Did you have a shoulder injury and even though everything is healed up, you still feel the pain? Does movement in the shoulder provoke the pain without having suffered any previous injury? In this article we will try to explain you the problematics of this less known illness - arthrosis of the shoulder joint. And if you have similar problems, we will offer you options of how to get rid of them.
THE CAUSE OF ORIGIN AND MANIFESTATIONS
Arthrosis of the shoulder joint is fairly rare illness, because the shoulder is not a carrying joint and therefore there is not such pressure involved on it. Omarthrosis is rather caused by an injury mechanism, incorrectly healed bone after fracture, or deflection of the bone from the axis. The reason can be also congenital defect of the shoulder joint, inflammatory process in the joint and surrounding soft structures, instability (inconstancy and imbalance) of the shoulder joint etc… we meet frequently with insufficiently treated, or for long term untreated, impingement syndrome, syndrome of the rotator cuff or other illness, which can result in development of arthrosis.
What happens in a shoulder joint during arthrosis?
Arthrosis is a degenerative illness. In the first stage it only leads to destruction of the surface of the cartilage, usually in the area of the articular cartilage, which is consisted of scapula (shoulder blade), and gradually also by the joint head piece of the humerus bone, which can be affected by osteophytes (bony spurs). In case the arthrosis is accompanied also by inflammation, the cartilage get affected completely. The surrounding soft tissues (muscles, ligaments, joint capsule) react to this process by reflexive contracture (hypertonus), the joint capsule often retracts (draw back) and by the muscles of the rotator cuff it can result in contracture. Similar reaction have also seemingly distant parts of the body (cervical, thoracic and lumbar spine or even ribs), which can be reflexively blocked. That results in significant muscle imbalance in the area of the neck, torso and naturally also arms.
Movement in the shoulder is accompanied by pain, at first it appears only during physical activity, later also in a peaceful regime, e.g. during night. Pain restricts the range of movement. Blockages of the facet joints, ribs, collarbones, elbows or shoulder blades may also occur. All these manifestations can also lead to headaches.
OPTIONS OF TREATMENT
Similarly as by heavy cases of arthrosis of hip or knee joints, it is possible to replace the disabled joint surface or whole joint by endoprosthesis. Very often and less invasive method of surgery of the shoulder joint is arthroscopy, during which the surgeon is able to „clean” the affected joint surface. In combination of timely applied and intensive physiotherapy, the return back to the physical activity is very fast.
In acute phase it is ideal to apply every 3 hours Priessnitz compress, which can lower the inflammatory processes. We try to relax the reflexive spasms in the area of the chest muscle, latissimus dorsi muscle, muscles of the shoulder blade, cervical spine etc… Pleasant procedure is the gentle manual traction (stretching), mobilization of the shoulder joint and surrounding joints. We should also pay attention to recovery of the mobility of the ribs, cervical and thoracic spine.
When we get over the acute problems the therapy comes next, and it is focusing on the recovery of the functional coordination between muscles and muscle groups, which were by this affected. We try to relieve the muscles in higher tension (hypertonus), and exercise the weakened muscles. In order to achieve the correct harmony between the muscles, we have a wide range of tool that we can use, such as BOSU, Propriomed, Theraband and Flowin. Just as effective are methods according to which you can exercise at home: PNF, Brügger, Brunkow etc…
- First aid during pain in the shoulder
- Exercises during pain in the shoulder
- Exercises during pain in the shoulder with help of a second person
- Exercises during pain in the shoulder with exercising tool
- Exercises for strengthening and stabilization of the shoulder
- Exercises for stabilization of the shoulder with exercising tool
FOCUSED SHOCKWAVE THERAPY
High-energy focused shock wave therapy can be applied especially in first phases of this illness. It is very effective in the area of joint inflammation or surrounding soft tissues, but it can just as effectively affect the tension (hypertonus) of the muscles or the above mentioned contracture (shortening) of the muscles of the rotator cuff. Immediately the first application will boost the metabolism and natural repairing process of the tissues, which also speeds up the healing of the inflammations. It can also effectively relieve the muscle spasms and trigger points. Consequent therapy with functional tape (elastic cotton band) will stabilize the whole segment and support the circulation of the lymphatic fluid, therefore there won’t be any accumulations or swellings, and the patient will subjectively feel instant relief. Application of the focused shockwave therapy should be applied 1-3x within 7-10 days.
Author: Mgr. Iva Bílková, FYZIOklinika fyzioterapie Ltd, Prague, Czech Republic
Source: KOLÁŘ, P. et al., Rehabilitace v klinické praxi, Praha: Galén, 2012, ISBN: 978-80-7262-657-1; Clinical experience in diagnostics with use of focused shock wave