Shoulder-scapular periarthritis
Periarthritis of the shoulder scapula is an inflammatory process accompanied by degenerative changes in the periarticular tissues that are involved in the functioning of the shoulder. Ligaments, muscles, tendons, synovial bags suffer from humeroscapular periarthritis.
The scapular type of pathology in the general system of periarthritis occurs more often than others. It accounts for up to 80% of the total number of rheumatic inflammations of the shoulder. About 10% of the world's population will experience symptoms of this disease in one way or another. Such a wide spread of the disease is due to the fact that the muscle tendons surrounding the shoulder joint are in tension almost all the time. As a result, degenerative processes develop very early there. The most commonly diagnosed humeral scapular periarthritis in women who have crossed the age of 55 years, although its symptoms may begin to bother at an earlier age.
Patients most often complain of right-sided periarthritis, since the load on the right limb is usually higher. However, the development of left-sided and bilateral humeral-scapular periarthritis is not excluded.
Content:
- Causes of the humeroscapular periarthritis
- Symptoms of the scapular periarthritis
- Diagnostics of the humeroscapular periarthritis
- Treatment of humeroscapular periarthritis
- Prevention of humeroscapular periarthritis
- Answers to popular questions
Causes of the humeroscapular periarthritis
Scientists consider two main reasons that can lead to the development of humeral scapular periarthritis:
- Neurodystrophic changes occurring in the tendons, which manifest against the background of diseases of the musculoskeletal system in the cervical spine (osteochondrosis, spondylosis, vertebral displacement). In this case, the nerve roots are pinched, the vessels at the reflex level are compressed, the normal blood supply to the shoulder joint begins to suffer. As a result, the development of inflammation and the manifestation of dystrophic processes in the tendons of the shoulder girdle.
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Injury to the soft structures of the shoulder girdle. A person can get injured when performing cyclical stereotyped actions that load the shoulder joint, or when an emergency occurs (falling on an arm extended forward, receiving a strong blow on the shoulder, joint dislocation, etc.). In this case, the tendons are torn, the integrity of the shoulder cuff is disrupted, the tissues responsible for shoulder movements swell, a failure occurs in the normal blood supply system and inflammation develops.
Sometimes the reasons for the development of humeroscapular periarthritis cannot be clarified.
It is impossible not to mention the risk factors that increase the likelihood of the manifestation of periarthritis in the shoulder-scapular region:
- The person is over 40 years old.
- Hypothermia, both local and the whole body as a whole.
- Pulmonary tuberculosis.
- Long pastime in dampness.
- The presence of diseases of the musculoskeletal system in a person: arthrosis, sciatica, arthritis.
- Cervical spondylosis with radicular syndrome is combined with periarthritis in 80% of cases.
- Diabetes.
- The presence of congenital developmental anomalies in the shoulder region.
- Neuropsychiatric disorders, including those associated with traumatic brain injury. Brain tumors and kinsonism are also dangerous.
- Coronary heart disease. At the same time, periarthritis is capable of manifesting both at the peak of an attack of angina pectoris, and during its extinction.
- Postponed myocardial infarction. Periarthritis is observed on average in 10-15% of patients.
- Hemiplegia (complete unilateral paralysis of the hand), which occurs after a stroke, or against the background of other lesions of the spinal cord and brain.
- Parkinson's disease.
- Surgery that interferes with the blood supply to the shoulder joint, such as a mastectomy.
What happens with periarthritis of the shoulder scapula?
To understand exactly what processes occur in the tendons during the development of humeroscapular periarthritis, it is necessary to understand the structure of the joint, and also consider the pathogenesis of the disease.
The system that is responsible for hand movements is quite complex. In addition to the "true" shoulder joint, the "second" shoulder joint is of no small importance. It is represented by musculoskeletal and capsule-tendon formations. Its upper layer is formed by the acromion and deltoid muscle, and the lower layer is formed by the tendons responsible for the rotation of the shoulder. The tendons are intertwined with a muscle capsule that covers the true joint and humeral head. Together, these joints form the cuff, which is responsible for the rotation of the shoulder. The center of the "second" shoulder joint is represented by serous bursae and loose connective tissue. This allows the muscles to slide freely relative to each other.
With the development of the disease, collagen fibrils break, which are located inside the tendons, which leads to the formation of foci of necrosis on them. Further, the foci of necrosis are opened into the cavity of the serous bursae, which represent the middle layer of the "second" shoulder joint. If the disease is severe, then a complete rupture of the tendon is possible.
In parallel, the reactive inflammatory process is developing and gaining strength. The tendon thickens, irregularities appear on it, it is possible that it will be completely turned out of the intertubercular groove.
Complications of the disease
Against the background of the current inflammatory process, calcifications begin to form in the tendon. Some of them are able to dissolve on their own, while others penetrate into the serous bags and provoke additional foci of necrosis in their cavities. With chronicity of the process, the walls of the bags may merge, which causes a pronounced limitation of mobility in the shoulder joint.
Not only the "second" shoulder joint, represented by the muscles, suffers, but also the "true" joint. In the place where it borders on the inflamed tendon, shrinkage of its capsule may occur. This process is called fibrous capsulitis. As a result, normal shoulder mobility is further compromised.
Another danger that threatens people with humeroscapular periarthritis is the compaction of the bone tissue of the greater tubercle of the shoulder head with the removal of lime from it and the formation of osteophytosis in this zone.
In addition to the fact that the foci of necrosis are able to calcify and scar, impairing the mobility of the limb, they can also undergo aseptic inflammation.
Blocked shoulder syndrome with complete immobilization is the most formidable complication of the disease.
Symptoms of the scapular periarthritis
There are three forms of periarthritis, each characterized by a specific set of symptoms.
- A simple form of the disease, which foreign authors call "a simple painful shoulder."
- Acute form of the disease.
- A chronic form of the disease, which is called "frozen shoulder", "ankylosing periarthritis", "blocked shoulder".
If the disease develops against the background of trauma, then from the moment it is received until the first symptoms appear, it can take from 3 days to a week. Often this factor is the reason that patients are not always able to indicate the cause that led to the formation of periarthritis.
Symptoms of a simple form of periarthritis, which is fairly easy and has the most favorable prognosis:
- Complaints of mild pain arising in the shoulder area.
- Pain appears only at the moment when a person performs certain movements (he can designate them independently).
- At rest, pain is absent.
- The pain intensifies at the moment when the patient tries to rotate with the participation of the shoulder joint, or tries to overcome resistance.
- Restriction of mobility is poorly expressed: it is difficult for the patient to raise his hand high up, and also to bring it behind his back. If this succeeds, then the patient is not able to touch the spinal column with his fingers. Other movements do not cause pain.
- Pain during a night's rest is possible, especially for people who are used to sleeping on their backs.
- During palpation, the doctor identifies painful points located on the antero-outer surface of the shoulder, if the supraspinatus and infraspinatus muscles are involved in the pathological process. The bicipital groove responds with pain if the head of the biceps muscle becomes inflamed.
- The general condition of the patient is not disturbed, blood counts remain within normal limits.
- Most often, the simple form of periarthritis is self-relieved after a month.
With an unfavorable course of the disease, with an increase in the load on the diseased area or with repeated injury, simple periarthritis can turn into an acute form. However, in some cases, acute periarthritis develops as an independent disease and is not preceded by a simple form of the disease.
For acute periarthritis, the following symptoms are characteristic:
- The pain comes on suddenly and tends to intensify. It is caused by the migration of calcifications from the short tendons into the bursae. The pain is diffuse and most often occurs after severe physical exertion.
- The pain is localized not only in the shoulder area, but also spreads to the neck and arm.
- During the night's rest, the painful sensations intensify.
- Rotating the joint and pulling the arm back causes severe pain in the patient. Therefore, his movements are sharply limited.
- Relief comes when a person holds his hand next to his chest, while bending it at the elbow.
- The frontal surface of the shoulder has slight swelling.
- The general well-being of the patient is impaired: the body temperature rises to subfebrile levels, insomnia increases, and performance deteriorates.
- The blood picture shows an increase in ESR, and during the X-ray, calcifications are most often found.
- Acute periarthritis lasts about a month or less. Then the pain decreases, the range of motion is restored. In some cases, calcifications are able to resolve on their own.
If acute periarthritis has not been treated qualitatively, then in 50% of cases it will turn into a chronic form of the disease.
The symptoms of the disease are as follows:
- The pain is not too intense, localized in the shoulder.
- During movement of the shoulder joint, the pain tends to intensify, which causes some discomfort.
- During a night's rest, there may be a feeling of an ache in the shoulder girdle.
- Painful lumbago periodically occurs when trying to rotate the arm, when making sudden movements.
If chronic periarthritis is ignored, then it can provoke ankylosing periarthritis. This process does not take place instantly, but over several years.
Its symptoms are as follows:
- The tissue surrounding the joint becomes very dense to the touch.
- The shoulder will be completely immobilized.
- When you try to raise your hand or put it behind your back, a person experiences severe pain, which is almost unbearable.
This is the final stage of the development of the disease, which occurs in about 30% of all patients.
Algodystrophic syndrome
Algodystrophic syndrome is a special form of periarthritis of the shoulder scapula. This syndrome was first described by Steinbrocker in 1947. Also, algodystrophic syndrome is called "shoulder-hand".
It is characterized by the following symptoms:
- The appearance of sharp pain.
- The presence of cold, dense and diffuse edema.
- Cyanosis of the hand and fingers.
- Thinning of the skin.
- Strengthening the fragility of the nail plates.
- Atrophy of muscle tissue and subcutaneous adipose tissue.
- Formation of contracture of the fingers.
- A sharp limitation of the mobility of the shoulder and hand.
Risks of developing algodystrophic syndrome:
- In 20% of cases, the disease develops after a heart attack. The disease manifests itself approximately 1-6 weeks after the happened cardiovascular catastrophe and is characterized not only by pain in the limb, but also by its cold snap, increased sweating, cyanosis of the skin.
- In 20% of cases, the syndrome occurs against the background of existing cervical spondylosis.
- In 23% of cases, the causes of development remain unclear.
- In 10% of cases, algodystrophic syndrome develops after an injury. Most often men are affected. In this case, pain occurs spontaneously, makes itself felt when flexing and extending the shoulder.
- Against the background of other diseases, this form of periarthritis develops in 6% of cases.
The course of the disease is protracted, it can last for several years. Although it is not uncommon when, after 1-2 years of treatment, the patient gets rid of vasomotor disorders and he manages to partially restore limb movements. Although it will not be possible to get rid of finger contractures and trophic changes 100%.
Diagnostics of the humeroscapular periarthritis
If you have shoulder pain and limited movement, you should consult a doctor. A therapist deals with the diagnosis of humeral periarthritis. It is possible that after the examination, the doctor will redirect the patient to a narrower specialist: a surgeon, neurologist, rheumatologist or orthopedist.
In addition to external examination of the patient and collection of anamnesis, the doctor will necessarily assess the motor activity of the shoulder joint, palpate the area of inflammation.
To clarify the diagnosis and find out the reasons for the development of periarthritis, an X-ray of the diseased joint and cervical spine is performed, it is also possible to conduct ultrasound and MRI diagnostics.
As for laboratory tests, the doctor sends the patient to donate blood. If a patient has periarthritis in an acute stage, an increase in ESR and CRP will be observed. In other forms of the disease, the blood picture remains unchanged.
If there is a need for an operative intervention, then before carrying out it, the patient can be referred for invasive diagnostic procedures: for arthrography or for arthroscopy.
It should be borne in mind that periarthritis of the scapular region can be confused with other diseases that give similar symptoms. Therefore, it is important to carry out a differential diagnosis with arthritis, arthrosis, Pancost's syndrome against the background of lung cancer, thrombosis of the subclavian artery.
Treatment of humeroscapular periarthritis
Treatment of periarthritis of the shoulder scapula should be long-term and persistent. First of all, it is necessary to remove the load from the diseased tendon, which minimizes the risks of its further injury. For this purpose, support bandages or plaster splints are used.
Inflammation and pain are controlled with the following drugs:
- From the group of NSAIDs: Ketorol, Nimesil, Dikloberl, etc. These drugs not only eliminate a pain attack, but also relieve inflammation from the affected muscle.
- Pain relievers such as Baralgin or Analgin.
- Muscle relaxants, for example, Mydocalm. This group of drugs allows you to relax muscles, relieve spasm from them by reducing muscle tone.
- Chondroprotectors, for example Structum. These drugs are aimed at improving the physiological activity of the joint, at reducing intra-articular fluid, at eliminating swelling. Thus, not only the analgesic, but also the therapeutic effect is achieved.
If the pain cannot be eliminated with the above drugs, then subscapular nerve blockade is possible. The injection is introduced into the subacromial space. For this purpose, the drug Diprospan is used. Injections are given 2 times during the entire treatment, the interval between procedures should be 20 days, but not less. A combination of drugs such as Flosterone, Metipred and Diprospan is also possible.
Before agreeing to perform blockades, you should familiarize yourself with the side effects that they can give: atrophy of the skin at the injection site, inflammation of the shoulder joint, degenerative processes in the periarticular region, tendon atrophy, etc.
Another type of pain blockade in shoulder periarthritis is the introduction of Novocaine. The effect of such an injection is observed almost instantly. Often, novocaine blockade is combined with glucocorticoids. This allows you to reduce inflammation, eliminate pain, relieve swelling. However, it should be understood that hormonal drugs suppress the patient's immune system, so they can be used under strict medical supervision.
Physiotherapy in the treatment of shoulder-scapular periarthritis
Physiotherapy techniques are a separate direction in the treatment of periarthritis of the shoulder scapula.
The following influences are possible:
- Electrostimulation of the muscles of the shoulder girdle. The procedure allows you to normalize muscle tone.
- Laser treatment. To get rid of pain, you need to go through at least 10 sessions, the duration of each of them is 5 minutes.
- Phonophoresis improves tissue nutrition, promotes their early recovery.
- Shock wave therapy quickly heals the damaged areas of the tendons, helps dissolve calcifications.
- Other methods of treating periarthritis: acupuncture, magnetotherapy, hydrotherapy, hirudotherapy, stone therapy, taking sulfide and radon baths.
- Manual therapy is indicated when periarthritis was triggered by displacement of the vertebrae.
Surgery
In the case when the drug correction does not allow achieving the desired effect for 6-8 months, the patient is shown an operation.
It is advisable in the following situations:
- Partial damage to the integrity of the tendons, which led to disruption of muscle function.
- Wide cuff tears.
- Severe damage to the cuff.
- Inflammation of the radial or subscapular nerve.
- Tunnel Syndrome.
However, the operation can not always be carried out.
Obstacles to surgical intervention are:
- Formed persistent contracture.
- Purulent inflammation, regardless of its location.
- The presence of contraindications to the introduction of anesthesia.
- Refusal of the patient himself to carry out the operation.
Surgical treatment of an advanced form of shoulder periarthritis is reduced to an arthroscopic subacromial decompression. Its essence lies in the fact that the patient is removed acromion (a small process on the scapula), as well as one ligament in the joint. This makes it possible to ensure that the tissues do not injure each other, which means that the inflammation is eliminated. In parallel, the doctor removes the formed contractures. If the operation is successful, then the patient's entire range of motion is fully restored.
It is possible to carry out surgical intervention both by an open method and using endoscopic equipment. The postoperative period requires wearing an orthosis, which allows the patient to recover faster.
There is no need to adhere to any special dietary food during treatment. It is only important to ensure that the diet is balanced and allows it to cover all the needs of the body, which spends additional energy on repairing damaged tendons.
During the acute stage of the disease, massage is categorically contraindicated. He is prescribed at the stage of recovery. However, the procedure should be carried out exclusively by a specialist with medical education, bypassing the inflamed areas of the muscle.
Physiotherapy
Therapeutic gymnastics is one of the conditions for a speedy recovery. It is good if you can do exercises in the water. Swimming and hydrokinesis therapy are part of all recommended complexes for periarthritis of the shoulder scapula. Exercising in the pool allows you not only to normalize muscle tone and remove excess tension from them, but also to increase the range of motion in the damaged joint.
The main goals of the gymnastic complex:
- Normalization of blood flow.
- Enrichment of tissues with oxygen.
- Elimination of stagnation.
- Strengthening the muscles.
- Normalization of metabolic processes.
You should not start performing the gymnastic complex during the acute stage of the disease, with severe pain in the joint.
Several effective exercises to help speed up your recovery:
- Legs should be spread shoulder-width apart, arms raised above your head. You should reach with your fingertips towards the ceiling, but do not lift your feet off the floor. First, both arms are extended, and then each limb in turn.
- Hands should be spread apart and left at shoulder level. Next, you should perform turns with the body and head, but at the same time keep your hands in their original position.
- Raise your hands above your head and grab your elbows. You need to slowly move your hand back, without making any sudden movements.
Perform simple gymnastic exercises 3 times a day. This is the best prevention of disease recurrence.
Prevention of humeroscapular periarthritis
Measures aimed at preventing periarthritis of the shoulder scapula:
- It is necessary to prevent macro and microtrauma of the shoulder girdle.
- It is important not to allow excessive and monotonous loads on the shoulder joint.
- All diseases of the spinal column must be treated in a timely manner.
- Hypothermia should be avoided.
- To prevent recurrence of the disease, you need to perform physical exercises aimed at working out the shoulder muscles.
- You should always monitor your posture, regardless of the type of activity that a person is engaged in.
Answers to popular questions
- Is disability indicated in periarthritis of the shoulder scapula? If a patient has a persistent disruption in the functioning of the shoulder joint, and the operation does not allow to restore the range of motion, then the patient is sent to a commission for disability.
- Is it possible to visit the bathhouse for periarthritis? You can visit the bath only at the stage of recovery, when an acute attack of the disease has been removed.
- Is it possible to warm up a sore muscle area? Warming up can be performed only when there is no acute inflammation. In other cases, thermal treatments can increase blood circulation in the damaged area and reduce pain.
- What doctor treats shoulder periarthritis? A rheumatologist is involved in the treatment of periarthritis, but for the initial diagnosis it is necessary to contact a local therapist.
Author of the article: Kaplan Alexander Sergeevich | Orthopedist
Education: diploma in the specialty "General Medicine" received in 2009 at the Medical Academy. I. M. Sechenov. In 2012 completed postgraduate studies in Traumatology and Orthopedics at the City Clinical Hospital named after Botkin at the Department of Traumatology, Orthopedics and Disaster Surgery.
