Articular cartilage damage most commonly occurs in the knee, but the elbow, wrist, ankle, shoulder, and hip joint can also be affected. The glenohumeral joint consists of the humeral head (caput humeri) and the glenoid cavity (cavitas glenoidales), both of which are covered with cartilage. The cartilage structure and synovial fluid ensure that there is no friction or pain during movement. If there is cartilage damage, i.e., a kind of tear in the cartilage tissue, pain may occur, which may need to be treated. This can be a small tear, but it can also be much more extensive under certain circumstances.
The problem with cartilage damage is that the cartilage does not have its own blood supply like most other structures in our body, but is mostly supplied by other structures. If cartilage tissue is damaged, the body’s own regeneration is usually very limited for this reason.
Causes of cartilage damage
The reasons for cartilage damage cannot always be clearly diagnosed. One damage can have several causes. A previous accident is typical for such an abrasion of the cartilage tissue, but also wrong; excessive loads can cause such damage as a consequence. If the joint is subjected to a sudden, very heavy load, for example in a car accident or during sports, the cartilage can be damaged.
In the shoulder, the occurrence of cartilage damage can typically be promoted by certain sports. These include tennis, American football, wrestling, bodybuilding, and shot put. It is also common for a piece of cartilage to chip off, which can lead to pain and restricted mobility.
Permanent mechanical stress on the joint over a long period of time also results in cartilage damage in the joints. Risk factors for the development of a chronic disease of the joints, such as arthritis, are typically overweight and certain occupational groups, which therefore expose their joints to high stress. Often, the damage caused by these factors is more extensive than damage after an accident or sports injury.
Influencing factors such as age and individual stress on the joint also play a decisive role in the development of these diseases.
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Symptoms of cartilage damage
The symptoms of cartilage damage to the shoulder are very similar to other shoulder injuries. These include:
- Pain, often associated with “overhead” work, a “cracking” in the joint, with or without associated pain
- Pain in the night
- a feeling of instability of the shoulder joint
- Restrictions of movement in the joint
- Starch losses
- Other signs of inflammation such as warming and redness
Diagnosis of cartilage damage
The experts for injuries to the joints, and therefore also for diseases that are associated with cartilage damage in the shoulder joint, are specialists in orthopedics or general medicine. To make a diagnosis, it is important to know whether the pain is directly related to an accident, how long it has existed, and during which movements pain occurs. To find this out, the attending physician will carry out some tests to examine, among other things, stability and freedom of movement.
To rule out other problems, X-rays can be taken, but cartilage tissue cannot be examined in them. To be able to assess this, an MRI of the shoulder joint (magnetic resonance tomography) is therefore usually ordered. In this case, a contrast medium may be injected in order to assess the damage better. In most cases, however, the final diagnosis can only be made during an arthroscopy.
The International Cartilage Repair Society has established different degrees of severity for the classification of cartilage damage:
- Grade 0: (normal) healthy cartilage tissue
- Grade 1: The cartilage has soft spots or blisters
- Grade 2: Small damages of the cartilage are visible
- Grade 3: Damage with gap formation (in more than 50% of the cartilage tissue in the joint)
- Grade 4: The damage to the cartilage extends to the underlying bone and exposes it.
The cartilage damage in the shoulder joint can best be assessed by MRI.
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Therapy of cartilage damage
There are two concretely different therapy approaches for cartilage damage in the shoulder joint. Firstly, there is conservative therapy, to which many patients respond well, depending on the size and type of cartilage damage.
This therapy includes the use of pain and anti-inflammatory drugs (NSAIDs) and exercises for the joint with physiotherapy or at home.
Also, conservative therapy is recommended to alleviate the symptoms and expose the joint to as little stress as possible. If the damage is not excessive, this treatment may meet all the patient’s needs.
However, if this conservative method proves to be inadequate, the attending physician may consider surgery. Most cartilage damage to the shoulder joint is treated by arthroscopy. This is a minimally invasive operation in which the cartilage tissue can be restored using various methods.
In most cases, a technique called microfracture is used. This is intended to produce bleeding, which stimulates the tissue to form cartilage. The procedure of cartilage transplantation, in which cartilage is taken from other joints and inserted into the affected joint, has not yet become established in the treatment of cartilage damage in the shoulder joint.
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Conservative therapy options of cartilage damage
Can hyaluronic acid help?
Hyaluronic acid is an important component of the connective tissue and also of the joint fluid, which can be used in the context of arthrosis therapy. Especially in patients with cartilage damage, the availability of hyaluronic acid in the joint is significantly reduced.
The preparation obtained from animal source material is injected into the damaged joint in several sessions (1-5 injections), where it then serves as a kind of “joint lubricant” and shock absorber. Especially in the early stages of cartilage damage, this procedure can lead to a significant reduction in shoulder joint pain, so that better loading is possible.
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Can chondroitin/glucosamine help?
In addition to injecting hyaluronic acid into the shoulder joint, some people also talk about the possibility of taking certain dietary supplements (chondroitin sulfate and glucosamine) to counteract arthrosis.
Chondroitin sulfate is a natural molecule that is formed by cartilage-forming cells in the body and is involved in the building and strengthening of joint cartilage. The sugar derivative glucosamine is also an important component of cartilage tissue. However, initial medical studies on the therapeutic effect of the orally taken preparations are contradictory. A significant improvement in symptoms or a reduction in cartilage damage has not yet been reliably recorded.
Can homeopathy help?
As an alternative or even accompanying measure, a homeopathic approach can be taken. Here, a wide range of homeopathic medicines are available for degenerative diseases such as cartilage damage.
Common remedies include Acidum formicicum, Acidum sulfuricum, Aranin (extracted from the black night spider), Aristolochia (pipe flower), Calcium sulfuricum, Formica rufa (extracted from the redwood ant), Harpagophytum (devil’s claw), Potassium sulfuric.
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Can acupuncture help?
Acupuncture can be considered as an alternative or complementary therapy for cartilage damage in the shoulder joint. According to traditional Chinese medicine, the fine needle punctures in very specific, selected points of the body irritate these areas. This allows particular body regulations to be influenced.
However, the exact mechanism of action has not yet been clarified. Some patients report that regular acupuncture for arthrosis therapy reduces the pain in the affected joint and improves mobility. Initial medical studies investigating the effectiveness of acupuncture for osteoarthritis of the knee joint are showing a positive result.
Can osteopathy help?
Osteopathy, as a field of alternative medicine, diagnoses and treats certain functional disorders of the human locomotor system. Particularly in the case of painful cartilage damage in joints, it is possible to unconsciously adopt relieving postures that not only lead to muscular tension but also further promote the onset of osteoarthritis.
With certain manual techniques, osteopathy can detect and remedy these relieving postures. Besides, the osteopathic approach to therapy can work in parallel with orthopedic and physiotherapeutic treatment methods to restore and maintain mobility in the shoulder joint.
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Which home remedies can I take to support my mobility?
In most cases, drug therapy is unavoidable to treat the symptoms of cartilage damage in the shoulder joint or osteoarthritis in general. However, various household remedies can also be used as a supplement.
Who benefits from shoulder surgery?
Only when all conservative treatment options have been tried and exhausted should surgical treatment of cartilage damage to the shoulder joint be discussed.
This means that an artificial joint replacement should only be considered when treatment with medication, orthopedics, physiotherapy, or alternative medicine no longer leads to a reduction in symptoms.
Surgical intervention should be delayed as long as possible is not necessarily only due to the associated surgical risks. It is rather because an artificial joint replacement does not have an unlimited life span (approx. 10 years), so that a joint replacement at a younger age may be accompanied by one or even several operations for material replacement in the course of life.
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