pathology: periarthropathia humeroscapularis

yogabook / pathologie / periarthropathia humeroscapularis

Definition

Collective term for various types of pain in the shoulder girdle area caused by degenerative processes in the soft tissues (joint capsule, rotator cuff). The shoulder is one of the most complex joints in the body; its structure offers extreme mobility, which comes at the expense of stability. Metabolic disorders in which lactic acid in the interstitium leads to acidosis can be the cause. It is not uncommon to see long-lasting restrictions in quality of life and ability to work. Active mobility is more significantly restricted than passive mobility. Proactive patients have a clear advantage, as PT exercises performed at home are of great value. Prevention of contralateral shoulder problems is also important. Early intervention is beneficial. Those affected show an early lack of endorotation and exorotation in the shoulder joint, both of which are painfully restricted.

Peak age: 40–60 years old, women > men. In 25% of cases, the second shoulder is affected shortly after the first. The condition usually burns out after 6–24 months and can be divided into phases:

  1. Stage 1: pronounced painful movement, possibly also pain at rest, no restriction of mobility yet. Analgesics provide little relief.
  2. Stage 2: after about 3 months, pain subsides but mobility restrictions increase; lateral abduction is limited to less than 90°. No more inflammation of the capsule, but scarring, it shrinks and thickens.
  3. Stage 3: decreasing mobility restrictions, risk of permanent weakening of the shoulder joint

International Classification of Diseases, 7th Revision, M75.0

cause

  1. Primary form (autoimmune-inflammatory): unknown
  2. Secondary form: trauma, fracture, ruptures within the „rotator cuff„, surgery, degenerative diseases such as osteoarthritis

Predisposing

– Behaviour

  1. lack of exercise
  2. repeated monotonous movements (narrow use)
  3. acidic (acid-forming) diet

– Musculoskeletal system

  1. calcific tendinitis
  2. Immobilisation of the shoulder joint

– other factors

  1. Metabolic disorders such as diabetes mellitus, hypercholesterolaemia, hyperthyroidism, hypothyroidism, metabolic syndrome
  2. Perimenopause and menopause due to oestrogen deficiency
  3. Aromatase inhibitors in breast cancer treatment

diagnosis

  1. primarily clinical/functional diagnostics and anamnestic
  2. difficult to visualise in imaging
  3. detectable by arthroscopy

symptoms

  1. Movement-dependent pain, painful restriction of movement in all directions; as a rule, lateral abduction is significantly restricted by pain, passive movement is possible to a slightly greater extent than active movement.
  2. Highlight: nocturnal resting pain when lying on the affected side
  3. sudden severe pain, occurring independently of strain or trauma during everyday activities
  4. Persistent pain, inability to perform certain movements, even chronic pain
  5. Eventually, the constantly painful and rested shoulder stiffens.
  6. Significant pressure pain in the inflamed capsule (stage 1)

complications

  1. psychological stress
  2. temporary incapacity for work, if applicable
  3. subacromial impingement

therapy

  1. calm down first
  2. Administration of analgesics, optionally also anti-inflammatory drugs
  3. It is beneficial to administer local anaesthetics such as lidocaine, procaine, etc. (which should not contain adrenaline) via wheals, which has an additional blood circulation-promoting effect (tip: prick briefly (1 second), inject a little, then deeper and more, placing the next wheal in the already anaesthetised area).
  4. For frozen shoulder: anaesthetic mobilisation and consistent active physiotherapy, otherwise there is a risk of recurrence.
  5. alkaline diet therapy, avoidance of foods containing arachidonic acid
  6. ultrasound therapy
  7. Water-filtered infrared-A heat therapy (wIRA lamp)
  8. Exercise therapy: stretching, strengthening, coordination
  9. Surgery (minimally invasive) only if conservative treatment fails: arthrolysis. Post-op: immediate permanent movement training of the shoulder on a motorised splint under analgesia.
  10. Temporary switch to shoulder-friendly sports
  11. A significant reduction in the duration is hardly achievable.

guideline

AWMF, external link: https://register.awmf.org/assets/guidelines/187-020l_S2e_Schultersteife_2022-07.pdf