Osteoarthritis of the shoulder.
(Joint wear and tear in the shoulder)
Importance of the shoulder.
The anatomy of the shoulder, a highly complex joint in the shoulder girdle, ensures comparatively very good mobility. The secondary joints making up the actual shoulder joint are involved in the mobility of the entire shoulder girdle. Diseases in these secondary joints have a considerable effect on shoulder function. Good shoulder girdle function is not significant for the body at rest, but is immensely important when performing manual activities, particularly those involving overhead motions.
What is meant by wear and tear of the shoulder joint?
This disease involves degenerative damage to anatomical structures in the joint between the shoulder socket and the head of the upper arm bone (humerus), resulting in functional impairment in the shoulder and localised pain. The early stages of primary arthritis often involve changes to the structures providing stability in the shoulder (the labrum (a ring of fibrous cartilage), capsule and biceps tendon). Furthermore, the cartilage will in most cases suffer increasing wear and tear over time in the area of the joint surfaces described above, resulting in limited mobility, as well as reduced strength. In the end stage, mobility is almost non-existent and increasing damage occurs to the bone in the joint.
What are the symptoms of arthritis of the shoulder?
After patients report non-specific pain in the shoulder, they typically complain in the first instance of a reduced ability to rotate the shoulder outward and move the arm outward to the side (abduction). Later, patients experience generalised reduced mobility and strength in the shoulder. When the process is active, it is not easy to find any swelling in the joint by hands on examination, partly due to the thick musculature surrounding the shoulder. When checking the movement of the shoulder, a scraping can be felt and the the degree to which pain limits the range of motion can be tested. If the patient also has a rotator cuff problem, the head of the upper arm bone (humerus) can be expected to be higher than normal. The neighbouring joints are also frequently affected: There will be arthritis in the shoulder and considerable narrowing of the gliding plane between the roof of the shoulder and the possibly still undamaged rotator cuff, as well as impaired mobility in the gliding plane between the shoulder blade and the chest wall due to various muscle contractions.
Why does arthritis develop in the shoulder?
The disease rarely develops primarily, i.e., without known cause. It is assumed that minor damage in the cartilage or the structures that stabilise the shoulder was first present. An increase in friction maintains the inflammatory process, damaging the joint surfaces further until all symptoms of the disease develop. Increased loading at work or during leisure time/ sport has also been discussed as a possible cause.
The symptoms of the disease often develop following a number of injuries:
- Incorrect healing of fractures in the upper arm or the socket of the shoulder joint
- Chronic instability of the shoulder following repeated or permanent contorted movements
- Chronic inflammatory diseases caused by rheumatic disease or bacteria
- Circulatory disorders in the head of the humerus (osteonecrosis)
- The presence of long-term defects in the rotator cuff (cuff arthropathy)
Diagnostics & Therapy
Shoulder osteoarthritis can be treated, depending on the severity with conservative measures or surgical care.
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