Periarthritis is a degenerative inflammatory lesion of the periarticular tissues (serous bags, ligaments, tendons) around large joints, usually occurring in people over forty years of age (in women, this disease occurs more often). The most common form is the periarthritis of the shoulder joint - humeropathy periarthritis
Periarthritis - causes of development
In the development of this disease, the following predisposing factors are of great importance: congenital deficiencies in the development of the upper shoulder, neurological and mental disorders, prolonged exposure to damp conditions, hypothermia, age over forty, various diseases - sciatica , spondylosis, arthrosis , diabetes , etc.
One of the main etiological factors are micro and / or macro traumas caused by professional or sports activities. Often, humeroparous periarthritis develops in patients who have coronary disease (often in the phase of subsidence or during an attack of angina), or myocardial infarction (in 15% of people who have had a heart attack). Cervical spondylosis with concomitant radicular syndrome, which directly contributes to the disruption of the periarticular humerus tissue, with the subsequent development of the degenerative process, is often enough to cause the shoulder flecker periarthritis. Women during the menopause are susceptible to the development of various endocrine disorders, which also contributes to the occurrence of periarthritis.
According to statistical data, the prevalence of periarthritis today is about 10% of the total adult population
Periarthritis - symptoms
In the initial stage of the humeroparous periarthritis, there is usually a slight focal necrosis, or partial fractures of the tendons of the supraclavicular muscle are present without obvious clinical manifestations. In case of more pronounced changes, the development of reactive inflammation in the tendon itself is first observed, and then in the podkarmialnoy and fake bags with swelling of the bag and tendon. This process is accompanied by strong pain and limiting the withdrawal of the shoulder, which further strengthens the reflex spasm of regional muscles.
With a favorable course of the process, all the pathological manifestations described above can gradually disappear on their own, or residual effects such as chronic fibrous capsulitis and adhesive bursitis
The main clinical forms of humeropathy periarthritis:
- "Simple painful shoulder" or simple humeroscapular periarthritis
- "Acute painful shoulder" or acute humeroscapular periarthritis
- "Blocked shoulder" or chronic ankylosing humeroscapular periarthritis
является начальной и наиболее часто встречаемой формой плечелопаточного периартрита. A simple humeropathy periarthritis is the initial and most common form of humeroparous periarthritis. This form is based on an isolated tendonitis of the subacute and supraspinous muscles. Clinically, this form is manifested by minor pain and almost imperceptible restriction of movement in the shoulder. Localized pains in the upper anterior part of the shoulder at the place where short rotators attach to the large tubercle of the tendon. The defining symptom of simple humeroscapular periarthritis is the intensification or occurrence of pain in the retraction and / or rotation of the arm. Most often the patient is not able to raise his arm up and can not bring his fingers to the spine while trying to get his hand behind his back. All other movements in the shoulder joint are painless and free. Sometimes pain can appear at night, especially when lying on a sore shoulder.
On the anteroposterior surface of the shoulder, or in the distance of the bicipital trough, painful points are determined during palpation, Dauborne's symptom is characteristic: when the arm is drawn to 45-90, pain disappears after it is further removed or lifted upwards. When carrying out the reverse movement, the same symptomatology is repeated. Also, pain occurs when trying to make any movement with an intentionally fixed hand. All passive movements in the shoulder joint remain absolutely painless, and the laboratory parameters and the general condition of the patient are normal. Carrying out radiography does not reveal any pathological deviations. Only in the case of a prolonged chronic course of the disease, bone props come together and as a result of their friction, osteoporosis and small sclerosis. The outcome of a simple humeropathy periarthritis can be a complete recovery in a few days / weeks, and further recurrence of the pathological process with the transition to a chronic form without a pronounced restriction of movements in the shoulder.
может быть как самостоятельной формой, так и осложнением предыдущей. Acute humeropathy periarthritis can be either an independent form or a complication of the previous one. It is based on the presence of acute tendobursitis with calcification of tendons. Most often, suddenly, usually after physical exertion, there is an increasing diffuse, intensifying pain in the shoulder at night, giving the arms and neck, resistant to analgesics, to the back surface. Movements in the hand are markedly limited, while the patient tries to keep it bent and brought to the torso.
On the front surface, as well as on the outer and anterior surfaces, palpation reveals quite painful points of different localization. In some cases, in these painful areas there is swelling with little fluctuation, muscle hyperemia, subacute muscle atrophy. The movements in the shoulder are very sharply limited (especially rotation and diversion), while the movement of the arm itself is quite free. Insomnia develops as a result of severe pain, which in turn negatively affects the general well-being of the patient; increased ESR, observed subfebrile temperature. On the roentgenogram in the podkarmialnoy area are found calcifications.
The attack of acute humeropathy periarthritis can last as few days and weeks, after which the pain is reduced, and the movements are restored. In some cases, a gradual dissolution of calcifications is observed. In very rare cases, acute humeroscapular periarthritis leads to a reduction of the choroid contracture of the shoulder.
является наиболее неблагоприятной формой периартрита, в основе которой лежат капсулит и фиброзный бурсит. Chronic ankylosing humeropathy periarthritis is the most unfavorable form of periarthritis, which is based on a capsulitis and fibrous bursitis. Most often this form is the outcome of acute periarthritis, but its independent development is not excluded. The initial symptomatology of this form is the dull pains in the shoulder that increase during movement, localized at the sites of attachment of the tendons. Progressive stiffness of the shoulder is the most characteristic symptom, and sharply disrupted both internal rotation and lateral abduction of the shoulder. In the place of attachment to the shoulder of the deltoid muscle, along the groove of the biceps muscle, characteristic pains are noted in front and under the acromion during palpation. Laboratory indicators, body temperature and overall health remain normal. In the course of the affected tendons, when carrying out an X-ray, there may be detections of calcifications
Periarthritis - treatment
Considering the long and persistent course of primary periarthritis, the cause of which lies in the very slow resolution of calcifications and foci of degeneration, as well as the continuing microtraction of tendons, an indispensable condition for proper treatment is persistence and durability.
максимальная разгрузка пораженного сухожилия, применение противовоспалительных и болеутоляющих медикаментозных препаратов, применение бальнеологических и физических методов, хирургическое вмешательство (редко). The main methods of treatment of periarthritis: maximum unloading of the affected tendon, use of anti-inflammatory and analgesic medications, balneological and physical methods, surgical intervention (rarely).
Immobilization of a diseased limb is used to unload the affected tendon. If the case is not serious, limiting limb movement is achieved by applying a supporting bandage, wire or wooden tires. Recovery after such immobilization may come in a few days. In more serious cases, the use of a removable gypsum board is indicated. After reduction of painful sensations it is necessary to begin easy light movements using simultaneously the following analgesics in the usual dosage: Reopyrin, Butadion, Indocid, Brufen, Analgin, acetylsalicylic acid, etc. In case of persistent pain, infiltration of the affected area with hydrocortisone in combination with novocaine is indicated.
Improve blood circulation and have a good analgesic effect such physical methods of treatment as sinusoidal currents, hydrophotodisone phonophoresis, ultrasound, etc. If there is persistent pain syndrome, X-ray therapy is used. In the chronic course of the disease, hydrogen sulphide and radon baths are well proven. In chronic periarthritic periarthritis, the best method of preventing blockade of the shoulder is a systematic physical training for several months.
Therapeutic massage with all forms of periarthritis is strictly contraindicated. Only in mild cases and only when the pain has subsided, it is possible to apply a superficial massage of the limb, with compulsory traversal of the affected area. In case of ineffectiveness of the conservative treatment, surgical treatment is indicated
Treatment of periarthritis with the methods of physiotherapy
Treatment of humeroparous periarthritis is complex, in which methods of physiotherapy and manual therapy are widely used.
Pharmacopuncture - used to eliminate the inflammatory process and consists in the precise administration of the drug.
Acupuncture - has an analgesic effect and relieves muscle tension.
Acupressure acupressure improves motor activity, eliminates muscle spasms, improves nutrition and blood supply of the periarticular tissues.
Magnetotherapy, laser therapy - stimulate nutrition and blood supply of tissues, mobilize the body's defenses and increase immunity, have anti-edematous, anti-inflammatory and analgesic effect.
Electromassage, vibromassage - have an analgesic effect, eliminate hypertonic muscle, promote the renewal and regeneration of tissues, stimulate blood supply, increase local immunity, improve blood circulation.
Shockwave therapy - improves blood circulation, increases local immunity, cleans tissues of toxins and toxins, improves lymph flow.
Hirudotherapy - improves the blood supply of the periarticular tissues and directly the joint itself, contributes to the elimination of the inflammatory process.
Mud applications - stimulate the regeneration of tissues, increase local immunity, contribute to the elimination of pain in the shoulder and inflammation of the periarticular tissues.
Electrophoresis - used to introduce into the focus of inflammation directly through the skin surface of the necessary drugs.
Treatment of humerous periarthritis is often supplemented by an individually selected course of therapeutic physical training. The methods of integral medicine in the treatment of brachyopathy periarthritis can achieve a long lasting improvement in well-being and a pronounced therapeutic effect in the absence of absolutely any side effects.