Periarthritis of the shoulder blade – a chronic degenerative pathology. It is accompanied by an inflammatory process in the periarticular soft tissues located near the shoulder joint and taking part in its functioning. The leading symptom of periarthritis is aching pain. Its intensity increases during movement or tension of the periarticular muscles. Edema and compaction of tissues located in the shoulder area also become clinical manifestations of the pathology.
To diagnose the disease, a number of instrumental studies are carried out: radiography, thermography, MRI. In the medical treatment of humeroscapular periarthritis, drugs of various clinical and pharmacological groups are used: NSAIDs, analgesics, glucocorticosteroids, vitamins.
Pharmacological drugs for the main treatment
To eliminate severe pain, patients are shown parenteral administration of drugs – injections of glucocorticosteroids, analgesics, NSAIDs. With a mild pain syndrome, such a pharmacological load is not required. In therapy, tablets or funds for local application are used: ointments, gels, creams.
Shishkevich Vladimir, orthopedic and traumatologist, project editor-in-chief ExpertNews.
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Nonsteroidal anti-inflammatory drugs
Nonsteroidal anti-inflammatory drugs (NSAIDs) eliminate almost all the symptoms of a shoulder-shoulder periarthritis. They stop the inflammatory process, contribute to the resorption of edema and reduce the severity of pain. The acute form of pathology often proceeds against the background of the development of subfebrile condition – a constant increase in body temperature to 38 ° C. NSAIDs prevent the development of fever mediators – prostaglandins. They facilitate the well-being of the patient by eliminating hyperthermia.
With severe pain, often provoking insomnia, parenteral administration of solutions of Diclofenac, Ketorolac, Voltaren is prescribed. If the pain syndrome is moderately expressed, then funds in tablet forms are included in the treatment regimen:
Even NSAIDs of the latest generations (Nimesulide, Celecoxib) have a negative effect on the gastric mucosa. During their intake, glandular cells produce an increased amount of caustic hydrochloric acid. It is abundant enough not only for digestion of food, but also for ulceration of the gastrointestinal mucosa. Therefore, NSAIDs are necessarily combined with proton pump inhibitors (Ultop, Omez, Nolpaza), which reduce the production of gastric juice.
The duration of the therapeutic course is 10-14 days. If the pain is not completely eliminated, then patients are recommended to use NSAIDs in gels, creams, ointments. Their active ingredients penetrate into the systemic circulation in a small amount insufficient to damage the gastrointestinal tract, liver, and kidneys. The safest and most effective are Fastum, Voltaren, Nise, Ketorol, Finalgel.
These are synthetic analogues of adrenal hormones produced to relieve inflammation, eliminate pain and swelling. Medication for brachiocephalic periarthritis with glucocorticosteroids is performed when NSAID injections are ineffective. The use of hormonal drugs in tablets is rarely practiced because of their pronounced systemic side effects. Periarticular or intraarticular administration of glucocorticosteroids helps minimize undesirable effects and at the same time achieve positive dynamics in treatment. The greatest therapeutic efficacy is characteristic of such drugs:
The patient is shown 1-3 times the use of hormonal drugs. This amount is enough to stop inflammation. Longer therapy can cause thinning of bones, increasing their fragility. Glucocorticosteroids are not used in the treatment of patients with pathological bleeding, osteoporosis, aseptic necrosis. The use of drugs is strictly prohibited when an acute infectious process occurs in the shoulder-shoulder area.
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In some cases, a person experiences such severe pain that it is impossible to eliminate them either by injections of NSAIDs or by periarticular administration of glucocorticosteroids. The patient is shown blockade with anesthetics, usually with Novocaine. Its active substance procaine has a wide range of therapeutic effects. It blocks the sodium channels, preventing the generation of impulses, their passage through nerve fibers. Also, for pain relief and anesthesia, lidocaine is administered periarticularly, which has a pharmacological effect similar to Novocaine.
Local administration of anesthetics is carried out using punctures in such structures of the shoulder-shoulder segment:
- soft tissues in which pain is felt most strongly;
- compacted area of the periosteal muscle;
- a bicitital groove located near the medial edge of the biceps;
- suprascapular nerve.
High precision manipulation provides x-ray control. The drugs are introduced into the synovial bag and connective tissue structures located near the shoulder joint – tendons, soft tissues. Sometimes when piercing the capsule, the syringe is filled with exudate, indicating the development of bursitis. The doctor drains the synovial bag, removes pathological fluid, treats the capsule cavity with glucocorticosteroids in combination with anesthetics.
In orthopedics, multiple drug administration is not practiced. This method of using anesthetics increases the risk of nerve damage or penetration of pathogenic bacteria through a puncture. If the pain syndrome in a particular patient can be eliminated only by blockade, then it is advisable to install a special catheter for the introduction of anesthetics, glucocorticosteroids, and, if necessary, chondroprotectors.
A time-tested remedy for the relief of shoulder inflammation, resorption of edema and pain relief – compresses with Dimexide. The drug exhibits a pronounced anti-inflammatory, antispasmodic, antifibrotic, local anesthetic activity. A 50% solution is usually used for application. It is moistened with a sterile napkin and applied to the area of pain and swelling for 30-40 minutes. The maximum duration of the procedure is 1 hour. The concentration of the solution is reduced to 20-30% if the patient has sensitive skin. Before applying the compress, the shoulder-shoulder area is degreased with any alcohol solution.
With intensive clinical manifestations, the therapeutic regimen can be supplemented. For example, potassium-sparing diuretics (Veroshpiron, Diakarb) are used to eliminate extensive edema. Also, medicamentous treatment of shoulder-shoulder periarthritis can be done with the following drugs:
muscle relaxants M >
After stopping the inflammatory process, the patient is recommended to use ointments with a warming, distracting, local anesthetic effect. The most commonly used are Viprosal, Kapsikam, Apizartron. After applying the ointment to the shoulder-shoulder area, blood circulation accelerates in it. Replenished reserves in the tissues of nutrient and biologically active substances, stimulating their accelerated regeneration. The use of warming agents helps to significantly reduce the dosage of NSAIDs, muscle relaxants, glucocorticosteroids, minimizing their side effects.
The doctor draws up a therapeutic regimen taking into account the form of pathology, the degree of tissue damage, and the general health of the patient. The main goals of the treatment of the shoulder-shoulder periarthritis are to reduce the severity of pain, and prevent muscle contracture. The course administration of drugs is necessarily combined with the observance of a sparing motor regime, unloading the hand with a plaster bandage or an elastic bandage.