Orthopedics - Oleksa A.P. 2006

Occupational musculoskeletal disorders
Humeroscapular periarthritis

The condition develops As a result of prolonged overstrain of the shoulder girdle Muscles and repetitive excessive movements in the shoulder joint region.

It is commonly observed in workers of various occupations: painters, loaders, shipbuilders, boiler operators, and masons.

Pathogenesis. Performing work that involves frequent and extensive lateral abduction and Rotation of the shoulder creates conditions for chronic microtrauma to the ligamentous-tendinous apparatus of the joint and synovial bursae, thereby triggering tissue regeneration accompanied by reactive aseptic inflammation.

Thus, when lifting the arm maximally abducted to the side, the greater tubercle of the humerus comes into contact with the acromion and the coracoacromial ligament, creating conditions for trauma (compression) of the shoulder Joint Capsule. Therefore, it is no coincidence that the term "scapulohumeral periarthritis" encompasses a range of disorders in the shoulder region: subdeltoid bursitis, calcific bursitis, subacromial bursitis, and acromioclavicular osteoarthritis.

Each of these forms of scapulohumeral periarthritis possesses not only distinct topographical and pathomorphological features but also clinical peculiarities; nonetheless, they share a similar Clinical presentation and result in impaired upper limb function.

The long-held belief that scapulohumeral periarthritis is the result of a rheumatic process or metabolic disorder has recently been entirely discarded.

Pathological anatomy. Pronounced degenerative changes are observed in the tendons of the supraspinatus and subscapularis muscles, which may be accompanied by deforming osteoarthritis of the shoulder joint. Degenerative-dystrophic changes primarily localize in the ligaments, tendons, and joint capsule, whereas involvement of the subacromial bursa appears only secondarily.

Diagnosis. Scapulohumeral periarthritis is diagnosed based on specific functional impairments of arm mobility: inability to perform lateral abduction, shoulder rotation, and the sign of placing the hand behind the back. It is essential to rule out bone pathology, deforming osteoarthritis, inflammatory conditions of the joint and synovial bursa, as well as cervical spine disorders.

X-ray Examination occasionally reveals sclerotic changes On the surface of the humeral tubercle along with calcific shadows varying in size, shape, and thickness.

Most commonly, radiographs demonstrate salt deposits located within the synovial bursae (subacromial and subdeltoid) and other periarticular Tissues. The presence of sclerosis and destruction of the greater tubercle of the humerus is of high diagnostic value. Periarticular calcium deposits tend to decrease during Treatment and may eventually resolve completely.

Occupational scapulohumeral periarthritis is characterized by a gradual onset, and the disease is not accompanied by fever or an elevated ESR. The clinical course is chronic, marked by alternating periods of exacerbation and remission.

Assessment of work capacity. The condition requires prolonged treatment, following which the patient must be temporarily reassigned to light duty, supported by a two-month disability certificate. Patients with chronic periarthritis require vocational rehabilitation and placement in jobs that do not involve heavy loads on the shoulder girdle muscles or excessive arm movements. In cases of permanent loss of occupational skills, patients are referred to the medical and social expert commission (MSEC).