Periarthritis of the Shoulder Joint

Information

One of the most commonly encountered conditions of the periarticular soft tissues in practice is the so-called periarthritis of the shoulder joint, or rotator cuff disease of the shoulder. The biomechanics of movement in the shoulder joint is a complex system involving the contraction of 26 muscles and smooth movement both within the shoulder joint itself and between the scapula and the rib cage.

The structures affected are: two serous sacs (bursae) of the shoulder, the joint capsule, the joint ligaments, and the muscles and their tendons located around the joint that form the so-called "rotator cuff." One of the causes of damage to this anatomical complex is the bony structure of the outer part of the shoulder, beneath which, as under an arch, the main motor muscles of the shoulder joint pass. Under such pressure, conditions are created for swelling, micro-hemorrhages, inflammation and thickening of the tendon, calcium and bone deposits, and finally - partial or complete tears, due to the degeneration that has occurred. In young people under 40, the changes are reversible, as long as they remain in the inflammatory phase (tendinitis). In older individuals, in cases of tearing, the changes are irreversible. It is currently believed that degenerative changes in the structures themselves (tendons, etc.) are the leading factor, and are related to advancing age and aging. Complaints involve pain in the shoulder, which may have a gradual onset (more often) or an acute onset. Overload and chronic microtrauma are at the root of the condition. In athletes, changes in training volume, intensity and technique are important, and complaints are largely associated with a decline in performance. In all patients, however, there is long-standing pain, which intensifies with movement and, in the early stages, decreases at rest. Patients are unable to sleep on the affected shoulder. The ability to work overhead is also affected. In some patients, there is also weakness, stiffness, and limitation of movement in the shoulder joint ranging from minor to complete rigidity - the so-called "frozen shoulder."

There is also clicking, and a change in the intensity of pain within the arc of raising or lowering the upper limb. Treatment is generally non-surgical in almost all forms and requires a great deal of diligence on the part of the physician. Initially, all movements that provoke pain should be avoided, while the remaining movements should not be restricted, in order to maintain their range. Cryotherapy (ice treatment) is an effective method for achieving a pain-relieving and anti-inflammatory effect. Ice massage is performed twice daily for 15-20 minutes, and always after activities and movements that have caused pain. Anti-inflammatory tablets are taken, mainly for their pain-relieving effect. Infiltration of corticosteroid preparations into the periarticular spaces is applied, but only under carefully assessed indications. The mainstay of treatment for periarthritis of the shoulder joint is physical therapy, involving a specially selected set of exercises adapted to the phase of the disease, carried out persistently, competently and systematically. Consistency and cooperation on the part of the patient are required. The failure of a well-designed and well-executed rehabilitation program may be an indication for surgical treatment.