What degree of disability is associated with shoulder arthrosis?
The degree of disability in shoulder arthrosis depends on the extent of the movement restrictions and stiffening. The mobility of the shoulder girdle is also crucial. If the arm can only be lifted by 120 degrees and the ability to rotate and spread is restricted, the degree of GdB/MdE is 10. If the restrictions are severe, the degree of GdB/MdE can be up to 50.
Cause and development of shoulder arthrosis
Known causes of shoulder arthrosis are mechanical overload, damage to the rotator cuff (muscle and tendon sheath that moves and stabilizes the shoulder joint), conditions after surgery, inflammation and accidents. In most patients suffering from shoulder arthrosis, however, the cause remains unclear. In these cases, one speaks of primary shoulder arthrosis or primary omarthrosis.
The symptoms are rather uncharacteristic and manifest themselves as shoulder pain and restricted shoulder movement. The diagnosis is made on the basis of x-rays of the shoulder. Both conservative and surgical treatment methods (shoulder prosthesis) can be consideredAs a rotator cuff, several shoulder-embracing muscles and tendons are described that move the shoulder joint and keep it in an optimal position for joint function.
Defects of the rotator cuff lead to muscular imbalance and loss of stabilizing balance. The supraspinatus muscle under the acromion is most frequently affected by injuries, mostly caused by degeneration (wear and tear), less frequently by an accident. When the supraspinatus tendon ruptures as the cause of shoulder arthrosis, the mechanics of the glenohumeral joint is severely disturbed.
In extreme cases, a complete tear, the head of humerus leaves its original position in the joint and rises to the top of the shoulder below the acromion. This leads to incorrect loading of the shoulder joint cartilage, resulting in increased cartilage abrasion and ultimately shoulder joint arthrosis. The final stage of this development is described by the term defect arthropathy, in which the head of humerus comes into contact with the bone of the acromion.
The peak frequency of wear-related rotator cuff injuries is in the 4th and 5th decade of life. Operations on the shoulder can cause shoulder arthrosis if the shoulder balance is disturbed. The most important example of this is surgery to stabilize the shoulder anteriorly after dislocation of the shoulder joint (shoulder luxation).
The usually necessary refixation of the joint lip (labrum) and, above all, the gathering of the anterior shoulder capsule can lead to the head of humerus being pushed backwards if the shoulder joint capsule is shortened too much. As in the previous example, a disturbance of the shoulder joint mechanism occurs. In this case, the glenoid cartilage in the back of the shoulder is overloaded.
Injuries to the joint-forming shoulder blade (e.g. luxation fractures of the glenoid when the shoulder is dislocated) or to the head of humerus can lead to unevenness of the cartilage surfaces or to joint malpositions. Both cases result in increased cartilage abrasion, which gradually develops into shoulder arthrosis. Bacterial inflammation of the shoulder is rare and is caused either by germ transfer via the bloodstream (very rare) or by medical treatment (iatrogenic), e.g. after surgery or injections.
The shoulder joint can quickly be seriously damaged by the bacteria themselves and by cartilage-damaging substances produced by them. The most common form of non-bacterial shoulder joint inflammation is chronic polyarthritis (“joint rheumatism“). The chronically inflamed joint mucosa proliferates into the joint cartilage and progressively destroys it. The rare death of the head of humerus due to loss of blood supply to the bone also leads to shoulder arthrosis when the cartilage-bearing part of the head of humerus collapses.
