A variety of degenerative diseases can occur in the shoulder over the long term. These include, for example, impingement syndrome, rotator cuff rupture or osteoarthritis of the shoulder joint. Which diseases of the shoulder can also develop how they manifest themselves and how treatment is carried out, you can learn here.
Degenerative shoulder diseases: What forms are there?
Nearly 150 years ago, the French physician Simon Duplay coined the term “periarthritis humeroscapularis” (PHS) for all degenerative changes in the area surrounding the shoulder joint. Until the end of the last century, this term was used to refer to all possible forms of painful frozen shoulder – but diagnostic possibilities have since matured to the point where the various disease processes can be clearly distinguished from one another and the diagnosis of PHS should be a thing of the past.
Impingement syndrome (the tight shoulder syndrome).
Impingement syndrome is a shoulder tightness that can occur in a number of ways. Between the top of the humeral head and the bony prominence that is the shoulder level, the space is sized just right for the anatomical structures that normally belong there. These include the long biceps tendon, the sinewy muscle attachments of the rotator cuff, and a large bursa that acts like a lubricating layer to allow the muscles to move against each other. All of these structures can swell in the event of inflammation, calcium can build up in the tendons under constant stress, and they can fray and ultimately tear – similar to a rope – due to constant overstraining. In addition, both the shoulder joint and the joint above it, between the level of the shoulder and the collarbone, can wear out, swell and form more bone substance at the edge. Increased fluid can accumulate in the bursa, creating a vicious cycle: a slight increase in volume of a tendon attachment due to fraying irritates the bursa; the bursa responds with an increase in volume because it produces more inflammatory fluid. Thus, various mechanisms lead to impingement syndrome – the physician can distinguish which cause is present on the basis of movement tests and X-rays. For the affected person, shoulder impingement presents as feeling pain in the shoulder during movements that require lifting the arm above the horizontal.
Rupture of the rotator cuff.
In this clinical picture, which affects men ten times more often, part or all of the tendons that attach the rotator cuff muscles to the humeral head rupture. Often, a careless movement is enough to cause the tendons, which are pre-damaged by wear and tear, to rupture. The rupture is extremely painful, and the arm can no longer be raised above horizontal.
Calcareous shoulder (tendinosis calcarea).
In calcific shoulder, calcium is deposited in the tendon attachments of the rotator cuff. This deposit is favored by poor blood circulation to the muscles and tendons, which occurs, for example, during overhead work (such as by painters or stucco workers). The deposits in the tendons occur unnoticed, but often the calcium deposits extend into the bursa, which is very painful. Fortunately, the deposits usually dissolve under therapeutic measures – but pain can occur in this case as well.
The damage to the long biceps tendon
The long biceps tendon is encased in a tendon sheath, runs through a bony groove of the upper arm, and undergoes all shoulder movements. Both the tendon sheath and the tendon can wear out, and the bone then builds bone material around this chronic inflammatory process as a result, which in turn can increase inflammation. In its final state, the tendon can tear, which can be seen impressively in muscular people as the muscle belly contracts above the elbow.
The arthritis of the shoulder joints
As a sign of wear and tear, osteoarthritis of the joint between the level of the shoulder and the collarbone or between the head of the humerus and the glenoid cavity on the shoulder blade can develop. This joint wear and tear results in pain with every shoulder movement. As a consequence of all degenerative diseases, a frozen shoulder can develop, in which all movements hurt and the range of motion decreases more and more due to pain.
Treatment of degenerative shoulder diseases
In principle, degenerative shoulder diseases usually occur at an older age and the treatment – even of frozen shoulder – is first conservative. However, when young people who are very active in sports are affected “prematurely,” so to speak, by a sign of old age in the shoulder, the damage is repaired surgically. Rupture of the long biceps tendon and rotator cuff rupture in particular have a good chance of complete recovery if surgery is performed early.
Conservative therapy for degenerative shoulder disease
Conservative treatment measures include:
- Analgesic drug therapy.
- Physiotherapeutic exercises
- Electrotherapy
- Heat and cold treatments
If the trigger is known, avoiding the cause of the overuse is also an important part of the therapy of degenerative shoulder disease. Such triggers include constant typing on a typewriter or computer, working overhead, or playing sports such as tennis and badminton.
