Shoulder Osteoarthritis - Causes, Symptoms and Treatment

Arthrotic changes in the shoulder

Arthrotic changes in the joints are basically a painful process. What's more, they are now one of the most common causes of joint discomfort and continued loss of exercise. In addition to the knee joints, the shoulder joints are also increasingly affected by the arthritic wear process.

contents

• Arthrotic changes in the shoulder
• definition
• Causes of shoulder osteoarthritis
• Primary osteoarthrosis
• Secondary osteoarthrosis
• symptoms
• diagnosis
• Detailed history
• Physical examination
• Imaging research
• Laboratory diagnostic procedures
• treatment
• Medication
• nutritional intervention
• movement measures
• Naturopathic treatment:
• Operative treatment

The reason for this is, on the one hand, the fact that man's activities, even in the course of evolution, have become very poor for upright Homo sapiens. On the other hand, modern everyday life also promotes increasing wear on the shoulder joints.

Shoulder arthrosis is a process of wear on the shoulder joint. (Picture psdesign1 / fotolia.com

definition

Like all joints of our body, the shoulder joint (articulatio humeri) is composed of several bone and cartilage elements. The bony structures are placed by the humerus and the scapula.

While the spherical head of the humerus (Caput humeri) represents the actual articular surface of the shoulder, which allows the rotation and the lifting of the upper arm, the plate-shaped shoulder blade socket (Cavitas glenoidalis) acts as ball-bearing for the shoulder joint. The two parts of the bone are held by a series of muscle tendons and ligaments, which on the one hand stabilize the position of the joint, but on the other hand guarantee the free rotation of the shoulder. To name here are decisive:

• rotator Cuff - probably the most important section of the shoulder muscles. As the name suggests, the rotator cuff or muscle tendon cap is responsible for the rotational movement of the shoulder. To her belong four muscle strands:
  • Upper shoulder bone muscle (Supraspinatus muscle),
  • lower shoulder bone muscle (Infraspinatus muscle),
  • lower scapular muscle (Subscapularis muscle),
  • small round muscle (Teres minor muscle).
• deltoid (Deltoid muscle) The rotator cuff is covered by the so-called deltoid muscle. He coordinates the flexion movements of the shoulder joint.
• biceps (Biceps brachiiThe bicep is responsible for the stretching of the shoulder joint.
• Great pectoral muscle (Pectoralis major muscleIn addition to its function in the area of ​​the respiratory support muscles, the large pectoral muscle is also involved in the internal rotation of the shoulder.
• Transverse ligament of the humerus ( Ligamentum transversum humeri) This shoulder strap stabilizes the biceps in its position between the humerus bumps.
• Reinforcement band of the shoulder joint capsule (Ligamentum coracohumeral) This ligament device stabilizes the shoulder joint itself.

In addition to the stabilizing and movement-inducing elements on the shoulder joint, there are also some joint parts that serve to relieve pressure and protect the articular surfaces from rubbing against each other. They play a special role in the development of shoulder osteoarthritis, as their wear usually marks the onset of the disease.

For the initial genesis of shoulder osteoarthritis, the capsule (Capsula articularis) is particularly important. A connective tissue cartilage mass that rests directly on the joint cavity of the humeral head and thus serves as a protective cushion against any friction caused by movement of the shoulder. The joint capsule of the shoulder is built up like all joint capsules in the body from two membrane layers:

• Membrana fibrosa - The outer layer of the joint capsule consists of collagen-containing connective tissue and is fused at the edge with the periosteum of the joint.
• Synovial Membrane - The inner layer of each articular capsule is much more sensitive than the outer membrane fibrosa. It consists of connective tissue cells that are closely related to the immune cells of the blood.

There are many muscles around the shoulder joint that may be compromised in shoulder osteoarthritis. (Image: artstudio_pro / fotolia.com)

The osteoarthrosis always begins at the Membrana fibrosa of the joint capsule, whereby the wear progresses in the further course up to the synovial membrane and beyond. In the advanced stage of shoulder osteoarthritis, the articular surfaces themselves are increasingly affected by the wear process, which leads to painful joint inflammation and severe loss of movement of the shoulder.

Likewise, the bursae of the shoulder joint may be affected by joint wear. They are liquid-filled bags, which are located in the recesses of the joint cavities and act as shock and pressure-absorbing airbags. Shoulder arthrosis can lead to a painful bursitis (Bursitis) here and thus further restrict the freedom of movement of the shoulder.

Attention: A bursitis in the shoulder area is all the more painful if it affects several bursae at the same time. In addition, an inflammation on the bursa of the lower bony muscle (Bursa subacriminalis) is not desirable. It is the largest bursa in the human body and can cause particularly severe pain in inflammatory processes.

Causes of shoulder osteoarthritis

In the development of osteoarthritis, several factors usually play together. Relevant here

• genetic predisposition,
• mechanical load
• and pre-existing diseases or pre-injury of the shoulder joint

Depending on the cause of the disease, the osteoarthrosis can also be divided into two different forms. As the primary omarthrosis while wear processes in the shoulder are referred to, which have arisen for no apparent reason. Most of the time one assumes age-related joint wear and tear, with lifelong stress factors also contributing to the event.

Omarthrosis is caused by wear on the shoulder joint. (Picture: YakobchukOlena / fotolia.com)

Secondary osteoarthrosis, on the other hand, has its origin in targeted damage to the shoulder joint. Both accident injuries and joint diseases are conceivable as a cause here.

Primary osteoarthrosis

The fact that it comes in the course of life to a natural wear of the shoulder joint, is completely normal. The cartilage mass of the joint, as well as the tendon, ligament and bone substance decrease steadily over time, which sooner or later leads to age-related joint wear. Worryingly, such signs of wear and tear have become increasingly common in younger years. And although the causes have not been sufficiently clarified so far, doctors suspect some unhealthy everyday habits behind the phenomenon. These include in particular

• curved shoulder posture (e.g., by computer or factory work)
• sustained heavy lifting (e.g., heavy backpacks or heavy loads)
• unclean shoulder / arm movements (for example during sports or work)
• lack of exercise (especially by predominantly passive everyday life)
• nutritional aspects (e.g., nutritional deficiency or obesity)

To what extent these aspects favor premature joint wear is in many cases not clearly understood. However, it can not be denied that the everyday behavior of patients has a decisive influence on the health of the shoulder joints.

Secondary osteoarthrosis

In the case of secondary shoulder arthrosis, shoulder diseases and shoulder injuries are clearly in the foreground of the spectrum of causes. Although bad postures of the shoulder may also be involved as indirect influencing factors here, however, osteoarthritis occurs exclusively as a complication of serious illnesses. The range of possible health complaints is relatively diverse in this context.

It is conceivable, for example, an accident injury to the band devices of the shoulder. As a result, the head of the humerus is often marginally displaced so that its articular surface is no longer accurately located in the shoulder blade socket. The articular cartilage begins by the malposition of the bone head then increasingly scrub on the scapula and sooner or later wears off more and more.

A dislocated shoulder (shoulder luxation) also strains the tendons and ligaments of the shoulder joint to a great extent and can weaken their substance sustainably, whereby misalignment of the joint and associated friction wear are more likely.

Accident scenarios of this kind occur, in particular, in arm-poor sports. However, team sports such as football also contribute to sprains, fiber tears and bruises on the shoulder muscles and tendons due to its high risk of falling. In addition, even solid fractures, such as the upper arm fracture are not ruled out as the trigger of shoulder arthrosis. Such a fracture can result not only in sports, but also in a traffic accident or even in everyday life, if a heavy impact, fall or impact on the shoulder was involved.

The wear of the joints over time is inevitable. (Picture: Picture-Factory / fotolia.com)

Also in the course of a basic disease of the shoulder, which had a shift of the shoulder's own joint parts result, it can cause the wear of the articular cartilage by increased friction and pressure load. In addition, some shoulder diseases involve the risk of cartilage damage. This applies in particular to inflammatory processes and tissue regeneration, which provoke substance damage to the cartilaginous or connective tissue joint elements. A small but permanent exposure is already sufficient in these cases to trigger the osteoarthrosis. Typical pre-existing diseases, which repeatedly cause a shoulder arthrosis in this regard, are:

• congenital malformations of the shoulder,
• connective tissue (Collagenosis),
• arthritis (Arthritis),
• cartilage growths (Chondromatosis),
• muscular dystrophy (Muscular atrophy),
• rheumatism,
• Schulternekrose.

symptoms

The main symptom of shoulder arthrosis is pain in the joint in question, which initially begins to creep, but subsequently increases in intensity and duration. For this reason, many patients with shoulder arthrosis initially report only mild shoulder pain that occurs only after major physical exertion or effort.

Common scenarios include, for example, shoulder pain after training in the gym or lifting moving boxes. As soon as the sufferers have allowed their shoulder some rest, the pain usually fades away again, which causes the treacherous fallacy that it is a spontaneous and short-term overload of the shoulder. And even with repeated "Ziepen" many still assume a banal overload and take, instead of going to the doctor, to painkillers. No wonder then that shoulder arthroses are often diagnosed very late.

A high level of suffering, which ultimately causes the affected person to visit a doctor, often only occurs when the pain gradually becomes stronger and can no longer be controlled even with sufficient rest and regeneration phases. But then the joint wear is often so advanced that a heavy wear process can not be stopped so easily.

As the joint wear increases, so does the extent of shoulder discomfort. Initially, the discomfort is more diffuse, the shoulder area hurts slightly to moderate after major stress, certain movements are stiff and the arm affected weaker than usual in its exercising power. At least at the beginning of the disease, however, these symptoms also recede after some protection, so that the range of motion and strength are temporarily fully restored.

In the course of the wear process, however, joint fatigue and movement restrictions also occur more frequently and at ever shorter intervals. In addition, there are nocturnal pain attacks and more intense movement pains, which additionally severely impair arm and shoulder-heavy courses of action. This is particularly noticeable in relevant activities such as

• Work overhead (such as washing your hair, styling or throwing),
• Lift or grab objects above shoulder height,
• Abspreizen the arm to the rear (for example, pulling pants or going to the bathroom).

Lifting movements often trigger shoulder pain that indicates osteoarthritis. (Image: Antonioguillem / fotolia.com)

Typically, the painful loss of exercise can now no longer be mitigated with sufficient rest and sufferers note a generally existing stiffness of the shoulder. Involuntarily for the avoidance of pain is then often taken a certain restraint in the shoulder and upper arm area, which in turn promotes pain, stiffness and reduced mobility.

Because in the course of restraint, the substance of muscles, ligaments and joint capsule is formed back. This vicious circle-like combination of shoulder pain, restricted movement, stiffness and involuntary restraint is referred to in medicine as Frozen Shoulder Syndrome.

In view of the described course of the disease in an advanced stage, it seems all the more important to interpret the first signs of osteoarthritis in time. The earlier treatment measures are initiated, the better the symptoms and the threat of consequential damage can be alleviated by appropriate therapeutic measures.

It is important for early detection to pay attention to the subtle pain nuances and apparently harmless concomitant symptoms. Especially the following symptoms should not be dismissed lightly:

• Pain with external pressure on the shoulder area e.g. when sleeping in certain positions, while wearing a backpack or a bag, too narrow bra braces;
• Crunching and rubbing noises in the shoulder joint e.g. when rotating the arms or during everyday operations such as cooking
• Cracking noises during certain movements e.g. putting on a jacket or stretching your arms
• Radiating the complaints in the upper back, neck and upper arm;
• morning stiffness in the shoulder gels;
• Overheating and redness in the shoulder area (Inflammation).

diagnosis

The diagnosis of suspected shoulder osteoarthritis involves several steps. Because behind the typical symptoms, other illnesses can be concealed, which must be medically excluded by differential diagnosis in order to provide a secure single diagnosis. These differential diagnoses exclude:

• Congenital malformations, such as the scapula elevation - e.g. the congenital scapula, also known as paraplegic deformity;
• Diseases of the skeletal system - e.g. Biceps tendon rupture, humeral necrosis of the head, gout, polyarthritis, fractures or rheumatism;
• Diseases of internal organs - z. As splenic rupture or gallbladder inflammation;
• Cardiovascular disease - e.g. Angina pectoris, heart attack, thrombosis or arterial occlusions;
• Diseases of the nervous system- e.g. Carpal tunnel syndrome or herniated disc in the cervical spine;
• infectious diseases- e.g. Herpes zoster or infection-related bursitis;
• Cancers - e.g. Pancoast tumor or metastases of other primary tumors.

In order to be able to exclude these diseases and initiate a therapy adapted to the actual underlying disease, the diagnosis assurance comprises the following steps:

1. detailed medical history,
2. physical examination,
3. Imaging procedures,
4. Laboratory diagnostic procedures.

Detailed history

The anamnesis interview is essential for the doctor to get an overview of the past disease. Also, existing symptoms that are mentioned in the conversation may already help the physician make initial differential diagnostic assumptions. He will therefore ask very precise questions

• to the symptoms,
• to the previous course of the pain (for example with regard to a gradual course),
• to the family medical history (e.g., familial accumulations of arthrosis),
• to previous accidents and shoulder injuries,
• and the current treatment of existing medical conditions (e.g., with cortisone)

put. In addition, precise information on the age of the patient, as well as his everyday behavior, such as work and exercise habits important to draw a picture of the everyday shoulder load.

In the course of a detailed medical history, the doctor tries to determine the causes of shoulder arthrosis. (Picture: Chinnapong / fotolia.com)

Physical examination

After the anamnesis interview, the attending physician will set a first focus and perform the physical examination based on it. For this it is imperative that the person concerned makes the upper body free to allow the doctor an unrestricted view of the shoulder. He will now examine the upper body for asymmetries between the halves of the body, for existing posture and for externally recognizable features such as local swelling, redness or rash.

Thereafter, the doctor scans the affected joint area and checks it for possible pain points, muscle tension as well as miscarriages and regressions in the area of ​​the shoulder tissue. In the last step, the mobility of the shoulder joint and the manifestation of the pain in certain movements is tested by having the patient move the patient's arm in all directions while watching the affected person and the shoulder joint for abnormalities (such as humeral head displacements, clicks).

Imaging research

In order to substantiate the suspected diagnosis with the help of imaging techniques, the doctor has various options available. These include above all:

• radiographs,
• Ultrasound examinations (sonography),
• CT / MRI.

Often it is enough to make the diagnosis with simple x-rays. Here, the trained doctor can recognize the typical for shoulder arthrosis narrowing of the joint space between the humeral head and shoulder socket, as well as newly formed bony prominences. Sonographic procedures can also be used to assess joint cysts and calcification of the muscle tendons. In addition, CT / MRI techniques can be used to assess the extent of joint wear and the nature of the acetabulum by using a variety of techniques, such as staining techniques or contrast administration, to initiate potential surgical intervention as needed.

Laboratory diagnostic procedures

Laboratory diagnostics refers primarily to the examination of the blood with regard to certain parameters in order to be able to diagnose a possible accompanying inflammation and to be able to exclude similar type of diseases by differential diagnosis. Also triggering pre-existing conditions of the shoulder arthrosis can often be reliably proven by laboratory tests. For example, inflammatory parameters, rheumatoid factors and bacterial titers can be determined. Ultimately, spotted joint fluid from the joint space (in the context of arthroscopy) can also be examined with regard to various parameters.

For example, arthrosis can be differentiated from inflammatory diseases of the shoulder based on the blood picture. (Image: StudioLaMagica / fotolia.com)

treatment

Osteoarthritis, regardless of which joint it is in, is still considered incurable. Because once an articular cartilage has worn out, the cartilage mass can not be stimulated to regrow again, despite ongoing research and modern treatment methods.

Although minor cartilage defects can be replaced with autologous cartilage transplantation, this method is still considered to be very immature and experimental and is therefore not yet standard.

For this reason, the treatment goals in the treatment of shoulder arthrosis relate primarily to palliative care and the prevention of a severe or rapidly progressing course. The focus of the therapy is accordingly on the following measures:

• pain relief,
• inflammation,
• Recovery of shoulder mobility through:
  • Mobilization of contractile structures (capsule stiffening),
  • Strengthening of the musculature,
• Training the person concerned in dealing with osteoarthritis,
• Slowing down the degradation process.

The treatment of shoulder arthrosis does not only include the focus on conventional medical procedures, but also places the patients themselves in a great responsibility. Without active participation of the patient, the degradation process is unstoppable and the shoulder very quickly loaded with frightening and above all manifest restrictions. In addition to medical and possibly also surgical care, therapeutic private measures are therefore important.

Medication

Despite the incurability of osteoarthrosis, conventional medicine now offers a number of procedures that support some of the above goals. These are mainly the areas of pain relief and anti-inflammatory, which can be achieved with appropriate painkillers and anti-inflammatories. Preparations that are used repeatedly here are, for example, ibuprofen, diclofenac, arcoxia and cortisone.

As shoulder osteoarthritis is a chronic disease, it usually requires long-term treatment. In view of the extreme burden on the digestive tract, which is based on the continued intake of medicinal ingredients, the attending physician should always pay attention to a sufficient protection of the gastric mucosa of the patient. Because the above-mentioned drugs as a side effect often negatively affect the acid mantle of the gastric mucosa and ultimately can even trigger severe complications such as gastric bleeding and stomach ulcers. Prevention can be prevented by the administration of remedies such as pantoprazole, which inhibit acid secretion in the stomach.

nutritional intervention

Patients with shoulder osteoarthritis can actively help to shape their therapy through a healthier lifestyle, positively influencing the ongoing process of their disease. The measures focus mainly on nutrition and exercise. The diet helps in this regard, on the one hand, to reduce the already mentioned burden on the gastrointestinal tract by medication. For example, probiotics (for example in the form of yoghurts or yoghurt drinks) are able to strengthen the intestinal flora as well as the digestive tract's defenses. On the other hand, the connection between diet and arthrosis has become very clear. For example, there are a number of foods and stimulants that promote inflammation in the joints and thus increase the breakdown of cartilage mass. These include, among others, saturated fatty acids from animal and hydrogenated fats, nicotine, coffee and alcohol. Consequently, these should be drastically reduced by those affected in their quantities supplied.

Mediterranean cuisine helps against osteoarthritis. (Picture kab-vision / fotolia.com)

On the other hand, there are foods that have a positive influence on the joints and are even considered to be joint-protective. Which includes:

• unsaturated fats,
• Vitamin A, C and D,
• calcium,
• fluorine,
• lysine,
• magnesium,
• phosphorus,
• proteins.

The nutrients have been proven to contribute to the inhibition of inflammation, strengthen the bone substance and also contribute to the natural cartilage buildup in the joints. And overweight, which adds to the joints by additional weight, postural damage and clumsiness, can be counteracted by the right choice of nutrient-containing foods. The vitamins, minerals and fatty acids mentioned in leek vegetables, high-quality vegetable oils, cold-water fish, dairy products and, of course, in fruits and vegetables can be found particularly rich.

Tip: Studies have shown that the inhabitants of the Mediterranean region rarely suffer from joint diseases. Responsible for this is the special diet based on the Mediterranean cuisine. Patients with osteoarthritis are therefore increasingly recommended the so-called Mediterranean diet. Also their good effect against joint wear could be proved in different attempts.

movement measures

In cooperation with a good physiotherapist, measures can also be taken for osteoarthritis, which strengthen the muscles in the shoulder area, loosen stiffened structures and increasingly stimulate the formation of healthy joint fluid. Regular movements, for example in the morning directly after getting up, help to minimize existing restrictions on movement and to prevent consequential damage.

In addition to medication, physiotherapy can relieve the pain. (Image: AntonioDiaz / fotolia.com)

The physiotherapist should train in single sessions the movements together with the affected persons and train the use of aids (for example Faszienrolle, Theraband) to avoid movement errors. Only then should affected people become active at home.

Naturopathic treatment:

Naturopathy regards osteoarthritis as a sign of an imbalance in the joint and therefore relies on a holistic approach consisting of nutritional change, acupuncture, pattern-changing movement therapy and exorcising therapy of harmful substances. In the context of acute pain, the

• devil's claw,
• arnica
• and comfrey

proven as medicinal plants. They can be applied in the form of drops or capsules internally or as an external tincture or ointment. For the discharge of hazardous substances are also suitable detoxifying teas

• nettle leaves,
• senna
• or juniper berries.

Operative treatment

Surgery is rarely used in the therapeutic support of shoulder arthrosis because it rarely leads to the desired outcome, but carries a number of risks. Nevertheless, there are operational procedures that are sometimes used:

•  Shoulder arthroscopy: to confirm the diagnosis and, for example, to level painful ruffles in the joint space,
• Shoulder prosthesis: for very severe forms of osteoarthrosis,
• Autologous cartilage transplantation: for reconstruction of weakened articular cartilage.

Diseases as causes of shoulder arthrosis: Ligament injuries, shoulder dislocation, upper arm fracture, collagenosis, arthritis, chondromatosis, muscular atrophy, rheumatism, shoulder necrosis, sprengel deformity. (Ma)