Diagnosis of shoulder joint arthrosis
A precise description of the symptoms often makes it possible to make a suspected diagnosis of acromioclavicular joint arthrosis. However, further imaging procedures and a precise clinical examination are necessary for an exact diagnosis. During palpation, the physician pays attention to swelling, pressure pain and stress pain in the joint.
Diagnostic imaging includes X-rays in two planes showing a narrowing of the joint space and bony protrusions (osteophytes) growing into the joint space. The ultrasound examination also reveals a narrowing of the joint space, as well as capsule swelling and increased fluid in the joint. Damage to the tendons under the acromioclavicular joint and bursitis are also visible.
Due to its very good resolution, magnetic resonance imaging of the shoulder (MRI) offers an ideal assessment of the osteophytes that extend into the space below the acromioclavicular joint. The contact of the tendons with the bony projections and the associated risk to the tendons can also be assessed.
- The x-ray image and/or
- A magnetic resonance tomography of the shoulder (MRT of the shoulder) and/or
- An ultrasound (sonography).
Therapy
First, local anesthetics and anti-inflammatory drugs can be injected into the joint space, thereby relieving the pain in the shoulder joint and relieving the inflammatory swelling. Surgery for acromioclavicular joint arthrosis is usually performed only in exceptional cases. In this case a resection arthroplasty is performed.
In this procedure, a few millimeters of the lateral clavicle or joint are removed, so that the joint space becomes wider again. The ligament structures are preserved so that no instability occurs. Often the symptoms are significantly better very soon after the operation.
However, due to the invasiveness of the procedure, conservative therapy is always undertaken first. With a cortisone injection, cortisone is injected directly into the shoulder joint, where the inflammation is located. The inflammation can be located and visualized in advance by ultrasound.
However, a cortisone injection should only be given in cases of severe arthrosis of the shoulder joint. This means that all other conservative measures, such as taking anti-inflammatory painkillers, have not been successful. Even if the cortisone injection is successful, it should under no circumstances be a permanent therapy.
Although cortisone has a strong anti-inflammatory effect, it can cause atrophy of surrounding structures such as muscles, tendons, bones and other tissue. To further delay surgery, the injection of hyaluronic acid into the joint can be attempted as an alternative to other conservative methods. On the one hand, the wear and tear of the joint should be delayed.
On the other hand, the hyaluron should act as a buffer between the affected joint partners. The hyaluron should replace the synovial fluid, which is usually lost due to the inflammation, and facilitate the sliding of the joint partners, so that pain is reduced and the joint can recover. The injection of hyaluronic acid is offered by many orthopaedic surgeons, but it is not a service provided by the health insurance companies and must be paid for by the patients themselves.
Before every operation, the non-operative (conservative) therapy is exhausted. However, if there is no improvement despite therapy or if there is still severe pain, surgery should be considered. Especially for young, athletically active people, an operation may be the only possibility to maintain the accustomed or desired quality of life.
In most cases, an arthroscopy is performed, whereby damaged and pain-inducing joint surfaces are removed. Exercises are an important part of the treatment of acromioclavicular joint arthrosis. The exercises ensure that pain is relieved and mobility is maintained.
The focus is on strengthening the muscles so that the shoulder joint is not put under further strain. Before the exercises, a warm up should take place, shoulder circling is suitable for this. During a possible exercise, the person concerned sits.
The forearm is laid flat on a table or a pad. The angle in the elbow joint should be 90 degrees. Now the forearm is pressed on the pad for several seconds and then relaxed again.
This should be repeated 15 times and several times a day. Even simple shoulder lifting with arms hanging down the side of the body can improve the symptoms of acromioclavicular joint arthrosis. This exercise should also be performed 15 times several times a day. Which exercise is best suited to each individual is best discussed with the doctor or physiotherapist. This topic could also be of interest to you:
- Sports with arthrosis
