Periarthritis - degenerative inflammation of the periarticular tissues (serous bags, ligaments, tendons) around the large joints, usually occurs in people over forty years (in women, the disease is much more common).The most common form is the periarthritis of the shoulder joint - frozen shoulder
Periarthritis - causes of
in the development of the disease are important following predisposing factors: congenital defects of the top of the shoulder girdle, and neurological and psychiatric disorders, prolonged exposure to wet conditions, hypothermia, age over forty years, a variety of diseases - sciatica, spondylosis, arthritis, diabetes and so on.
One of the main etiological factors are micro and / or makrotramy due to professional or sports activity.Often, frozen shoulder develops in patients who have coronary heart disease (usually in remitting phase or during an attack of angina) or myocardial infarction (15% of people have had a heart attack).The cause of frozen shoulde
According to statistics, the prevalence of periarthritis currently stands at about 10% of the adult population
Periarthritis - symptoms
In the initial stage of frozen shoulder is usually observed a slight focal necrosis, or the present partial tendon ruptures Supraspinous muscles without a clearclinical manifestations.In the case of more pronounced changes in the beginning there is the development of reactive inflammation in the tendon and then podakromialnoy and subdeltoid bags with bags and swelling of the tendon.This process is accompanied by severe pain and limitation of shoulder abduction, which further strengthens the regional reflex spasm of muscles.
With a favorable course of the process, all of the above pathological manifestations can gradually yourself disappear, or there may be such residual effects as chronic fibrous capsule and the adhesive bursitis
main clinical forms of frozen shoulder:
- «simple painful shoulder" or a simplefrozen shoulder
- «acute painful shoulder" frozen shoulder or acute
- «The blocked shoulder" or chronic ankylosing frozen shoulder
Simple frozen shoulder is the initial and most common form of frozen shoulder.At the heart of this form of tendonitis is isolated infraspinatus and supraspinatus muscles.Clinically, this form appears minor pain and almost imperceptible movement restriction in the shoulder.Localized pain in the shoulder verhneperedney in a place of attachment to the greater tuberosity tendon short rotators.The defining symptom of frozen shoulder is a simple amplification or the occurrence of pain in abduction and / or rotation of the hand.In most cases the patient is unable to raise the arm up and can not bring his fingers to the vertebral column while trying to make his hand behind his back.All the other movements of the shoulder joint are painless and free.Sometimes the pain can appear at night, especially when lying on the sore shoulder.
perednenaruzhnoy on the shoulder, or away bitsipitalnogo trough defined tender points on palpation, typical sign of Dauborna: the abduction hands on 45-90˚poyavlyayutsya pain that subsides after further diversion and / or raised.During the reverse movement of the same symptoms repeated.Also, the pain occurs when you try to make any movement deliberately fixed hand.All passive movements of the shoulder joint are still completely painless, and laboratory parameters and the general condition of the patient to normal.Radiography shows no abnormalities.Only in the case of prolonged chronic disease occurrence a convergence bony prominences and as a result of friction - osteoporosis and low sclerosis.Exodus simply frozen shoulder can be a full recovery within a few days / weeks, and a further recurrence of the pathological process with the transition to a chronic form with no clearly defined limitation of movement in the shoulder.
Acute frozen shoulder can be a form of self and previous complications.It is based on the presence of acute tendobursita with calcification of tendons.Most often suddenly, usually after exercise appears growing worse at night diffuse shoulder pain radiating to the back surface of the hands and neck, resistant to analgesics.Movements in hand significantly limited, while the patient tries to keep it folded and supplied to the body.
on the front surface and on the outer surfaces and perednenaruzhnoy palpation detected sufficiently tender points different localization.In some cases, these painful areas of swelling is observed with little fluctuation, flushing muscle atrophy subacute muscle.Movement in the shoulder is very sharply limited (especially rotation and abduction), while the movement of the hands forward runs quite freely.Due to severe pain developing insomnia, which in turn adversely affects the overall health of the patient;increased erythrocyte sedimentation rate, there is low-grade fever.On the X-ray field in podakromialnoy detected calcifications.
acute attack of frozen shoulder can take as a matter of days or weeks, and then reduced the pain and restored movement.In some cases, there is a gradual absorption of calcifications.In very rare cases acute frozen shoulder privodyascherotatornoy leads to contracture of the shoulder.
chronic ankylosing frozen shoulder is the most unfavorable form periarthritis, which is based on the fibrous capsule and bursitis.More often than not, this form is the outcome of acute periarthritis, but does not exclude its independent development.The initial symptoms of this form of act aggravated by movement blunt shoulder pain localized in the attachment of tendons.Progressive stiffness of the shoulder is the most common symptom, and dramatically disrupted the internal rotation and lateral shoulder abduction.In place of attachment to the shoulder deltoid, biceps along the furrows, in front of and under the acromion palpation and characteristic pain.Laboratory parameters, body temperature and general condition remains normal.In the course of the affected tendon during the X-ray can be detected calcifications
Periarthritis - treatment
Considering the long and persistent course of primary periarthritis, the cause of which lies in the very slow resorption of calcification and foci of degeneration, as well as the ongoing micro-traumas tendons, compulsorycondition of the correct treatment - is perseverance and duration.
main treatments periarthritis: maximum unloading of the affected tendon, the use of anti-inflammatory and analgesic of drugs, use of balneology and physical methods, surgery (rare).
To unload the affected tendon apply immobilizing the patient limb.If the case is not serious, limb movement restriction is achieved by overlaying the sling, wire or wooden tires.Recovery from such immobilization may occur within a few days.In more serious cases, shows the use of a removable plaster splint.After reducing the pain should begin light careful movements at the same time using these analgesics in usual dosage: Reopirin, Phenylbutazone, Indotsid, brufen, Analgin, acetylsalicylic acid and so forth. In the case of persistent pain shown holding infiltration affected area hydrocortisone combined with novocaine.
improves blood circulation and have a good analgesic effect such physical therapies like sinusoidal currents, hydrocortisone phonophoresis, ultrasound and so on. If there is persistent pain is used radiotherapy.In chronic course of the disease are proven hydrogen sulfide and radon baths.In chronic frozen shoulder the best method to prevent the blockade of the shoulder is carried out systematically over several months physiotherapy.
Massage Therapy in all forms of periarthritis is absolutely contraindicated.Only in severe cases and only when the pain stihnuvshih possible to use the surface massage the limbs, with the obligatory bypass the affected area.In case of failure of conservative treatment shows performed surgical treatment
periarthritis Treatment methods of physiotherapy
Treatment of frozen shoulder is complex, which is widely employed methods of physical therapy and manual therapy.
Pharmacopuncture - used to eliminate inflammation and is accurately administering a drug.
acupuncture - has an analgesic effect and relieves muscle tension.
point massage (acupressure) - improves motor activity, eliminates spasms of muscles, improves nutrition and blood supply of the periarticular tissues.
Magnetic therapy, laser therapy - food and stimulate blood circulation, mobilize the body's defenses and improve immunity, have anti-edema, anti-inflammatory and analgesic effects.
electromassage, vibratory - have an analgesic effect, eliminate the hypertonicity of muscles, promote renewal and regeneration of tissues, stimulate blood circulation, improve the local immune system, improve blood circulation.
Shockwave therapy - improves blood circulation, increases local immunity, cleanses the tissues of toxins, improves lymph circulation.
Hirudotherapy - improves blood flow to tissues around the joint itself, and directly contributes to the elimination of the inflammatory process.
Mud - to stimulate tissue regeneration, increase local immunity, help to eliminate pain in the shoulder and inflammation of the periarticular tissues.
Electrophoresis - used for administration in the inflammation directly through the surface of the skin the necessary medicines.
Treatment of frozen shoulder are often supplemented by individualized course of physiotherapy.Methods of integrated medicine in the treatment of frozen shoulder can achieve long-term sustained improvement of health and pronounced therapeutic effect in the absence of absolutely any side effects.