Drug blockade of the knee joint is an injection method for treating various diseases and injuries. With its help, you can quickly stop, remove, restore normal or stop the development of degenerative changes in the joint. The administration of medications helps to achieve the effect of the procedure.

What is a knee block, in what cases is it performed, and how does the procedure work?

Joint blockade is also called a sharp restriction of knee mobility, accompanied by severe pain. The reason for this condition is the infringement of a damaged or articular mouse - a torn fragment of cartilage, bone or osteochondral tissue.

Types of drug blockades

Painkillers

Amide-type anesthetics are basic drugs: they are most often used for pathologies of the knee joint. These agents are also included in mixtures for multicomponent blockades.

Preparations for injections:

Corticosteroids

Steroid hormones are also basic drugs. They are suitable for both intra-articular and periarticular administration. This means that corticosteroids can be used to treat inflammatory diseases of the joints, ligaments, joint capsules and any other structures of the knee joint. Steroids are usually administered along with painkillers.

Corticosteroids used in orthopedics and traumatology:

Blockade of the knee joint with Diprospan is widely used to relieve pain in severe gonarthritis. After the procedure, the person’s well-being improves for several weeks. Over time, the blockade has to be done again. The only way to completely get rid of chronic knee pain is through surgery.

Hyaluronic acid

In recent years, hyaluronic acid preparations are increasingly used for blockades for arthrosis of the knee joint. As practice has shown, a three-month course of treatment helps to significantly relieve pain, reduce stiffness in the knee, and improve a person’s well-being. It has been proven that local administration of hyaluronic acid is much more effective than glucocorticosteroid therapy.

Chondroprotectors

Blockades of the knee joint are used for arthrosis, accompanied by severe pain. Intra-articular administration of chondroprotectors is the best alternative to taking pills. Drug blockade helps to achieve faster and more pronounced results. After a course of treatment, patients' pain decreases and their quality of life improves.

Combined treatment with oral and parenteral chondroprotectors is much more effective than monotherapy. In people who are given two drugs at once, there is a noticeable decrease in the intensity of the pain syndrome.

The inclusion of hyaluronic acid in the treatment regimen also helps improve the functional state of the joint.

Progress of the procedure

The manipulation is performed on an outpatient basis (except in cases where the person’s condition requires hospitalization). Since drug blockade is an invasive procedure, its implementation requires compliance with all the rules of asepsis and antisepsis. This means that the injection is given in a special room, and the skin is carefully treated before the injection.

If several drugs are planned to be administered to the patient, they are pre-mixed. Adrenaline is added to the local anesthetic solution in a ratio of 1:200 thousand. When simultaneously administering a corticosteroid and an anesthetic, the hormonal agent is first drawn into the syringe.

The therapeutic mixture is administered very slowly and carefully. This helps to avoid mechanical tears and damage to soft tissues.

Possible complications

Correct selection of drugs for blockade and compliance with the rules for their administration usually helps to avoid undesirable consequences. However, in 0.5% of cases, patients still develop complications.

Types of complications during medical and drug blockades:

• allergic(anaphylactic shock, Quincke's edema, urticaria). Develop due to individual intolerance to certain drugs;
• traumatic(hematoma). The cause is mechanical damage to soft tissues from an injection needle;
• purulent(nonspecific inflammation). Occur due to infection during the procedure;
• toxic. They develop in case of incorrect selection of the drug, non-compliance with the dosage or blockade technique. All this can be caused by insufficient experience of the specialist performing the injection.

Drug blockade of the shoulder joint.

Blockade of the shoulder joint is a local injection of a drug to eliminate and (or) strong. The result of a short drug procedure is a persistent analgesic effect, sometimes lasting for several weeks. For therapeutic blockades, solutions of drugs of various clinical and pharmacological groups are used -,. The first choice drugs are Diprospan, Novocaine, Lidocaine, which have an analgesic effect almost immediately after their administration.

Despite the high therapeutic effectiveness of drug blockades, doctors do not always use them to improve the well-being of patients. The procedure and the drugs used for it have a wide range of contraindications. There is also a possibility of developing local or systemic adverse reactions. The doctor makes the decision to inject solutions into the shoulder joint area only after examining the patient, taking into account other pathologies in the anamnesis.

How is a shoulder block performed?

Basic principles of the treatment procedure

The drug procedure is based on blocking the muscles located near the joint. This allows you to prevent the destruction of shoulder tissue, stop inflammatory processes, and eliminate even the most acute pain. The drug solution is injected into the pathological inflammatory or destructive-degenerative focus. Direct delivery of the drug increases its clinical effectiveness and promotes the development of a better and significantly faster pharmacodynamic response.

An important advantage of blocking the shoulder joint with Diprospan or anesthetics is the versatility of the therapeutic effect of the therapeutic manipulation:

• the inflammatory process and associated pain syndrome are quickly relieved;
• skeletal muscles relax, painful muscle spasms and swelling are eliminated;
• metabolism is normalized, restoration of tissues damaged by pathology or injury is accelerated;
• the functional activity of the shoulder joint increases, including its mobility;
• trophism and innervation in the shoulder area improves.

When carrying out a therapeutic blockade, the active ingredient of the drug is localized directly at the site of the pathology, and penetrates into the systemic bloodstream in a minimal amount. The pharmacological load on the patient’s body is reduced, the likelihood of side effects is minimized, and the period of remission is extended.

Injection of anesthetics and analgesics into the affected joint.

What types of shoulder blocks are there?

Drug blockade of the shoulder joint is classified depending on the level of interruption of the transmission of nerve impulses. The doctor makes a choice in favor of one of the methods, taking into account the clinical condition of the patient and (or) the stage of the diagnosed disease. What types of shoulder blocks are there:

• periarticular. The medicinal solution is injected into the periarticular areas - the structures of the ligamentous-tendon apparatus, muscle tissue. This is the most painless and safe way to block skeletal muscles, characterized by a more prolonged analgesic effect;
• paraarticular. This is the name for subcutaneous or intradermal injection of an injection solution into the area of ​​the affected joint. The main advantages of the method include a rapid analgesic effect and a low likelihood of adverse reactions. Therefore, paraarticular blocks are often used in long-term treatment;
• intra-articular. The medicinal solution is injected directly into the cavity of the shoulder joint. This method of minimally invasive surgery is used to relieve the symptoms of facet syndrome and eliminate pain.

Shoulder blocks are not only therapeutic. Diagnostic manipulation is used to identify the causes and mechanisms of development of pathology. Symptomatic blocking injections are used to prevent complications of the disease.

How is a medical shoulder block performed?

The technique of blocking the shoulder joint is determined by the attending physician. An anesthetic or hormonal solution is injected into the joint from the back, front or lateral side. When choosing a method for performing a drug blockade of the shoulder, the doctor takes into account the degree of damage to the joint, the type of injury or pathology. The procedure is carried out in compliance with all antiseptic rules in a small operating room, dressing room or treatment room. When providing emergency medical care (fractures, etc.), it is permissible to perform a technically simple blockade outside the walls of a hospital facility.

The doctor treats his hands immediately before the procedure with antiseptic solutions, and first applies a 5% alcohol solution of iodine to the patient’s skin, and then 70% ethanol. Sometimes chlorhexidine bigluconate in the form of a 0.5% aqueous-alcohol solution is used for treatment. Sterile linen or dressing material is applied to the blockade area.

Before inserting the needle, the skin is wiped again with a sterile swab soaked in ethyl alcohol, and then slightly shifted to prevent the formation of a straight injection channel. To reduce the severity of pain, the skin is infiltrated with a thin needle with a solution of any anesthetic (Novocaine, Lidocaine). A so-called “lemon peel” is formed, through which a longer and thicker needle is inserted into the shoulder joint. Each of its advances is accompanied by an aspiration test - a manipulation necessary to make sure that there is no tip inside the blood vessel.

At the end of the solution administration, the needle is removed and a sterile napkin is applied to the skin, secured with an aseptic bandage or bactericidal adhesive plaster. In some cases, a plaster cast or use is required.

Method of performing a shoulder joint block	Technique
Front	The patient lies on his back with his arm bent at the elbow. This joint should be in the frontal plane, so it moves slightly outward. When the patient is positioned correctly, the lesser tubercle of the humerus is clearly visible. Between it and the coracoid process of the scapula, a place is selected for inserting the needle from front to back
Behind	The patient lies on his stomach, and the doctor feels the posterior surface of the upper part of the acromion process, as well as the deltoid muscle located under it. It is here that there is a shallow fossa, bounded by the edges of the deltoid and periosteal muscles. A needle is inserted into the bottom of the fossa so that it moves towards the coracoid process
From the lateral side	The patient sits on the couch or lies on his healthy side with his arm extended along the body. The needle is inserted between the acromion process and the greater tubercle of the humerus bone

Using Diprospan for shoulder block

Diprospan is often the first choice drug for drug blockades. The active ingredient of the drug is betamethasone, a glucocorticosteroid, a synthetic analogue of hormones produced by the adrenal glands. It inhibits the release of interleukins and interferon gamma from macrophages and lymphocytes. The drug is characterized by pronounced anti-inflammatory, antihistamine, antishock, analgesic, antitoxic and immunosuppressive effects.

Diprospan blockade of the shoulder joint is performed periarticularly or intraarticularly at a dose of 4-8 mg. The therapeutic effect occurs after 10-15 minutes and lasts for 3 days. Injection into the joint cavity is usually carried out to relieve a severe aseptic inflammatory process. Before administration, the suspension is diluted with a solution of an anesthetic - Lidocaine or Novocaine. In combination, a glucocorticosteroid and an anesthetic enhance and prolong the effect of each other.

Blockades with Diprospan are not prescribed to patients with hematopoietic disorders, periarticular infections, severe arthrosis without signs, or aseptic necrosis.

Indications and contraindications

Drug blockades are used to quickly relieve pain and prevent shock in shoulder injuries - fractures, dislocations, muscle and tendon ruptures. For such injuries, the anti-inflammatory and decongestant effects of the drugs used are important. The following inflammatory and degenerative-dystrophic pathologies are the indications for the treatment procedure:

The procedure cannot be prescribed to a patient if he has been diagnosed with individual intolerance to the drug used. Shoulder blockade is not performed on patients under 12 years of age or on pregnant or breastfeeding women.

1. Reasons for development
2. Shoulder joint treatment
3. Recovery Exercises
4. Blockade for glenohumeral periarthritis
5. How to prevent illness

Humeroscapular periarthritis is a collective concept that combines several diseases of the peripheral nervous system and musculoskeletal system into a single group. This pathology is characterized by versatile symptoms, the intensity of which depends on the degree of progression of the disease.

ICD 10 code - M 75.0 (shoulder lesions). The international classification does not contain a separate diagnosis called “humeral periarthritis”.

Recognizing the disease will not be difficult. People experiencing the disease indicate constant and intense pain in the shoulder joint.

The shoulder joint area experiences daily stress, which can damage the surrounding soft tissue, blood vessels, and nerve endings. The result of this process is a right- or left-sided inflammatory process.

Reasons for development

The main reasons that contribute to the development of the disease include:

1. Spinal diseases. We are talking about structural changes in the cervical spine. Displacement of intervertebral discs, hernia and protrusion can be a factor in the development of glenohumeral periarthritis. Degenerative-dystrophic processes in the neck contribute to pinching of blood vessels and nerve endings. As a result, blood flow in the shoulder joint decreases and aseptic inflammation develops (without the participation of microbes).
2. Related diseases of organs and systems. Less rare factors are: liver disease, chronic spasm of blood vessels, mastectomy in women, and myocardial infarction.

Shoulder joint treatment

With minor manifestations of glenohumeral periarthritis, you can be treated at home with folk remedies that have a local anesthetic, warming and anti-inflammatory effect.

The local inflammatory process can be recognized by a number of characteristic clinical signs:

• Severe limitation of mobility in the shoulder joint. It is impossible to move your hand behind your back.
• The pain syndrome is pronounced, the pain intensifies in the evening and during physical activity.

The listed symptoms are characteristic of the initial stage of glenohumeral periarthritis. If left untreated, the disease progresses to an acute stage. It can be caused by heavy lifting or a shoulder injury. The acute stage is characterized by:

• Formation of swelling in the front of the shoulder;
• Intense pain, especially at night;
• Irradiation of pain into the cervical and thoracic spine, as well as into the arm on the affected side is typical;
• A decrease in pain is observed when the arm is bent at the elbow joint and pressed against the chest;
• Inability to perform rotational movements with the hand;
• Weakness and general malaise;
• Increase in body temperature to 37.5 degrees;
• Insomnia.

Drug treatment of this form continues for 14-16 days. Without treatment, in 80% of cases, the acute condition develops into a chronic course.

In clinical practice, there is the term “frozen shoulder” or adhesive capsulitis. This condition is often a consequence of a long-term chronic course of glenohumeral periarthritis. Adhesive capsulitis is characterized by the fusion of two bones in the joint area, as a result of which any movement in the glenohumeral joint is excluded.

Recovery Exercises

An important stage in the treatment of glenohumeral periarthritis is therapeutic exercises. A suitable set of exercises is offered by Dr. Popov’s course. This widely known specialist in the treatment of various diseases has developed a complex of exercise therapy that eliminates joint contractures and helps normalize motor activity in the shoulder joint.

Exercise therapy according to Popov is a systematic stretching of the soft tissues of the shoulder joint, as a result of which trophism and nerve conduction improve. Another distinctive feature of gymnastics is the gradual increase in load on the shoulder joint.

Therapeutic gymnastics of Dr. Popov contains the following techniques:

• Sitting on a chair, you need to put your hands on your knees and relax. After this, move your legs, imitating steps. During the movement, the upper limbs should not be lifted from the knees, they should move together with the legs;
• The next exercise is a continuation of the previous one. Without stopping your steps in a sitting position, you need to make circular movements with your palms along the surface of your thighs. During this technique, a person carries out systematic movements in the shoulder joints;


• While continuing to sit on the chair, you need to lower and align your arms along your body so that they are in a lowered and relaxed position. After this, you need to imagine an imaginary load in your hands. In this position, we carry out movements with the shoulder girdle, using our arms as much as possible. During the exercises, carefully monitor the position of your back; it should be straight;
• The next stage of gymnastics is rotational movements of the shoulders in the posterior direction. While raising and abducting the shoulder, straighten your back as much as possible. This exercise must be repeated in the same order in the anterior direction;
• Next exercise. While in a standing position, we swing our arms back and forth. Next, you need to sit on a chair, cross your straightened arms, bring your shoulders together as much as possible and exhale;
• While sitting on a chair, you need to put your legs as wide as possible and place your palms on your knees. Next, we tilt our torso down, touching our legs first with the right and then with the left shoulder.

After completing the exercises, we carry out 4-5 swings of the arms up and to the sides to completely relax the muscles. The entire charge lasts 25-30 minutes.

A very effective way to restore motor activity in the shoulder joint is post-isometric relaxation. The essence of the method is the systematic stretching of soft tissues, which helps eliminate muscle hypertonicity and relieve pain.

The post-isometric relaxation technique has contraindications, therefore, for your own safety, it is recommended to coordinate the exercise plan with a medical specialist.

The therapeutic effect of manipulation is based on the gradual involvement of deeply located muscles. The soft tissues around the shoulder joint relax, and the person stops feeling intense pain. Dr. Bubnovsky’s gymnastic courses offer an alternative way to treat glenohumeral periarthritis.

Detailed information on how to treat according to Bubnovsky can be found on forums about diseases of the musculoskeletal system.

Another specialist in the field of traumatology and orthopedics, Alexander Saraev, has compiled a short and effective program for restoring the shoulder joint. Alexander Saraev divided the general plan of gymnastic events into 2 parts.

Each exercise must be performed in a sitting position in order to maximize the use of the muscles of the shoulder girdle. The technique includes the following gymnastic exercises:

• Smooth and slow rotation of the shoulder forward and backward;
• Slowly raising the shoulders and then lowering them;
• Flexion of the upper limbs at the elbow joint;
• Both hands are joined into a lock and raised above the head with maximum stretching;
• The arm on the side of the sore shoulder is pulled forward. Then make smooth rotational movements clockwise and counterclockwise.

The second part involves a set of exercises with a wooden cane:

• The cane must be taken in the hand on the affected side and gradually moved to the side;
• It is necessary to raise the hand with the cane above your head, and also slowly lower it to the starting position.

Massage is an effective addition to therapeutic exercises. As an example, we recommend Andrei Ilyushkin’s technique. His massage was developed specifically for glenohumeral periarthritis. Completion time: 25-30 minutes. Improvement occurs after 3-4 sessions.

Massage measures according to Andrei Ilyushkin involve sequential treatment of the collar area with a transition to the shoulder area. It consists of the following movements:

• Gently stroking the trapezius muscles towards the shoulder joint;
• Intensive rubbing of the collar area with open palms;
• Spiral rubbing of this area using 4 fingers.

After warming up the muscles of the collar area, it is necessary to proceed to the following stages of the massage:

• Smooth, enveloping strokes of the entire upper limb, starting from the deltoid muscle;
• Spiral rubbing of the hand using 4 fingers;
• Grabbing a skin fold or pinching.

Outside the exacerbation phase, Jamaldinov Muslim’s technique is used. The author's development makes it possible to restore the mobility of the shoulder joint, eliminate contractures and normalize the nutrition of the soft tissues surrounding the glenohumeral joint.

Blockade for glenohumeral periarthritis

The techniques described in the table will provide significant assistance in the fight against pain.

Intra-articular drug blockades are also used for treatment. For this purpose, local anesthetics Lidocaine and Novocaine and glucocorticosteroids are used. Carrying out an intra-articular block is advisable only if the patient has severe pain and other medications have not worked.

The introduction of Diprospan and Flosteron allows you to get rid of pain after the first injection. It is important to remember that corticosteroids have a powerful effect, so their uncontrolled use is fraught with the development of adverse reactions.

Another way to relieve pain is novocaine blockades. The total duration of therapy is no more than 3 injections. After performing an intra-articular injection, the restoration of motor activity in the shoulder joint is assessed. If a person continues to complain of pain and stiffness in the shoulder area, then the doctor performs an intra-articular injection of a combination of glucocorticosteroid and Novocaine.

How to prevent illness

• The first task is to limit severe physical activity. For every person, regardless of age, morning exercises, walking in the fresh air and visiting the swimming pool are useful;
• The next link is rational nutrition. Eating foods rich in calcium, vitamin D3 and plant fiber.
• Don't get too cold. Particular attention should be paid to the neck and collar area, since myositis and periarthritis often occur under the influence of drafts.

Humeral periarthritis is no different from other pathologies of the musculoskeletal system. The effectiveness of its treatment directly depends on the degree of neglect of the pathological process. The sooner you pay attention to the disease and begin treatment, the more favorable the prognosis and restoration of function of the shoulder joint will be.

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Blockade with Diprospan

Currently, Diprospan is widely used as a medicine for blockade of the shoulder, knee or any other large joint. This drug, containing betamethasone, belongs to the group of glucocorticosteroids.

At the present stage, Diprospan is considered one of the most powerful anti-inflammatory drugs. Such medications are used only when other anti-inflammatory drugs are ineffective. In addition, Diprospan has a number of advantages, including:

• Contains two forms of the active substance, which can realize a therapeutic effect both quickly and slowly. In other words, after administration, it begins to act within a few hours and can maintain its activity for 2-4 months.
• Equally effective when injected into the joint cavity and surrounding periarticular tissue.
• One injection is enough to cope with a minor inflammatory process.
• If necessary, the drug can be re-administered.
• The medicine is quite cheap and has a long-lasting therapeutic effect, which makes it quite acceptable for most patients with chronic forms of arthritis and arthrosis.

Since Diprospan is injected into the joint cavity, it does not enter the bloodstream and practically does not cause adverse reactions.

Indications for testing

The effectiveness of the procedure depends on the pathological condition or disease for which this treatment method is used. Without the presence of an active inflammatory process inside the joint, in the synovium or periarticular tissues, the administration of Diprospan loses all meaning. For what diseases is this procedure indicated?

• Rheumatoid, non-infectious, psoriatic arthritis.
• Arthritis that occurs after injury or surgery.
• Inflammatory process in the periarticular surrounding tissues (periarthritis of the shoulder, elbow joint, tendovaginitis, bursitis, etc.).
• Arthrosis, but in the presence of characteristic symptoms of inflammation of the joint or synovium.

The procedure can also be used for mild signs of inflammation, but only in cases where it is not possible to use other treatment methods (for example, use non-steroidal anti-inflammatory drugs for erosive and ulcerative lesions of the gastrointestinal tract). Even if there are clear indications, the following nuances must be taken into account:

• The cause of the inflammatory process should not be an infection. Otherwise, carrying out, for example, a blockade of the knee joint with Diprospan for arthrosis, arthritis of the knee joint, can only aggravate the current situation and significantly complicate the course of the disease.
• Simultaneous administration of the drug into several affected large joints is undesirable.
• First of all, the procedure is carried out for those joints that play the most vital role for the patient.

Only a specialist doctor knows when and how to properly block the shoulder, elbow, hip and knee joints.

Contraindications

As with most treatment methods, there are absolute and relative contraindications. For what pathological conditions or diseases is intra-articular administration of Diprospan categorically not recommended due to the high likelihood of complications:

• Presence of local or general infection.
• Pathological bleeding caused by various diseases or medications (for example, the use of anticoagulants).
• Lack of stability in the joint, which may be associated with weakness of the tendon-ligament apparatus.
• Severe forms of arthrosis, in which pronounced disturbances in the shape and function of the joint are observed.
• Significant periarticular osteoporosis.
• Necrotic changes in the articular part of the bone (the presence of areas of necrosis).

With relative contraindications, there is often no therapeutic effect. Restrictions for intra-articular use of Diprospan include:

• General serious condition caused by a non-infectious process.
• Serious chronic kidney or liver problems.

Ineffectiveness from at least two previous injections (shots) is considered a relative contraindication.

If the possible benefits of using Diprospan significantly outweigh the expected risks, then the attending physician may neglect some restrictions on the use of the drug.

Technique

Before performing the procedure, the doctor must determine the dosage of the administered medication. The optimal dose is selected individually for each patient. For example, for a blockade of the knee joint for arthritis or arthrosis, it can be 5–7 ml. As a rule, the drug is diluted with either lidocaine or novocaine, depending on the sensitivity of the patient.

In some cases, local anesthesia may be used to numb the puncture area. In addition, the injection area is lubricated with iodine solution. A puncture is made in the targeted periarticular area, where the medicine is then injected. The entire procedure should be performed exclusively by a medical specialist (usually either a surgeon or an orthopedist).

It is worth noting that Diprospan begins to act almost immediately. Pain sensations are significantly reduced and mobility improves. The swelling gradually decreases and the redness of the surrounding soft tissue disappears. The duration of its action can last for several days.

Shoulder block

How is a shoulder joint block performed today? Most often, the procedure is performed due to inflammation of the periarticular soft tissues. The patient takes a comfortable position. Usually this is lying down or sitting. The puncture site is treated with alcohol and iodine solution. Then the doctor determines the puncture site.

The puncture can be done from three different sides: front, back or side. If the entry point is selected from the front, then the patient is placed on his back, the upper limb is bent at the elbow, brought to the body and turned outward so that the elbow is in the frontal plane. The needle is inserted from front to back between the lesser tubercle of the humerus and the coracoid process of the scapula.

To perform a lateral shoulder block, the patient sits or lies down on the healthy side. At this moment, the hand is along the body. The needle should be inserted into the space between the acromion process and the greater tubercle of the humerus. Before administering the medicine, remove accumulated fluid (exudate, pus, blood) from the joint cavity.

Hip block

What is the technique for performing a hip block? Currently, many modern clinics, in order to get inside the hip joint, perform the procedure under the control of an image intensifier (electron-optical converter) apparatus. Clinical practice has proven that intra-articular administration of the drug without an image intensifier is quite difficult.

For example, an experienced surgeon without additional diagnostic equipment successfully performs the procedure only in 50% of cases. While using an ultrasound machine (ultrasound), its chances increase by 80%.

Under the control of the image intensifier, puncture of the hip joint is successful in 100% of cases.

Knee joint blockade

How is a knee block performed? Clinical experience shows that this procedure is performed most often compared to other similar treatment methods. The patient lies down on the couch. A regular cushion is placed under the knee so that the leg is slightly bent and relaxed. Local anesthesia is often used. The site of the planned injection (injection) is injected with novocaine.

The puncture area is pre-lubricated with alcohol and iodine solution. There are several points for administering the drug into the knee joint. Typically, the needle is inserted into the area of ​​the outer edge of the patella in its upper part. Before administering the drug, excess fluid, which can be exudate, pus or blood, is removed from the joint cavity. The volume of administered medication during knee joint blockade can reach 10 ml.

After the blockade

Upon completion of the procedure, the patient is recommended to stay in the department for several hours to monitor his health and the effectiveness of the drug. You should create rest for the upper or lower limb for an average of 3–4 hours. Special orthopedic devices for immobilization (immobilization) do not need to be used. It is enough to just lie quietly without sudden movements.

After blocking the shoulder, hip or knee joint with Diprospan, on the same day you should refrain from attending physical therapy classes, massage and physiotherapeutic procedures. From the next day, the therapeutic course schedule is resumed according to the previous scheme.

Despite the possible improvement in the condition, you should not sharply increase physical activity or, conversely, try to protect the affected joint too much.

It should be noted that quite often many patients, due to the lack of the desired effect, turn to doctors with a request to increase the dosage or frequency of taking glucocorticoid drugs such as Diprospan. Not everything is so simple; there are specific restrictions on the use of this kind of drugs for intra-articular administration:

• Glucocorticosteroids are not injected into two or more large joints at the same time.
• Glucocorticosteroids are not injected into large joints more than three times in 12 months.
• The break between procedures should be quite long (preferably at least 12–14 weeks).

Complications

Recently, due to the growing professionalism of medical workers and the level of equipment with modern technology, the number of complications after blockades of the shoulder, elbow, hip, knee and other joints has sharply decreased. It is extremely rare, but the following types of complications are possible after such procedures:

• Infection of the joint or periarticular soft tissues (infection).
• Increased pain and inflammation due to incorrect administration of the drug.
• Violation of the general condition (nausea, vomiting, surges in blood pressure, etc.).
• Incorrect dosage or frequency of use of the drug can lead to a sharp progression of degenerative changes in the affected joint.

Forecast

According to clinical statistics, every third patient with various forms of rheumatoid arthritis undergo joint blockade with Diprospan. And almost every one of these patients feels the positive effect of this procedure. In addition, it has been established that local blockades help to significantly shorten the treatment period for inflammatory diseases of the joints and periarticular soft tissues (periarthritis, bursitis, synovitis, tendovaginitis, tendinosis, etc.).

But do not forget that the advisability of prescribing a therapeutic blockade is determined only by the attending physician, and depends not on your desire, but on the nature and severity of the rheumatological pathology.

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Therapeutic approaches to treating pain in the shoulder joint area

The therapeutic program is determined by a traumatologist, arthrologist or neurologist after determining the etiological cause of the disease. However, regardless of the provoking factors, doctors strictly follow the general algorithm for treating pain localized in the shoulder joint:

• elimination of factors that provoke pain (for example: in case of inflammatory lesions - taking measures to eliminate the source of inflammation);
• measures to restore damaged elements (for example: for arthrosis - the use of chondoprotectors);
• impact on pain receptor stimulants - the use of drugs that regulate the production of prostaglandins, for example: NSAIDs;
• ensuring a decrease in the sensitivity of nerve fibers transmitting pain impulses - external use of products based on capsicum;
• inhibition of the impulse process due to local administration of agents with anesthetic activity;
• using an arsenal of mechanical stimulation, for example: physiotherapy;
• overcoming the psychological components of the pain syndrome.

One of the powerful methods for quickly relieving pain in the joint area is drug blockade. These are modern and effective therapeutic methods that make it possible to achieve a noticeable improvement in the patient’s condition and an immediate weakening of the clinical symptoms of neurological and arthrological pathology. The principle of operation of such manipulations is quite simple. A pharmacological agent is injected directly into the focus where pain impulses occur, the active components of which, without loss of quantitative concentration, immediately begin to act to eliminate pain.

Advantages of drug blockades

The use of drug blockades started more than a century ago, and such long-term clinical practice has proven not only their high effectiveness in comparison with oral administration or intramuscular administration of dosage forms, but also a significantly smaller number of contraindications and a minimum of side effects. Among the extensive advantages of using blockades in the treatment of joint pathologies, obvious advantages should be highlighted:

• instant achievement of the required effect: analgesic, anti-inflammatory due to the flow of active ingredients of the drug directly into the affected area;
• minimal toxic harm to the body due to the fact that the pharmacological agent penetrates into the bloodstream in small quantities;
• absence of irritation of the mucous membrane of the digestive tract due to local administration of the medicinal composition;
• significantly less load on the urinary system, which is ensured, again, by targeted administration of the medication;
• significantly higher therapeutic result due to the penetration of the maximum concentration of the administered substance into the affected organs;
• the ability to simultaneously provide a diverse therapeutic effect when using multicomponent formulations;
• the admissibility of repeated blockades in the event of recurrent pain due to a minimal threat to health.

Types of therapeutic blockades

Depending on the mechanism of action and the effect produced, these therapeutic manipulations are divided into types:

1. analgesics and anesthetics (painkillers),
2. anti-inflammatory,
3. trophostimulating;
4. muscle relaxants;
5. thrombolytic;
6. angiospasmolytic;
7. absorbable;
8. destructive.

Based on the quantitative composition of the administered elements, blockades are divided into single-component and multi-component.

To relieve pain localized in the joint, drug blockades with analgesic effects are carried out, a traditional example of which is the administration of novocaine. Blockade with novocaine allows you to achieve an analgesic and anti-inflammatory effect. The manipulation is carried out exclusively by a trained doctor or in acute conditions, for example: a broken shoulder, by an ambulance paramedic.

Procedure technique: the patient is placed on a flat horizontal surface with his stomach down. Treat the area of ​​skin with an antibacterial agent. Using a ten-gram syringe with a long needle, a 0.25 or 0.5% solution of novocaine is administered in an amount not exceeding 250 ml. The drug is injected into the deep muscle tissue above the injured area, trying not to affect the neurovascular bundle.

In traumatological and neurological practice, along with the use of novocaine for pain in the joints and periarticular tissues, blockades with corticosteroids have become widespread. For example, in case of traumatic plexitis, it is advisable to carry out a drug blockade with a combination of anesthetics, hydrocortisone and vitamin B12. Hydrocortisone:

• has a local anti-inflammatory effect;
• has antishock and antiallergic activity;
• affects protein and lipid metabolism;
• reduces tissue swelling.

A pronounced analgesic effect is observed 15 minutes after administration of the composition, at the same time, a prolonged anesthetic background allows not only to restore the patient’s strength, but also to carry out other therapeutic manipulations more effectively.

For periarthritis of the shoulder joint, intra-articular injections of combined injections of contrical combined with xycaine are often used, which not only provides complete analgesia of the damaged area, but also achieves a lower intensity of recurrent pain.

Injections of the drug diprospan show a good therapeutic response. Technique for administering the drug: directly into the area of ​​the affected soft tissue or in the form of intra-articular and periarticular injections for various forms of arthritis of the shoulder joint.

In acute conditions, even one blockade with diprospan provides a satisfactory clinical response. In case of chronic inflammatory processes, long-term use of the drug is allowed depending on the individual response of the patient. Intra-articular administration of the drug allows not only to relieve pain, but also to restore joint mobility in rheumatoid arthritis. The advantage of using diprospan: rapid analgesic effect, predicted prolonged effect, high safety, minimal risk of complications. These properties of the drug are of particular importance for getting rid of acute pain syndrome during relapse of chronic inflammatory diseases and in the treatment of purulent-septic processes.

Medicinal intra-articular blockade into the shoulder joint provides quick relief from pain, provided that the manipulation is performed professionally.

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Causes of shoulder pain

We associate the expression “put it on our shoulders” with a difficult test that we overcome at some specific period in our lives. But in the literal sense, lifting weights often causes health problems. The shoulder joint does not immediately signal overload, but at some point pain and discomfort may appear.

The pain is pronounced. It spreads from the top point towards the entire arm. With any sudden movement, the pain can move to the cervical region. Very often the cause of its occurrence is an intervertebral hernia. It develops as a result of compaction of the intervertebral discs and loss of their elastic properties.

Pain syndrome manifests itself when the nerve roots extending from the branches of the main spinal nerve are pinched. The pain may increase as a result of the formation of vascular bundles and swelling in the area of ​​the clamp. The group of severe pain syndromes includes:

• capsulitis - in this case, stiffening of the shoulder muscles is noted. It is difficult for the patient to move his arm to the side, raise it, or place it behind his back. The development of capsulitis occurs gradually, but its consequences can lead to the patient being unable to perform even the most basic actions with this hand. This condition occurs as a result of damage to the rotator cuff of the shoulder joint, which can be caused by impressive physical exertion;
• tendobursitis - characterized by severe pain in the cervical region, shoulder girdle and arms. Its occurrence is associated with inflammation of the joint capsules.

There are the following reasons that can provoke shoulder pain.

Cause	Peculiarities
Tendit	This is a process caused by inflammation of the tendons that surround the joint. It appears as a consequence of excessive physical activity.
Calcinosis	This is a disease that occurs due to the leaching of calcium from the bones. A deficiency of this microelement in the body leads to inflammation of the joints, the development of tumors, and the risk of fracture.
Injuries with displacement of the humerus, arm flying out of the shoulder, tendon rupture, dislocation	This can happen as a result of an accident or intense training. Leaving such a problem without treatment, a person may not restore shoulder function at all.
Joint diseases	These include arthritis, arthrosis, gout.
Intercostal neuralgia	A disease that is accompanied by stabbing pain. Along with this, difficulty breathing and limited hand mobility may occur.

Pain Treatment Methods

Treatment in the event of pain is prescribed only by a specialist after diagnosis. Depending on the test results, the patient may be prescribed anti-inflammatory drugs or treatment for another condition causing shoulder pain.

Anti-inflammatory therapy includes the following measures:

• taking medications;
• therapeutic massage;
• carrying out physiotherapeutic procedures.

To reduce the load on the shoulder and relieve discomfort, the patient is recommended to use a special splint that is fixed on the arm. In severe cases, the patient is prescribed anti-inflammatory drugs or surgery. To avoid surgery, you should immediately seek medical help if pain occurs.

Effective ointments

One of the effective methods of treating and eliminating pain is the use of ointments. Particularly popular are products containing non-steroidal anti-inflammatory components and chondroprotectors. The main representatives of this group include Diclofenac, Voltaren, Chondroxide. They improve blood circulation, eliminate reflex muscle spasms in the shoulder, and reduce pain.

Patients are often prescribed ointments with pepper and salicylic acid. These drugs are inexpensive, but at the same time they perfectly eliminate pain and relieve inflammation. The most popular remedies are snake or bee venom, camphor, turpentine, nicoflex, and gold star. They have a warming effect, promote the dilation of blood vessels, due to which blood flows out from the source of inflammation, swelling is reduced and pain is eliminated.

Injections

Before relieving pain with the chosen drug, you should visit a doctor. After all, injections can also be used for treatment, which have an anti-inflammatory and analgesic effect. The most effective effects are provided by first generation drugs - Diclofenac, Ibuprofen. They are prescribed for acute pain in order to alleviate the patient's condition.

Second-generation medications are used for chronic shoulder diseases when daily pain relief is required. If treatment is not effective, doctors prescribe glucocorticoid anti-inflammatory therapy. Injections are given directly into the area of ​​inflammation. These include Diprospan, Flosteron. These medications have a strong effect, so sometimes one injection is enough.

In extremely severe cases, a blockade of the left or right arm of the shoulder joint is prescribed. However, not everyone knows what it is. The blockade is a combination of glucocorticoid anti-inflammatory drugs with local anesthetics (novocaine or lidocaine). This treatment helps to cope with unbearable pain.

With the help of the blockade, it is possible to avoid a serious complication in the form of contacture, which is characterized by limited range of motion in the shoulder joint. It is dangerous because it can provoke an irreversible process - atrophy of the muscle group responsible for the mobility of the shoulder joint. The effect after this procedure lasts a month. At the end of the blockade, it can be repeated. How it is carried out, look at the video (author Anton Epifanov).

In addition to drug treatment, the patient should adhere to the following recommendations:

• maintain bed rest;
• fix the shoulder joint with elastic bandages;
• wear orthopedic bandages, orthoses.

Other medications

For arthritis or arthrosis, treatment can be carried out with hormones such as Prednisolone and Dexamethasone, or narcotic analgesics, which include Promedol and Morphine. However, the use of these drugs is resorted to only in severe cases, when the pain causes severe suffering and becomes serious. These drugs can be administered in different ways: orally, intravenously, and even intra-articularly.

Collagen Ultra has proven itself well as a strong pain reliever. With its help, inflammation is suppressed and material metabolism is normalized. Thanks to the presence of collagen in the composition of the drug, the joints and ligaments of the shoulder are restored.

Pain is the main symptom of the development of inflammation in the shoulder. You should not hope that constant pain will go away over time. Its appearance indicates serious disorders in the body. Remember that only a timely visit to a doctor will allow you to understand the causes of this condition and restore the functionality of the shoulder joint, avoiding complications.

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Conservative treatment

Doctors call conservative treatment methods that are not related to operations - in other words, this is treatment with various medications prescribed both in the form of tablets and injections. Let's look at each group of drugs separately.

Nonsteroidal anti-inflammatory drugs (NSAIDs)

Please note: all drug names and dosages are provided for informational purposes only! Do not self-medicate, this can lead to unpredictable consequences! See a doctor in person, get examined and receive treatment under the supervision of a competent specialist!

Since the main symptom of glenohumeral periarthritis is pain in the arm and the area of ​​the joint itself, treatment of this disease usually begins with the prescription of NSAIDs - these are all known painkillers such as diclofenac, aspirin, voltaren, ibuprofen and others.

Non-steroidal anti-inflammatory drugs not only help reduce shoulder pain, but also successfully help reduce the severity of inflammation in the tissues.

However, remember that despite the value of these medications, they have significant side effects. Thus, NSAIDs are prescribed with great caution to people with diseases of the gastrointestinal tract, in particular with gastritis, duodenitis and peptic ulcers of the stomach and duodenum.

The fact is that anti-inflammatory drugs greatly irritate the gastric mucosa and contribute to the formation of ulcers in it. Therefore, NSAIDs are usually prescribed in short courses and under the supervision of a physician.

In recent years, a new generation of non-steroidal painkillers has appeared on the market, which have a more selective effect on the body and produce fewer side effects. This group of drugs includes drugs such as celecoxib, movalis, nimesulide. You can learn more about this group of drugs in the article Nonsteroidal anti-inflammatory drugs for arthritis and arthrosis of the joints.

Steroid (hormonal) anti-inflammatory drugs (corticosteroids)

Sometimes, when non-steroidal drugs do not help or their therapeutic effect is insufficient, the doctor may prescribe special hormonal drugs designed to reduce this inflammation to reduce inflammation and pain in the shoulder joint. For this purpose, medications such as flosterone or diprospan are usually used, the active medicinal substance in which is called betamethasone.

These medications have more powerful anti-inflammatory effects than NSAIDs, but they can also have more side effects. To prevent this from happening, doctors usually prescribe such medications not in tablets, but inject them locally in the form of injections directly into the area of ​​the sore shoulder joint - into the area of ​​the shoulder muscles and tendons.

Since corticosteroid hormonal drugs are quite powerful, usually this course of injections is very short, and only 2-3 injections are performed, and in some cases you can get by with a single injection of this medicine. In most cases, in 70-80% of patients with glenohumeral pariarthritis, such treatment is enough to stop the disease.

Novocaine blockades

If the use of non-steroidal and hormonal anti-inflammatory drugs, as well as the use of special physical therapy (physical therapy) for 15-20 days does not produce a sufficient therapeutic effect, the doctor may prescribe special periarticular novocaine blockades.

These are special procedures during which several injections are given into the area of ​​the affected tissues of the shoulder - the joint capsule, muscles and tendons - with the introduction of an anesthetic - novocaine - at a certain frequency. In some cases, according to indications, a glucocorticoid agent - Kenalog or hydrocortisone - can be additionally added to Novocaine.

The use of such a novocaine blockade allows one to avoid painful contracture, i.e. a condition in which movements in the shoulder are impossible due to severe pain when attempting such movements. After novocaine blockade, pain when moving the shoulder is often significantly reduced, and the range of motion increases.

If necessary, such a novocaine blockade can be repeated 1-3 more times within a month.

Physiotherapeutic treatment

Physiotherapy is an important component of treatment for glenohumeral periarthritis. As a rule, it can be prescribed by the attending physician literally from the first day of treatment in parallel with the prescription of medications. It is generally accepted that it is precisely this complex treatment - drug therapy, physiotherapy, therapeutic exercises - that allows one to achieve the best results in the treatment of this disease.

Remember this, do not try to cure periarthritis on your own, only with traditional methods. To overcome this difficult disease, you need to use all available medications and procedures!

Thus, laser therapy provides the most pronounced effect in the treatment of periarthritis of the shoulder. A physiotherapeutic method such as shock wave therapy has a good therapeutic effect in periarthritis by reducing inflammation in tissues, improving blood flow and accelerating the restoration of tissues that have been destroyed by inflammation.

Ultrasound therapy and transcutaneous stimulation heat inflamed tissues, thereby increasing blood flow, reducing pain, tissue repair, and reducing inflammation.

Magnetic therapy and the already mentioned laser therapy improve immunity, accelerate the regeneration of tissues affected by inflammation, effectively reduce pain in the shoulder, and help increase the range of motion in the shoulder joint.

Compresses with dimexide and compresses with bischofite also have a good therapeutic effect - with the only caveat that the latter cannot be used during the acute stage of this disease.

Hirudotherapy - treatment with leeches - also has effective healing properties. Almost the only contraindication to hirudotherapy is the occurrence of allergies in the patient. If it does occur, it’s okay: a competent doctor still has many other effective treatment methods in stock.

Therapeutic gymnastics

Therapeutic exercise, or exercise therapy, is an integral part of the treatment of periarthritis of the shoulder joint, without which the success of treating this disease is a big question.

Therefore, in parallel with drug treatment, the doctor refers the patient to a physical therapy instructor, under whose guidance the patient performs special physical exercises that help develop the shoulder joint, increase the range of motion in it, and prevent the development of contractures. In one of the upcoming articles we will tell you in detail about a set of such exercises.

Surgical (operative) treatment

Surgery for glenohumeral periarthritis is carried out, as a rule, in cases where conservative methods (drug and physiotherapeutic treatment, physical therapy) have not produced results, pain in the shoulder still remains, and in addition, mobility in the joint is sharply reduced, up to complete shoulder immobility (frozen shoulder or adhesive capsulitis).

The operation performed in these cases is called subacromial decompression. Its essence lies in the fact that a small fragment of the process of the scapula (called the acromion), as well as one ligament in this area, is removed. Thanks to this, nearby tissues stop injuring each other during movements, the contracture disappears, and the person regains the ability to move freely in full or to a significant extent.

Indications for subacromial decompression:

• patients who, despite ongoing pain treatment, still have pain in the joint area even after using corticosteroid injections;
• pain in the shoulder area recurs for six months or more even against the background of powerful anti-inflammatory treatment (using novocaine blockades, NSAIDs, hormonal injections);
• patients of working age (from 40 years), whose work requires active movements in the shoulder joint (including raising the arms above shoulder level), and for whom this disease significantly reduces the standard of living.

After the operation, the patient is prescribed special therapeutic exercises, during which the range of movements gradually begins to increase in the direction of his recovery.

What is important to remember when treating the disease

Let's summarize. Periarthritis of the shoulder joint is a disease that responds well to conservative treatment using medications, physiotherapy and therapeutic exercises.

But this is only true in cases where the patient did not self-medicate for a long time, but consulted a doctor in time, at the initial stages of the disease. The later a person seeks medical help, the worse the disease usually progresses and the longer it takes to recover.

In cases where significant improvement does not occur within 5-6 weeks of treatment, it is possible that such a patient needs to undergo surgery. As a rule, in 95% of cases, surgical treatment is effective, and the disease recedes.

In medicine, “joint blockade” refers to injections of anti-inflammatory or painkillers into its cavity or surrounding tissues (intra-articular or periarticular injection). This method, developed about 50 years ago, is now widely used by doctors who treat diseases of the musculoskeletal system. It allows you to inject medicine directly into the lesion, increasing the effectiveness of treatment and eliminating the side effects of certain medications.

The most commonly used drugs are hormones (glucocorticoids). With this route of administration, they enter directly into the intra-articular fluid and surrounding synovium. This ensures an immediate anti-inflammatory effect for a long time. Side effects of taking hormones due to their absence in the blood are practically absent.

Currently, many products have been created, of which diprospan is the most widely used.

This drug is a glucocorticoid - an artificially created analogue of the adrenal hormone. They are the most powerful anti-inflammatory agents in modern medicine. Their mechanism of action in the joints is to prevent the penetration of immune system cells through the synovium. Since they do not get inside, cytokines are not released - special proteins responsible for the development of inflammation.

Main advantages

Diprospan has a number of advantages that allow it to be used for chronic inflammatory diseases of the joints:

• Contains two main components that dissolve quickly or slowly. Therefore, it has both rapid (after 3 hours) and long-term elimination of inflammation and pain for up to two months.
• Does not form sediment on the joint capsule, therefore, there is a low risk of developing allergies.
• Unlike other glucocorticoids, diprospan does not cause malnutrition and depletion of surrounding tissues.
• With the same result, it can be injected both into the cavity and into the periarticular space.
• One injection is sufficient to eliminate minor inflammation.
• Repeated joint blockade is not contraindicated.

The relatively low cost of the drug and the duration of the therapeutic effect are beneficial for people with chronic arthritis and arthrosis.

Indications for blockade

To maintain the effectiveness of the method at 90–95%, as in the scientific literature, it is necessary to take into account the type and nature of the disease. A mandatory component is the presence of acute and active inflammation:

1. Inside the joint, especially with effusion into the cavity (most often rheumatoid or psoriatic arthritis).
2. Synovial membrane of the joint (synovitis with gout, arthrosis, trauma).
3. In periarticular tissues with damage to bursae (bursitis), ligaments (enthesitis), tendons (tendinitis) or other soft tissues.

For mild inflammation, it can be used only if it is impossible to treat with other methods, for example, with a stomach ulcer or allergies. There are three more criteria that must always be checked, even with clear indications:

• It is necessary to exclude infection as the cause of inflammation (the introduction of hormones will only worsen the process).
• The number of affected joints should be limited.
• Only those joints that are most significant for life are blocked (for example, a block of the knee joint).

Contraindications

They are divided into 2 main groups. In absolute cases, blockade with diprospan is prohibited, since complications are inevitable.

1. Infection in the joint, surrounding tissues or general (in the whole body).
2. Increased bleeding associated with illness or anticoagulant medications.
3. Pain and other symptoms are not caused by inflammation (such as nerve damage).
4. Late stages of arthrosis, accompanied by a violation of the shape of the joint and mobility in it.
5. Lack of stability in the joint (old ligament injuries, dislocations).
6. Death (necrosis) of the bone adjacent to the joint or intra-articular fracture.

In case of relative contraindications, the procedure is not performed, since there is a high probability of a lack of therapeutic effect. But it can be performed if the doctor or patient desires this, and also after assessing the possible risk.

These include a general serious condition, but not necessarily as a result of infection. It is possible after heart attacks or strokes, serious injuries. Severe chronic failure of any internal organ also greatly limits a person’s capabilities. The latter is the low effectiveness (or lack thereof) of at least 2 joint blockades performed previously.

Preparation for the procedure

Blockades are performed only in a hospital or clinic. They must have a special treatment room equipped with equipment and medications. A mandatory requirement is strict adherence to cleanliness and sterility on the part of both medical staff and the patient.

• At home, you need to take a shower and put on clean underwear.
• If you have body hair, it is advisable to shave it on the skin around the joint.
• It is necessary to take with you a clean change of clothes (for example, a nightgown and trousers) and shoes.
• If you have long hair on your head, you will need a scarf or a disposable cap to tidy it up.
• It is better not to talk during the procedure.

There is no need to be nervous - this will lead to fear of the procedure, and muscle tension will make the doctor’s work more difficult. It is best to take herbal sedatives in the evening.

Execution technique

To prevent complications, the healthcare worker ensures complete sterility of the technique. Only disposable instruments (syringes and needles) are used. Diprospan is specially dosed for 1 injection, so as not to leave the ampoule open. Therefore, to block different joints, clean instruments and drug solutions from different ampoules are used.

Dosage of the drug

All glucocorticoids come in the form of either a concentrate or a dry powder. The ampoule or vial represents a single dose, that is, for a single administration. Before the procedure itself, they are diluted with various solutions from 1 ml for small and up to 5 ml for large joints.

The volume of medication administered depends on the size of the joint.

1. If a blockade of the knee joint (large) is performed, then one dose is used.
2. Only half is inserted into the middle (ulnar) joint.
3. In small ones - already a quarter of the amount of diluted diprospan.

Knee block

It is used most often in clinical practice. This is predisposed by typical knee damage due to arthritis and arthrosis. Limitation of mobility and the risk for a person to become disabled leads to the priority of carrying out the procedure on this joint.

They begin with emotional and medicinal preparation of the patient. The doctor explains all possible “painful” moments of the intervention. Particularly alarming, you can give an injection of a sedative or perform local anesthesia (injection) with novocaine. You need to take a lying position and relax your leg.

Next, the skin is treated with antiseptics, after which the doctor, wearing sterile gloves, selects the site for the puncture. There are four standard points around the kneecap, usually the superior-outer one is chosen.

To begin, take an empty sterile syringe and carefully make a puncture (puncture) into the joint cavity. This is done to remove excess fluid from there, after which the needle is removed and discarded. Then, taking a syringe with diprospan, they similarly pierce the soft tissues, enter the cavity and slowly inject the drug.

Shoulder joint block

Indications for this type of manipulation are inflammations of various ligaments that encircle the shoulder in large numbers. They start with standard procedures - first, give the patient a comfortable position (lying or sitting with support for the back and arms). The skin is treated with alcohol and iodine solution three times, after which the doctor puts on sterile gloves and selects a puncture site.

There are two points for puncture: external and anterior. Since the biceps tendon is most often injured, anterior puncture is the method of choice. Pressing the muscles with his fingers, the doctor uses a “control” needle to enter the joint cavity and remove excess fluid. Then a new puncture is made and the periarticular tissues are injected or a solution of diprospan is injected inside.

After the blockade

It is not recommended to go home immediately, as active movements will lead to absorption of the drug and a decrease in the therapeutic effect. It is necessary to rest the limb for at least 3 hours. No special means of immobilization are required for this; just lying down is enough.

Over the next week, despite the improvement in your condition, you should not change your activity and protect the joint from overstrain. Short (no more than 30 minutes) walks in the fresh air will be useful.

Many patients, especially with a weak effect of the drug, try to require frequent blockades. But there are certain requirements for the use of hormones:

1. Firstly, there is a limit on the number of procedures performed. At the same time, they can be carried out on one large one (knee joint blockade) or from 3 to 5 small and medium ones. In the latter case, various combinations are possible, usually performed on one medium and several small ones.
2. Secondly, glucocorticoids should not be injected into supporting joints (hip, knee, ankle) more than 3 times a year.
3. Thirdly, the intervals between blockades should be long - at least 3 months.

Forecast

Currently, intra-articular administration of diprospan is performed in every 3 patients with rheumatoid arthritis. Efforts are being made to create special treatment rooms in clinics to perform this procedure. It has already been proven that the use of local blockades can reduce the treatment time for inflammatory joint diseases by up to 10 days.

Diseases seriously limit a person’s ability to work and can lead to disability. If 1-2 joints are affected, one blockade is enough to restore normal life without pain.

Humeral periarthritis is a neurodystrophic disease that is characterized by an inflammatory process that involves not only the shoulder joint, but also all surrounding structures. In practice, this means that those structures that form the joint itself are not changed or inflamed, but the joint capsule, tendons and ligaments that are nearby are affected.

Content:

Causes of the disease

One of the most common and common causes of glenohumeral periarthritis is trauma. This does not mean a dislocation, but too much and serious load on the shoulder, some kind of blow, or a fall on an outstretched arm. It should be noted that the disease does not make itself felt immediately - it may take about ten to fourteen days before the first symptoms appear.

symptoms of glenohumeral arthritis

In addition to injury, the cause of the disease can be a degenerative process in the cervical spine. It should also be noted that glenohumeral periarthritis can have different forms: mild, acute, chronic.
In the first case, it is difficult for the patient to raise his arm up or rotate it at the elbow in its axis. This form of glenohumeral periarthritis is easily treatable, unlike acute, which occurs in 60% of 100% cases.

Symptoms of the disease

At the very beginning of glenohumeral periarthritis, pain appears. Further, if the temperature does not appear, then this is a simple form of periarthritis. If the skin over the joint is increased in volume and appears swollen, this is an acute form of the disease. In this case, the patient tries to keep his hand pressed to his chest, and the temperature reaches low-grade levels.

nature of pain in glenohumeral arthritis

When describing the clinical picture, many authors note the appearance of acute and intense pain. Krupko, for example, noted it in 44 patients out of 150 examined. That is, in general this figure reaches 30%.

The nature of this pain is the same as after a severe injury, however, in the case of glenohumeral periarthritis, the pain is excruciating and severe. From the arm it is transmitted to the neck area, and at night it often becomes completely unbearable.
A symptom of this disease can also be a reaction to changes in weather. Unlike cold weather, which increases pain, warming, on the contrary, reduces it. A characteristic sign is the inability to move the shoulder back to a certain limit.

To the great regret of doctors, in half of the cases of periarthritis, it becomes impossible to relieve the patient of pain.

The inflammatory process subsides and stops, but the pain does not go away and remains a constant companion of a person. Movements in the joint are preserved, but are limited.

Features of the disease

Periarthritis has a number of characteristic features.

1. When the patient's arm is moved to the side, pain appears in the joint area.
2. If you lift the patient's arm with outside help, the pain will disappear after a certain moment.
3. In addition to pain, patients have a painful area in the joint area.
4. A sharp pain is felt when the coracoid process of the scapula is felt.
5. The volume of the muscles that surround the joint is transformed, most often decreasing.

Consequences of the disease

A frequent outcome of the appearance of glenohumeral periarthritis is its transition to a chronic form. At this stage, the disease is characterized by moderate pain, but with unsuccessful or sudden movements, the sore shoulder again makes itself felt.

It lasts from several months to several years, and then can disappear on its own without any medical intervention, but in some patients the disease progresses to the next stage - ankylosing periarthritis, which is often called “frozen shoulder”.

The transition to this stage is the most unfavorable outcome of glenohumeral periarthritis. In such cases, the sore shoulder gradually becomes dense to the touch and even looks “frozen.” In such cases, it is possible either the appearance of pain, which is incomparable even with a toothache, or its complete absence due to the blocking of all movements and the inability to move the shoulder.

Treatment

effective treatment of glenohumeral hyperarthritis

As with any other disease, treatment for glenohumeral periarthritis should be started as soon as possible. It is quite simple - taking anti-inflammatory drugs: Voltaren, diclofenac and others. In addition to them, special gels and ointments should be used.

There are cases when such treatment does not help and the disease continues to progress. In this situation, it is recommended to ensure complete rest of the injured limb and exclude subsequent traumatic factors. If the patient plays sports, then it is better to stop training during treatment.

Treatment with folk remedies is also possible, for example, various infusions and decoctions of herbs can be used as a compress or internally. They are designed to relieve and reduce acute pain during attacks.

Factors that can push the development of the disease

There are several factors that are some provocateurs for the appearance and development of glenohumeral polyarthritis. This:

1. Constant microtraumatization of tendons. Most often this is associated with a person’s profession (fitter, plasterer).
2. Metabolic disorders due to the presence of a particular disease (diabetes mellitus, obesity).
3. Endocrine disorders in women (during menopause).
4. Vascular diseases.
5. Diseases of the gallbladder and liver.

Diagnostic methods

In order to begin treating the patient, it is necessary to ensure the accuracy and correctness of the diagnosis. For this purpose, the following research methods are used:

1. Computed tomography.
2. Magnetic resonance imaging.
3. Arthrogram.
4. Ultrasound examination.
5. Radiography.

Blockade for glenohumeral periarthritis

Blockade for glenohumeral periarthritis in its classical form it represents a whole technique. In essence, the essence of the blockade is to inject novocaine into the shoulder joint. First, a three-point blockade is performed using this drug.

injections for glenohumeral arthritis

The feeling of “failure” indicates that the tip of the needle has entered the bag and if the patient also has bursitis, liquid “with flakes” will certainly appear in the syringe. In this case, the bursa is lavaged, and then Kenalog and hydrocortisone emulsion are administered.

The second injection is made into the bicipital groove. Additional sites of tissue blockage are the suprascapular nerve and supraspinatus muscle tightness.

Several blockades with corticosteroid drugs often provide partial recovery of the patient. The pain should go away in five to ten days, but after the second day you should start doing small exercises. The blockade, coupled with physical therapy, relieves pain and restores muscle sensitivity. If this does not happen, then surgery is recommended.

Surgical treatment

Indications for surgical treatment are the following factors:

1. Persistent pain for six to eight weeks.
2. Constant relapses for six to eight months, despite treatment, including blockades, exercises and drug therapy.
3. A pronounced defect of the shoulder cuff, which is confirmed by x-ray. In this case, the indication for surgical intervention should be the unsuccessful implementation of drug therapy and blockade.