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Shoulder osteoarthritis - causes, symptoms and treatment

Shoulder osteoarthritis - causes, symptoms and treatment


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Arthrotic changes in the shoulder

Arthrotic changes in the joints are fundamentally a painful process. Even more, they are one of the most common causes of joint problems and persistent loss of movement today. In addition to the knee joints, the shoulder joints are also increasingly affected by the arthrotic wear process.

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

Definition

Like all joints in our body, the shoulder joint (articulatio humeri) is made up of several bone and cartilage elements. The bony structures are provided by the humerus (Os humeri) and the shoulder blade (Scapula).

While the spherical head of the upper arm bone (caput humeri) represents the actual articular surface of the shoulder, which enables the rotation and lifting of the upper arm, the plate-shaped shoulder blade socket (cavitas glenoidalis) acts as ball-bearing for the shoulder joint. The two bone parts 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 also guarantee the free rotation of the shoulder. The following would be relevant here:

  • 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. It includes four muscle strands:
    • upper shoulder bone muscle (Supraspinatus muscle),
    • lower shoulder bone muscle (Infraspinatus muscle),
    • lower scapula muscle (Subscapularis muscle),
    • small round muscle (Teres minor muscle).
  • Deltoid muscle (Deltoid muscle) The rotator cuff is covered by the so-called delta muscle. It coordinates the flexion movements of the shoulder joint.
  • biceps (Biceps brachii muscle) The biceps is responsible for the stretching movements of the shoulder joint.
  • Large pectoral muscle (Pectoralis major muscle) In addition to its function in the area of ​​the auxiliary breathing muscles, the large chest muscle is also involved in the internal rotation of the shoulder.
  • Cross ligament of the humerus ( Ligamentum transversum humeri) This shoulder strap stabilizes the biceps in position between the upper arm bones.
  • Reinforcement tape of the shoulder joint capsule (Coracohumerale ligament) 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 joint surfaces from rubbing against each other. They play a special role in the development of shoulder arthrosis, as their wear and tear usually marks the beginning of the disease.

The joint capsule (capsula articularis) should be particularly considered for the initial development of shoulder arthrosis. A cartilage mass consisting of connective tissue that lies directly on the joint cavity of the humerus and thus serves as a protective cushion against any friction caused by movement stimuli of the shoulder. Like all joint capsules in the body, the shoulder joint capsule is made up of two membrane layers:

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

The osteoarthritis basically begins at the fibrosa membrane of the joint capsule, whereby the wear progresses further down to the synovial membrane and beyond. In the advanced stage of osteoarthritis of the shoulder, the joint 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 can be affected by the joint wear. They are sacks filled with liquid, which are located in the recesses in the joint cavities and act there as shock and pressure-absorbing airbags. Shoulder arthrosis can lead to a painful bursitis 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, inflammation on the bursa of the lower bone muscle (bursa subacriminalis) is also undesirable. It is the largest bursa in the human body and can therefore cause particularly severe pain in the presence of inflammatory processes.

Causes of shoulder arthrosis

Several factors usually play a role in the development of an osteoarthritis. Are relevant here

  • genetic predisposition,
  • mechanical load
  • and previous diseases or injuries to the shoulder joint

Depending on the cause, omarthrosis can also be differentiated into two different forms. The primary omarthrosis describes wear processes in the shoulder area that have arisen for no apparent reason. Usually, age-related joint wear is assumed here, and life-long stress aspects also play a role in the action.

The secondary omarthrosis, on the other hand, has its origin in targeted damage to the shoulder joint. Both accident injuries and joint diseases are conceivable causes.

Primary omarthrosis

It is quite normal for the shoulder joint to wear naturally over the course of a lifetime. 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. Such signs of wear and tear are worryingly increasing in the younger years. And although the causes have not yet been sufficiently clarified, doctors suspect some unhealthy everyday habits behind the phenomenon. These include in particular

  • curved shoulder position (e.g. through computer or factory work)
  • persistent heavy lifting (e.g. heavy backpacks or heavy loads)
  • improperly executed shoulder / arm movements (e.g. during sports or work)
  • Lack of exercise (especially through mostly passive everyday life)
  • Nutritional aspects (e.g. lack of nutrients or obesity)

The extent to which these aspects promote premature joint wear has not been clearly clarified in many cases. However, it cannot be denied that the everyday behavior of patients has a decisive influence on the health of the shoulder joints.

Secondary omarthrosis

With secondary shoulder arthrosis, shoulder diseases and shoulder injuries are clearly at the forefront of the causal spectrum. Incorrect posture of the shoulder can also be involved here as indirect influencing factors, but arthrosis only occurs as a complication of a serious illness. The range of possible health complaints is relatively diverse in this context.

For example, an accident injury on the shoulder strap devices is conceivable. As a result, the head of the humerus is often marginally displaced, so that its articular surface no longer lies accurately in the shoulder blade socket. The articular cartilage begins to rub against the shoulder blade due to the misalignment of the bone head and sooner or later wears out more and more.

A dislocated shoulder (shoulder dislocation) also strains the tendons and ligaments of the shoulder joint to a particular extent and can weaken their substance in the long term, making incorrect positioning of the joint and the associated wear due to friction more likely.

Accident scenarios of this type occur particularly in the context of arm-heavy sports. However, team sports such as football also contribute to sprains, torn fibers and bruises on the shoulder muscles and tendons due to the high risk of falling. In addition, tangible bone fractures, such as the fracture of the upper arm, cannot be excluded as a trigger for shoulder arthrosis. Such a fracture can occur not only in sports, but also in a traffic accident or even in everyday life, provided that a serious impact, fall or hit on the shoulder was involved.

Also in the course of a basic disease of the shoulder, which has resulted in a shift of the shoulder's own joint parts, the cartilage can wear due to increased friction and pressure. In addition, some shoulder diseases pose a risk of cartilage damage. This applies in particular to inflammatory processes and tissue degeneration, which provoke damage to the cartilaginous or connective tissue joint elements. In these cases, a slight, if permanent, load is sufficient to trigger the omarthrosis. Typical previous illnesses that always cause shoulder osteoarthritis in this regard are:

  • congenital malformations of the shoulder,
  • Connective tissue weakness (Collagenosis),
  • Inflammation of the joints (Arthritis),
  • Cartilage growths (Chondromatosis),
  • muscular dystrophy (Muscle atrophy),
  • Rheumatism,
  • Shoulder necrosis.

Symptoms

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

Common scenarios include shoulder pain after training in the gym or lifting moving boxes. As soon as those affected have given their shoulder some rest, the pain usually subsides, which leads to the insidious fallacy that it is a spontaneous and short-term overload of the shoulder. And even with repeated “beeps”, many still assume a banal overload and resort to painkillers instead of going to the doctor. No wonder that shoulder arthrosis is often diagnosed very late.

A high level of suffering, which ultimately leads the affected person to see a doctor, often only arises when the pain gradually increases and can no longer be controlled even with sufficient periods of rest and regeneration. Then joint wear is often so advanced that it is no longer easy to stop a difficult wear process.

With increasing joint wear, the extent of shoulder complaints also changes. Initially, the symptoms are rather diffuse, the shoulder area hurts slightly to moderately after major exertion, certain movements appear to be difficult and the affected arm appears weaker than usual in its exertion. At least at the beginning of the disease, these symptoms also regress after a little care, so that the range of motion and strength are temporarily available again in full.

However, in the course of the wear process, joint fatigue and restricted movement also occur more frequently and at ever shorter intervals. In addition, there are nighttime attacks of pain and more intense movement pain, which also severely impair arm and shoulder-heavy actions. This is particularly noticeable in relevant activities such as

  • Working overhead (e.g. washing, hairdressing or throwing movements),
  • Lifting or gripping objects above shoulder height,
  • Spread the arm backwards (e.g. pull up pants or go to the toilet).

Typically, the painful loss of movement can no longer be alleviated with sufficient rest, and those affected notice a generally existing stiffness of the shoulder. Involuntarily to avoid pain, a certain gentle posture is often taken in the shoulder and upper arm area, which in turn promotes painfulness, stiffness and restricted movement.

Because in the course of careful posture, the substance of muscles, ligaments and joint capsule continues to regress. This vicious circle-like combination of shoulder pain, restricted movement, stiffness and involuntary careful posture is referred to in medicine as frozen shoulder syndrome.

In view of the described course of the disease in the advanced stage, it seems all the more important to interpret the first signs of omarthrosis in good time. The earlier treatment measures are initiated, the better the symptoms and impending consequential damage can be mitigated by suitable therapy measures.

For early detection, it is important to pay attention to the subtle pain nuances and apparently harmless accompanying complaints. The following symptoms in particular should not be dismissed lightly:

  • Pain from external pressure on the shoulder area e.g. when sleeping in certain positions, when carrying a backpack or a bag, because the bra straps are too tight;
  • Crunching and rubbing noises in the shoulder joint e.g. when rotating the arms or during everyday operations such as cooking
  • Crackling noises with certain movements e.g. when putting on a jacket or stretching your arms
  • Radiating the complaints in the upper back, neck and upper arm;
  • Morning stiffness in the shoulder gel;
  • Overheating and redness in the shoulder area (Signs of inflammation).

Diagnosis

The diagnosis of suspected shoulder arthrosis comprises several steps. Because behind the typical symptoms, there can also be other illnesses that must be medically excluded by differential diagnosis in order to be able to make a reliable individual diagnosis. These clinical pictures to be excluded by differential diagnosis include:

  • Congenital malformations like the shoulder blade upright - e.g. the congenital shoulder blade protrusion, also known as Sprengel deformity;
  • Diseases of the skeletal system - e.g. Biceps tendon tear, humeral necrosis, gout, polyarthritis, fractures or rheumatism;
  • Internal organ disorders - e.g. B. rupture of the spleen or inflammation of the gall bladder;
  • Cardiovascular diseases - e.g. Angina pectoris, heart attack, thrombosis or artery occlusion;
  • Nervous system disorders e.g. Carpal tunnel syndrome or herniated disc in the area of ​​the cervical spine;
  • Infectious diseases- e.g. Herpes zoster or infection-related bursitis;
  • Cancer - e.g. Pancoast tumor or metastases from other primary tumors.

In order to be able to rule out these diseases and initiate a therapy that is adapted to the actual underlying disease, the diagnostic process includes the following steps:

  1. detailed medical history,
  2. physical examination,
  3. imaging techniques,
  4. laboratory diagnostic procedures.

Detailed medical history

The medical history interview is essential for the doctor to be able to get an overview of the course of the disease to date. Existing symptoms, which are mentioned in the course of the conversation, can also help the doctor to make the first differential diagnostic assumptions. He will therefore ask very precise questions

  • to the complaint picture,
  • the previous course of pain (e.g. regarding a creeping course),
  • family history (e.g. familial accumulations of arthrosis),
  • previous accidents and shoulder injuries,
  • and for the current treatment of existing medical conditions (e.g. with cortisone)

put. In addition, precise information about the age of the patient, as well as their everyday behavior, such as work and exercise habits, is important in order to be able to draw a picture of the everyday burden on the shoulder.

Physical examination

After the anamnesis interview, the attending doctor will set a first focus and carry out the physical examination on the basis of this. To do this, it is imperative that the person concerned clears the upper body to allow the doctor an unobstructed view of the shoulder. He will now examine the upper body for asymmetries between the halves of the body, for existing protective postures and for externally recognizable features such as local swelling, redness or rashes.

The doctor then scans the affected joint area and checks it for possible pain points, muscle tension as well as malformations 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 during certain movements are tested by the doctor letting the patient move his arm in all directions, observing the patient himself and the shoulder joint with regard to abnormalities (e.g. displacements of the humerus head, cracking noises) .

Imaging measures

There are various options available to the doctor to substantiate the suspected diagnosis using imaging techniques. Above all, these include:

  • X-rays,
  • Ultrasound examinations (sonography),
  • CT / MRI.

Often it is enough to confirm the diagnosis with simple x-rays. Here, the trained doctor can recognize the narrowing of the joint gap between the humerus and shoulder socket, which is typical of shoulder arthrosis, as well as newly formed bone projections. Joint cysts and calcifications of the muscle tendons can also be assessed using sonographic methods. The CT / MRT procedures also help to assess the extent of joint wear and the condition of the socket by using various techniques, such as staining techniques or the use of contrast media, in order to initiate a possible surgical therapy if necessary.

Laboratory diagnostic procedures

Laboratory diagnostics primarily relate to the examination of the blood with regard to certain parameters in order to be able to diagnose possible concomitant inflammation and to be able to exclude similar types of diseases by differential diagnosis. Even previous medical conditions that trigger shoulder osteoarthritis can often be reliably proven by laboratory tests. For example, inflammation parameters, rheumatoid factors and bacterial titers can be determined. Ultimately, punctured synovial fluid from the joint space (as part of arthroscopy) can also be examined with regard to various parameters.

Treatment

Osteoarthritis, no matter in which joint it occurs, is still considered incurable. Because once an articular cartilage is worn out, the cartilage mass cannot be stimulated to re-grow despite progressive research and modern treatment methods.

Smaller cartilage defects can be replaced using autologous cartilage transplantation, but this method is still considered very immature and experimental and is therefore not yet used as standard.

For this reason, the therapeutic goals in the treatment of shoulder arthrosis primarily relate 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,
  • Anti-inflammatory,
  • Regaining shoulder mobility through:
    • Mobilization of contractile structures (Capsule stiffening),
    • Strengthening the muscles,
  • Training of those affected in dealing with arthrosis,
  • Slowing down of the mining process.

The treatment of shoulder arthrosis does not only include the concentration on conventional medical procedures, but also takes a great responsibility for those affected themselves. Without the patient's active participation, the breakdown process is unstoppable and the shoulder is very quickly loaded with frightening and above all manifest restrictions. In addition to medicinal and possibly also operative care, private therapeutic measures are therefore not least important.

Medication

Despite the incurability of osteoarthritis, conventional medicine now offers some procedures that support some of the above goals. These are primarily the areas of pain relief and anti-inflammation, which can be achieved with appropriate pain relievers and anti-inflammatories. Preparations that are used again and again are, for example, ibuprofen, diclofenac, arcoxia and cortisone.

Since shoulder arthrosis is a chronic disease, it usually requires permanent treatment. In view of the extreme strain on the digestive tract, which is due to the continued intake of medicinal ingredients, the treating doctor should always ensure adequate protection of the patient's gastric mucosa. Because the above-mentioned drugs often have a negative effect on the acid mantle of the gastric mucosa and can ultimately trigger serious complications such as stomach bleeding and stomach ulcers. This can be prevented by administering agents such as pantoprazole, which inhibit the release of acids in the stomach.

Nutritional measures

Patients with osteoarthritis of the shoulder can actively shape their therapy through a healthier lifestyle and thus positively influence the progressing process of their illness. The measures focus mainly on the areas of nutrition and exercise. In this regard, nutrition helps to reduce the above-mentioned exposure of the gastrointestinal tract to medication. For example, probiotics (e.g. in the form of yoghurts or yoghurt drinks) are able to strengthen the intestinal flora and the immune system of the digestive tract. On the other hand, the connection between diet and osteoarthritis has become very clear. For example, there are a number of foods and stimulants that promote inflammation in the area of ​​the joints and thus fuel the breakdown of cartilage. These include saturated fatty acids from animal and hardened fats, nicotine, coffee and alcohol. As a result, those affected should drastically reduce their amounts.

In contrast, there are foods that have a positive influence on the joints and are even considered to be joint-protecting. Which includes:

  • unsaturated fats,
  • Vitamins A, C and D,
  • Calcium,
  • Fluorine,
  • Lysine,
  • Magnesium,
  • Phosphorus,
  • Proteins.

The nutrients have been proven to contribute to anti-inflammatory effects, strengthen the bone substance and also contribute to the natural build-up of cartilage in the joints. And being overweight, which affects the joints due to additional weight, postural damage and sluggishness, can be counteracted by the right selection of nutritious foods. The vitamins, minerals and fatty acids mentioned can be found particularly rich in leek vegetables, high quality vegetable oils, cold water fish, dairy products and of course in fruits and vegetables.

Tip: Studies have shown that Mediterranean residents suffer relatively rarely from joint diseases. The special diet based on Mediterranean cuisine is held responsible for this. For this reason, patients with osteoarthritis are increasingly recommended the so-called Mediterranean diet. Their good effect against joint wear has also been demonstrated in various tests.

Movement measures

In cooperation with a good physiotherapist, measures can also be taken against omarthrosis that strengthen the muscles in the shoulder area, loosen stiffened structures and increasingly stimulate the formation of healthy synovial fluid. Regular movement sequences, for example in the morning immediately after getting up, help to minimize existing movement restrictions and prevent consequential damage.

In individual sessions, the physiotherapist should train the movement sequences together with those affected and train them to use aids (e.g. fascia roller, Theraband) to avoid movement errors. Only then should those affected take action themselves at home.

Naturopathic treatment:

Naturopathy sees osteoarthritis as a sign of an imbalance in the joint and therefore relies on a holistic approach consisting of a change in diet, acupuncture, pattern-changing movement therapy and substances that harm harmful substances. In the context of acute pain, they have

  • Devil's claw,
  • arnica
  • and comfrey

Proven as medicinal plants. They can be used internally in the form of drops or capsules or as an external tincture or ointment. Detoxifying teas are also suitable for removing harmful substances

  • Nettle leaves,
  • Senna leaves
  • or juniper berries.

Surgical treatment

Surgery is rarely used to provide therapeutic support for shoulder arthrosis, as it rarely leads to the desired success, 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 smooth out painful roughening in the joint gap,
  • Shoulder prosthesis: for very severe forms of omarthrosis,
  • Autologous cartilage transplantation: for the reconstruction of weakened articular cartilage.

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

Author and source information

This text corresponds to the requirements of the medical literature, medical guidelines and current studies and has been checked by medical doctors.

Swell:

  • Ruchholtz, Steffen / Wirtz, Dieter Christian: Orthopedics and trauma surgery essentials: Intensive course for further training, Thieme, 3rd edition, 2019
  • Imhoff, Andreas B. / Linke, Ralf / Baumgartner, René: Checklist Orthopaedie, Thieme, 3rd edition, 2014
  • Deutsche Arthrose-Hilfe e. V .: What is osteoarthritis? (Access: 09.07.2019), arthrose.de
  • Robert Koch Institute: Issue on osteoarthritis, as of June 2013, rki.de
  • Institute for Quality and Efficiency in Health Care (IQWiG): Arthrosis (accessed: July 9, 2019), gesundheitsinformation.de
  • Arthritis Foundation: Osteoarthritis of the Shoulder (accessed: July 9, 2019), arthritis.org
  • Mayo Clinic: Osteoarthritis (accessed: July 9, 2019), mayoclinic.org
  • National Health Service UK: Overview Osteoarthritis (accessed: July 9, 2019), nhs.uk
  • UpToDate, Inc .: Shoulder osteoarthritis treatment (Beyond the Basics) (accessed: July 9, 2019), uptodate.com

ICD codes for this disease: M19ICD codes are internationally valid encodings for medical diagnoses. You can find e.g. in doctor's letters or on disability certificates.


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