There are three clinical pictures of inflammation of the main shoulder joint:
They differ in terms of cause, symptoms and treatment.
We look at these three clinical pictures below.
50 to 80 percent of patients suffering from rheumatoid arthritis show involvement of the shoulders during the course of the disease. Affected are
The course of rheumatoid arthritis in the shoulder is not fundamentally different from that in other joints. However, the shoulder is particularly dependent on the integrity of the surrounding soft tissue structures. The inflammatory change in the rotator cuff is therefore of particular importance.
Muscles and soft tissues around the shoulder joint © bilderzwerg | AdobeStock
The typical clinical symptoms of rheumatoid arthritis also affect the shoulder. These include
There can be considerable swelling of the shoulder joint.
However, omarthritis often remains largely symptom-free for a long time, especially if the disease has been present for many years and effective basic therapy has been used. Compared to other joints, the symptoms are often in the background.
Problems can arise due to increasing functional deficits of the rotator cuff. This is caused by the inflammation
thins out and becomes non-functional. There are then all the signs of a rotator cuff rupture with loss of strength.
In other cases, the symptoms of shoulder joint arthrosis (omarthrosis) develop with painful mobility. The involvement of the acromioclavicular joint leads to closely circumscribed swelling and tenderness.
Comparison of a healthy shoulder joint with a joint affected by osteoarthritis © bilderzwerg | AdobeStock
In most cases, the diagnosis of rheumatoid arthritis is already known when shoulder symptoms occur. Sonography(ultrasound) is well suited to assessing the synovial changes and the condition of the rotator cuff. X-rays typically show large usurpations at the cartilage-bone interface of the humeral head.
Attention should be paid to
Magnetic resonance imaging (MRI) provides important information about the condition of the rotator cuff.
It also provides information about the extent of the synovial inflammation. It is therefore often essential for further diagnosis and planning of surgical steps.
Systemic drug therapy for the underlying disease is the first priority. Physiotherapy is used to strengthen the muscles and prevent restricted movement at an early stage. Local injections with cortisone are effective. The main shoulder joint is also amenable to radiosynoviorthesis.
In the early stages of the disease, surgical
can be performed. Arthroscopic and open surgical procedures are used.
Severe cases require endoprosthetic joint replacement. The implants available do not differ from those used for shoulder osteoarthritis.
Bacterial omarthritis refers to infections of the main shoulder joint and the secondary shoulder joints.
This is usually preceded by punctures and drug injections. In addition to the main shoulder joint, the subacromial space is therefore a possible source of bacterial colonization. Open injuries or operations are less common causes of the infection, as is the seeding of bacteria via the bloodstream.
Bacterial shoulder inflammation spreads rapidly from the subacromial space into the main joint and vice versa via a gap in the muscle cuff.
The rotator cuff, which is relatively poorly supplied with blood, is then surrounded by pus and is at great risk.
If left untreated, the further course of bacterial shoulder inflammation can lead to complete destruction of the joint.
Patients usually report an acute onset and complain of pain at rest, but also pain on movement. The shoulder joint may be
be painful. However, the absence of typical clinical signs of infection can be misleading, especially in the shoulder joint! A distinction must be made between calcific shoulder (tendinosis calcarea), which can cause similarly painful conditions.
Bacterial omarthritis also causes pain in the shoulder © Bits and Splits | AdobeStock
The diagnostic measures are the same as those required for joint infections in other locations:
The therapeutic principles also correspond to those of general joint infection treatment.
If the clinical picture is unclear, untargeted antibiotic therapy is wrong. The focus is on surgical treatment of shoulder inflammation, which can be performed arthroscopically in the early stages. In more advanced stages, open surgical treatment of the joint is necessary.
Theaim is to clean out the joint and remove dead and highly inflamed tissue. A second and third surgical treatment may be necessary. This is accompanied by targeted antibiotic therapy according to the bacterial spectrum.
If shoulder inflammation is recognized at an early stage and treated correctly, there is a good chance of recovery. The infection can then heal completely and the shoulder joint remains fully functional.
If treatment is carried out too late or inadequately, the shoulder joint can suffer serious, permanent damage.
Adhesive capsulitis is the independent clinical picture of frozen shoulder. In this case, glenohumeral mobility (main shoulder joint) is restricted.
Other partial shoulder stiffness develops after prolonged rest of the joint following trauma, infection or surgery (secondary frozen shoulder). In adhesive capsulitis, however, there is no clinical, radiological or anamnestic evidence of the development of the disease.
The cause of this disease is unclear, but a disorder of the connective tissue cells is being discussed. The classification of adhesive capsulitis in the group of inflammatory diseases is questionable. Inflammation of the joint capsule is not a regular occurrence and is at best detectable by fine tissue examination in the initial phase.
Later, the microscopic picture is characterized by the proliferation of connective tissue cells and structural changes in the connective tissue fibres. This results not only in a thickening of the joint capsule, but also in a marked reduction in the joint space. Finally, there is a severe restriction of movement.
Adhesive capsulitis mainly affects women between the ages of 40 and 60. In a third of cases, both shoulders are affected.
The spontaneous course of adhesive capsulitis can be divided into three stages:
The disease process lasts for many months, the phases are of roughly equal length. The restriction of movement that occurs in the meantime can be considerable and significantly hinder the use of the arm.
The external rotation and abduction of the shoulder joint are particularly affected.
Apart from a slight decrease in bone density due to inactivity towards the end of the disease, laboratory tests and X-rays show no abnormalities.
Evidence is provided by arthrography with
As a rule, the disease heals within 24 months. This is almost independent of any therapy that has been carried out in the meantime. Occasionally, however, persistent (partial) stiffness can also occur, as with secondary frozen shoulder.
In principle, the spontaneous progression can therefore be awaited. Treatment is directed purely symptomatically against the pain. The current mobility and muscle strength can be maintained with physiotherapy.
In stage I, the focus is on medication with non-steroidal anti-inflammatory drugs. Physiotherapeutic mobilization treatment should only be started once the acute symptoms have subsided.
Other treatment methods attempt to shorten the spontaneous course of the disease. For a long time, brisement of the shoulder (mobilization under short anaesthesia) was common. Today there are other methods:
Temporary improvement may occur. In individual cases, it helps the patient to overcome the course of the disease more easily.
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