. The information obtained allows us to assess the degree of damage to muscles and tendons, as well as the presence of additional formations.

• Ultrasound examination

Ultrasound is one of the most informative methods. The main advantages of ultrasound examination are the lack of special preparation, painlessness, non-invasiveness and quick results.

• Magnetic resonance imaging

This examination can examine the bones, ligaments, tendons, cartilages, muscles and joint capsule of the shoulder. MRI can detect any stage of shoulder periarthritis, even those that could not be determined using the above methods.

• Arthroscopy

It is a kind of surgical intervention that allows to determine the cause of the pathology and, if possible, eliminate it. Diagnostic arthroscopy is performed if the pain and limitation of movement in the shoulder joint have an unclear etiology.

Therapeutic arthroscopy is performed in case of cuff pathologies, tendiosis, impingement syndrome. The procedure is prohibited in case of purulent-inflammatory diseases of the shoulder joint and limb, joint contracture and the general severe condition of the patient.

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Treatment of shoulder periarthritis

Treatment of periarthritis of the shoulder depends on the form of the disease and the patient's condition. Therapy can be either conservative, that is, medications and therapeutic exercises, or operative - surgical intervention. Mild forms of periarthritis are treated conservatively, with the help of various drugs (tablets, injections, ointments). Let's consider the main conservative methods of treating periarthritis of the shoulder:

Nonsteroidal anti-inflammatory drugs

Since the main symptom of the disease is pain in the shoulder area, painkillers and anti-inflammatory drugs are used to eliminate them. As a rule, such drugs as Diclofenac, Ibuprofen, Aspirin, Voltaren and others are used. But the use of these drugs is possible only under medical supervision. This is explained by the fact that NSAIDs have pronounced side effects. Therefore, the duration of use of such drugs should not exceed the period specified by the doctor.

Today, there are a number of new generation painkillers with minimal side effects: Celecoxib, Movalis, Nimesulide and others. But only a doctor can prescribe medications after diagnosis and determination of the nature of the pain.

Corticosteroids

Medicines used to reduce inflammation in the shoulder. If NSAIDs do not have the desired effect, the patient is prescribed hormonal anti-inflammatory drugs. Corticosteroids have many side effects, so they are used in the form of injections and injected into the affected area of the shoulder.

Thus, according to medical statistics, in 75% of cases of shoulder periarthritis, corticosteroids completely stop the disease. The therapy consists of 1-3 injections. Betamethasone, Diprospan or Flosteron are used as medication.

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Novocaine blockades

This method of treatment is used when the above-described methods have not yielded positive results. Periarticular novocaine blockade is performed very simply. A series of injections with anesthetic are administered into the painful area of the shoulder joint at regular intervals. In some cases, treatment can last for 1-3 months. The duration of therapy is selected individually for each patient, taking into account the degree of pain syndrome and motor functions of the shoulder. Novocaine is used as a drug for blockades.

Post-isomesitric relaxation (PIR)

Today it is considered the most effective method of treating shoulder periarthritis. According to medical statistics, about 80% of patients with various forms of shoulder joint damage fully recover after 15 sessions of post-isomeritic relaxation. This method of therapy is combined with massages and electrophoresis.

Treatment of periarthritis of the shoulder joint with ointments

Treatment of periarthritis of the shoulder joint with ointments is one of the simplest and most accessible methods of therapy. As a rule, anabolic, warming and pain-relieving ointments are used. Anabolic ointments relieve pain, and pain-relieving ointments relieve muscle spasms and swelling of soft tissues. Due to this, the metabolic and nutritional process in the joint is normalized, which protects it from dystrophy. Ointments are selected based on the cause of pain.

If the shoulder pain appeared after a minor injury, then a drug with a cooling or warming effect is suitable for treatment. Warming ointments most often contain red pepper extract and methyl salicylate. But such ointments cannot be applied immediately after an injury, since the affected area must be cooled. That is, with mild shoulder periarthritis, it is better to use a cooling ointment, and a few days after the injury - a warming agent. Cooling ointments contain menthol, essential oils, alcohol and blood-thinning components.

The composition of drugs that will help eliminate pain in the shoulder and neck area may include the following substances:

• Diclofenac is used for rheumatic pain, relieves pain and stops the inflammatory process.
• Menthol is a local irritant substance that relieves pain shock.
• Ibuprofen – relieves inflammation and effectively relieves pain.
• Snake and bee venom – improve blood circulation, initiate the process of tissue regeneration, relieve pain.
• Extract of red pepper or mustard – used to improve blood circulation and accelerate metabolic processes in tissues.
• Indomethacin – eliminates pain, swelling and inflammation.
• Camphor - relieves pain.
• Methyl salicylate – relieves pain and reduces inflammation.

Let's look at several effective ointments for shoulder periarthritis that contain the substances described above:

• Diclofenac

Voltaren Emulgel is a drug with anti-inflammatory action, produced in several pharmacological forms. Today, there are ointments, suppositories, tablets and solutions of the drug. For the treatment of periarthritis, it is best to use an ointment. Diclofenac is recommended for use in attacks of gout, osteoarthritis, arthritis and for the treatment of all forms of shoulder periarthritis. The product is gently rubbed into the affected surface of the shoulder, 2-3 times a day.

• Indomethacin

A medicinal preparation with anti-inflammatory action for eliminating joint pain. One gram of ointment contains about 100 mg of the active substance. The ointment is recommended for the treatment of shoulder, cervical-brachial and other types of periarthritis, gout, rheumatoid arthritis and other diseases of the joints and bones. The drug is effective for all pathologies that cause swelling, hematomas and discoloration of the skin. With gentle, smooth movements, rub the ointment into the affected area until completely absorbed. The product can be used no more than 3 times a day.

• Dolgit Cream

A drug with the active ingredient ibuprofen. Helps reduce pain, inflammation, muscle spasms and swelling. The active ingredient effectively thins the blood, thereby improving blood flow to bone and soft tissues. The ointment is rubbed into the skin until completely absorbed, but not more than 3-4 times a day. The course of treatment can last up to one month.

• Nise gel

A medicinal product with the active ingredient nimesulide. Despite its effectiveness, the product is not recommended for use in inflammatory and purulent lesions of the skin, ulcerative diseases of the gastrointestinal tract, infectious diseases, as well as during pregnancy and lactation. Like all products of similar action, the ointment is applied to the skin 2-3 times a day until completely absorbed.

In addition to the above-described ointments for the treatment of shoulder periarthritis, you can use Bystrumgel, Ketonal gel, Deep Relief gel and other drugs. But you can use ointments only after consulting your doctor. This will protect you from the side effects of drugs.

Physical therapy for shoulder periarthritis

Physiotherapy for shoulder periarthritis is necessary both for a simple form of the disease and for acute or chronic ones. And this is not surprising, since the disease is easily treated and prevented with the help of physiotherapy. Exercises are aimed at reducing pain, increasing joint mobility, cuff muscle strength and capsule elasticity.

But physical therapy can only be performed after consultation with the attending physician and a course of physical therapy to minimize pain. Let's consider an approximate set of therapeutic exercises for shoulder periarthritis.

• Sit on a chair, put your hands on your waist and smoothly move your elbows apart and together. The movements should not be abrupt, as this can damage the inflamed shoulder joint and cause pain. At first, 6-8 repetitions are enough, but as you perform the exercises, the number of approaches should be increased.
• Sit on a chair, place your palms on your waist, slowly move your shoulders back and forth, try to make circular movements. Do the exercise for 1-2 minutes.
• Place the sore limb on the opposite shoulder, press the elbow to the body. With the healthy hand, grasp the elbow and slowly pull the elbow of the sore arm up, creating resistance for yourself.

Therapeutic exercises for shoulder periarthritis

Therapeutic gymnastics for shoulder periarthritis is used both during the period of restoration of normal functioning of the limb and to reduce painful sensations. All exercises are quite simple and will not take much time to perform.

• Raise and lower your arms and shoulders alternately. Perform the exercise slowly, trying to work the muscles of the injured limb as much as possible.
• Bend and straighten your elbow joints. Your palms can be in different positions: on your waist, on your shoulders, or clenched into a fist at face level.
• Clasp your hands together, slowly lift them forward and up. Bend your arms in front of you, alternately to each shoulder.
• Cross your arms and stretch them out with your palms facing outward, first up, then down and forward. Repeat the exercise several times.
• Relax the affected limb and slowly swing your arm along your body. Do not change position, try to move your arm away, make circular movements, move it behind your back.

In addition to the above exercises, you can perform a therapeutic exercise complex aimed at restoring the mobility of the shoulder joint. In this case, gymnastics treatment should be started as early as possible, as this will not allow the disease to progress.

A set of exercises for shoulder periarthritis

A set of exercises for shoulder periarthritis is aimed at reducing pain and restoring joint mobility. Physiotherapy should be carried out simultaneously with taking medications. Such a comprehensive approach will allow you to achieve quick and maximally sustainable results.

You can do the exercises yourself or seek help from specialists. Physiotherapy and reflexology are represented by such techniques as acupuncture, point massage, electrophoresis, mud applications, vibration massage, magnetic therapy, shock wave therapy and laser therapy.

The attending physician will select an effective method of physiotherapy and a set of therapeutic exercises. This combination will allow the shoulder joint to be restored as quickly and safely as possible after an inflammatory lesion. But do not forget that inadequate treatment of shoulder periarthritis with the help of physical exercises can lead to very negative consequences: progression of inflammation, increased pain or deterioration of the periarticular tissues.

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Folk remedies for shoulder periarthritis

Folk remedies for shoulder periarthritis are time-tested recipes that are available to everyone. Such treatment will help relieve muscle tension, improve blood supply, nutrition and mobility of the shoulder joint, and also normalize the nervous system. For therapy, herbal herbs are used, from which rubbing, ointments, compresses and baths are prepared for the shoulder area.

• Salt dressing

To prepare this remedy, you will need a saline solution. Take 100 grams of salt and 1000 ml of water, stir the salt until completely dissolved. For the bandage, you will need a good piece of gauze, folded into 6-8 layers. The gauze should be carefully dipped in the solution for 2-3 hours. After this, it is recommended to warm up the vessel with the bandage and saline liquid and apply the hot gauze to the sore shoulder joint. It is better to fix the bandage with a scarf or towel. The duration of treatment is 14 days, compresses are recommended to be applied only at night.

• Honey compress

Apply a thin layer of honey to the skin surface, carefully distributing it over the collarbone, forearm and shoulder blade area. Cover the honey layer with cellophane film, a woolen scarf or shawl. It is best to make the compress at night and leave it on until the morning.

• Herbal compress

To prepare the compress, you need to take the herbs of chamomile, medicinal marshmallow and medicinal sweet clover in a ratio of 2:1:2. The plants are thoroughly crushed until a homogeneous dry powder is obtained. The crushed herbs are diluted with hot water until a thick gruel is obtained. After this, the mixture should be spread on gauze and a hot compress should be applied to the sore shoulder. In order to retain heat, you can use plastic wrap and a woolen scarf. Remove the compress only after it has completely cooled. The course of treatment is individual for each patient and depends on the severity of the disease. As a rule, compresses are used until pain and inflammation are completely eliminated.

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Surgery for periarthritis of the shoulder joint

Surgery for periarthritis of the shoulder joint is performed only if conservative therapy is ineffective. The procedure is called subacromial decompression and involves removing a fragment of the scapular process and ligament. This protects nearby tissues from further injury. Surgery is indicated in the presence of pathological degenerative changes and the absence of a therapeutic effect from drug therapy and therapeutic exercise for 3 months. Surgery is explained by the fact that conservative treatment cannot lead to positive results in the case of anatomical disruption of the integrity of tendons, ligaments and muscles. And surgery allows you to restore the continuous structure of the joint and its functions.

The main indications for surgery for periarthritis of the shoulder joint:

• Complaints of pain in the shoulder joint after a course of drug therapy and corticosteroid injections.
• Recurring pain in the shoulder area that lasts more than 6-8 months.
• The operation is necessary for patients over 40 years of age and those whose work is directly related to active movement of the shoulder joints.
• Partial damage to the tendons and dysfunction of the supraspinatus muscle.
• Percutaneous injury of the cuff tendons.
• Tunnel syndrome.

Contraindications to subacromial decompression:

• Persistent adduction contracture of the joint.
• The general serious condition of the patient.
• Diseases of any localization of a purulent and inflammatory nature.
• Inability of the patient to undergo rehabilitation measures for shoulder periarthritis.
• Refusal of surgical intervention.

If the operation is not performed in a timely manner, the mobility of the shoulder joint will significantly deteriorate, up to complete numbness. But even in the most severe cases, subacromial decompression gives positive results. After the operation, the patient will have a long rehabilitation course, during which the range of motion of the limb will gradually be restored. Regular physical exercise will restore the flexibility and mobility of the shoulder joint, minimize the risk of periarthritis recurrence. As a rule, full recovery after surgery occurs in 3-4 months. In 95% of cases, the operation is effective and permanently eliminates shoulder periarthritis.

Prevention of shoulder periarthritis

Prevention of shoulder periarthritis is aimed at restoring the joint's motor ability. In addition, prevention is necessary to prevent the disease. Preventing injury to the shoulder area, moderate physical activity, minor loads and normal general health are the key to the absence of various pathologies of bones, joints and the body as a whole.

The rehabilitation course is carried out after the main therapy. As a rule, prevention includes: the use of medicinal and vitamin preparations, therapeutic massage and physical training, electrophoresis, paraffin applications, a bath and other methods. But in any case, all prevention of periarthritis comes down to timely seeking medical help for any injuries to the shoulder joint.

Please note that periarthritis is treated by a traumatologist-orthopedist or a surgeon. But in addition to these specialists, it is necessary to undergo examinations by a physiotherapist, neurologist and rheumatologist. If the disease has caused irreversible dysfunction of the shoulder joint and surgery has not helped to restore mobility, the patient is assigned a disability group.

Prognosis of Shoulder Periarthritis

The prognosis of shoulder periarthritis is based on the form of the disease. The greatest danger is chronic - ankylosing periarthritis. Such pathology occurs in the absence of adequate treatment and is observed in 30-40% of patients. Without timely medical care, the tissues of the shoulder joint become denser, which leads to their stiffness. Pain syndrome can cause a state of shock. In addition, the progression of periarthritis entails disturbances in the contractile ability of muscles and blocking of the scapular-sternal bone articulation. As a result, the limb is completely immobilized, it is impossible to restore its functioning.

Shoulder periarthritis is easy to treat in the early stages. Therefore, at the first symptoms of painful sensations in the shoulder, it is recommended to seek medical help. Treatment will not take much time, but will allow you to maintain normal shoulder joint mobility.