ORTHOPEDICS

Degenerative shoulder diseases

Treatment of various diseases of the shoulder joint
SHOULDER TREATMENT

The latest methods of treatment

Degenerative shoulder diseases are a group of diseases that affect different parts of the shoulder joint and often vary in terms of the clinical picture in which they are presented.

In our Polyclinic, you have the opportunity to diagnose and treat such diseases with conservative, non-operative methods, which have been proving their effectiveness for many years.



The shoulder joint essentially consists of four separate joints that form a functional whole. Each of these joints is subject to characteristic degenerative changes. In general, when we talk about arthritic changes of various joints in the body, we most often refer to the hip and knee. In terms of arthritic changes, the shoulder is affected somewhat less frequently, primarily due to the extremely large range of motion and the relatively small contact of the bony structures that make up the joint. However, in a number of cases, such changes also occur, and risk factors include previous injury, fracture, unstable shoulder syndrome, and osteonecrosis.



ARTHROSIS OF THE GLENOHUMERAL JOINT

The changes that affect this joint are characteristic of the changes we see in all arthritically altered joints in the human body. On the X-ray image of the shoulder we notice:

  • Narrowed joint crack
  • Thinned articular cartilage
  • Sclerotic altered subchondral part of bone (hardening of part of bone just below cartilage)
  • Subarticular cysts (cystic structures in the immediate vicinity of the joint)
  • Osteophytes (bone shoots that occur at the site of repeated bone microtrauma)

Symptoms and clinical presentation of the disease

The clinical picture is dominated by the gradual onset of pain that intensifies with activity. Over time, the pain progresses until even the slightest movement in the joint begins to cause great pain. Mobility in the shoulder joint is extremely limited, and in the clinical finding, crepitations (“creaking”) are typical during passive joint movement.

Incidence of disease

The disease typically affects the elderly population, although it can exceptionally occur in younger people who suffer from unstable shoulder syndrome or undergo shoulder stabilization surgery in which the joint capsule is excessively shortened, which prevents proper joint function and is a predisposing factor for osteoarthritis.

ARTHROSIS OF THE ACROMYOCLAVICULAR JOINT

This type of arthrosis is somewhat more common than the previously mentioned arthrosis of the glenohumeral joint.



X-ray of a typical arthritically altered acromioclavicular joint

It most often occurs as a consequence of traumatic events, and somewhat less often as a consequence of surgical correction of unstable shoulder syndrome.

In the clinical picture, palpation pain is typical in the projection of the joint itself, while the radiological edges of the joint are thickened and permeated with osteophytes (bony outgrowths). There is pain when raising the arm above the head and placing the arm behind the back. Below shoulder level the movements are painless. The joint crack is narrowed.

ARTHROSIS OF THE STERNOCLAVICULAR JOINT

Although arthritic changes of this joint are typical of the aging process, they occur extremely rarely. They manifest as a protrusion at the junction of the collarbone and sternum, and are often incorrectly declared tumors in the working diagnosis, and patients are unnecessarily exposed to painful invasive procedures such as biopsies. The only significant symptom of this condition is pain in the projection of the joint itself. Surgery is extremely rare.

Treatment

Treatment of arthritic changes of the shoulder joint includes a conservative and operative approach. In medical practice, we generally follow the principle of “as little harm as possible”, so the established procedure is to avoid surgery until it becomes absolutely necessary.

With this in mind, we use proven, minimally invasive methods in the treatment of this disease, which have proven their success countless times in slowing down the development of the disease itself and alleviating the symptoms it causes.

CONSERVATIVE TREATMENT OF DEGENERATIVE SHOULDER DISEASES

The following are used in treatment:

The goal of physical therapy is to maintain mobility and range of motion in the shoulder joint. At the same time, various methods of physical therapy, such as the use of electricity, magnetic waves, ultrasound waves and lasers, seek to reduce the pain in the shoulder girdle, which are typically the most serious part of the symptoms of this disease.

A method that has also proven to be extremely successful in relieving pain caused by arthritic changes is the application of the so-called. “Blockade“. Blockage is an injection that consists of two components:

  • A short-acting component in the form of lidocaine, which has an anesthetic effect
  • Long-acting component in the form of corticosteroids, which has anti-inflammatory action

The long-acting component (corticosteroid) takes several days to achieve its effect (it acts directly on the number of inflammatory cells that cause pain and degeneration in the shoulder joint). For this reason, a short-acting component in the form of an anesthetic is included in the injection, which will cancel the pain until the onset of corticosteroid action. In this way, these two components complement each other, and the end result is a lower level of pain in the long run and a slowing down of the course of the disease.

A third method that can be extremely useful is the use of Platelet rich plasma (PRP). It is a derivative of your own blood, which is taken in an amount of a few milliliters, usually two ampoules, and the same blood is then centrifuged in a specially designed device. After the centrifugation process, erythrocytes and other larger blood components remain in the ampoule, and platelet-rich blood plasma is separated. Platelets contain substances known as growth factors, which in such situations are activated and promote the regeneration of all structures in the painful area.

PRP is applied in cycles. One cycle usually contains four injections given at one-week intervals each.

Applying any of these methods will not lead to a 100% cure because no one can guarantee it, but what we can promise you is that each of these methods will be of great benefit in terms of reducing pain, increasing range of motion in the shoulder joint and in general , in terms of the noticeable success of the applied treatment.



PRP is used extremely often and successfully in the treatment of shoulder girdle diseases

IS SURGICAL TREATMENT INEVITABLE?

Surgical treatment by arthroscopyor open method is applied only in the advanced stage of the disease. In the case of high-grade arthrosis in the glenohumeral joint, the implantation of a total shoulder endoprosthesis is indicated, which shows excellent results in terms of further quality of life. In the acromioclavicular joint, resection of the outer part of the clavicle is sometimes necessary in the case of advanced arthrosis, but such surgery is rarely used.



In short


Polyclinic Ribnjak is a unique institution in the Republic of Croatia. It unites different branches of medicine, all in order to stay true to its slogan “Health and Beauty. Together”. Orthopedics, advanced sports diagnostics, functional and kinesiological rehabilitation, cosmetic surgery and treatments are the services we provide on a daily basis, professionally and in accordance with the latest professional standards.






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