Extraarticular rheumatism of the shoulder

U području ramena postoje četiri zgloba koja usklađenim kretnjama omogućuju veliki opseg pokreta nadlaktice. Najveći i najvažniji je glenohumeralni zglob, a ostali su akromioklavikularni, sternoklavikularni i skapulotorakalni. Iako potonji nije pravi zglob jer nema zglobne površine i zglobnu čahuru on i dalje sudjeluje u kretnjama ramenog obruča klizanjem lopatice po prsnom košu. Za stabilizaciju ramenog zgloba odgovorni su ligamenti i mišići ramenog obruča. Uz stabilizaciju, mišići izvode i pokrete, a mogući pokreti ramenog zgloba su: abdukcija, adukcija, antefleksija, retrofleksija i unutarnja i vanjska rotacija. Izvanzglobni reumatizam je pojam koji obuhvaća upalne i degenerativne mišićnokoštane bolne sindrome koji zahvaćaju meko tkivo oko zglobova. Tkiva koja mogu biti zahvaćena su: tetive, tetivna hvatišta, burze, fascije, mišići i zglobna čahura. Izvanzglobni reumatizam dijeli se na primarni (nepoznate etiologije) i sekundarni (uzrokovan sistemskim reumatskim bolestima, endokrinološkim poremećajima, tumorom ili lijekovima). Opća dijagnoza koja predstavlja problem sa ramenom je sindrom bolnog ramena, a najčešće je uzrokovan izvanzglobnim reumatizmom. Izvanzglobni reumatizam ramena uključuje: subakromijalni sindrom sraza, subakromijalni burzitis, kalcificirajući tendinitis, rupturu tetiva rotatorne manšete, tendinopatiju duge glave bicepsa i adhezivni kapsulitis. Sve ih karakteriziraju slični simptomi poput boli i ograničenog opsega pokreta. Dijagnoza se postavlja iz anamneze, kliničke slike i fizikalnog pregleda. Ukoliko postoje dvojbe oko točne dijagnoze mogu pomoći slikovne metode poput ultrazvuka ili magnetske rezonance. Liječenje najčešće započinje fizikalnom terapijom uz potporu medikamentoznim liječenjem. Ako ne uspije konzervativna terapija može se pokušati i operativno liječenje.In the shoulder area there are four joints which, with synchronized movement, allow wide range of upper arm movements. The largest and most important is the glenohumeral joint while the other are acromioclavicular joint, sternoclavicular joint and scapulothoracic joint. Although the latter is not a real joint as it does not have articular surface or capsule, it still participates in movements of the shoulder by gliding of the scapula over the chest. Shoulder ligaments and muscles are responsible for stabilization of the shoulder joint. Besides stabilization, muscles also perform movements of the shoulder. Possible movements are: abduction, adduction, anteflexion, retroflexion, internal and external rotation. Extraarticular rheumatism is a term that encompasses inflammatory and degenerative musculoskeletal pain syndromes that affect soft tissue around the joints. Tissues that can be affected include: tendons, tendon insertions, bursae, fasciae, muscles and capsule. Extraarticular rheumatism is divided into primary (unknown etiology) and secondary (caused by systemic rheumatic diseases, endocrinological disorders, tumors or drugs). The general diagnosis that presents a shoulder problem is painfull shoulder syndrome and it is most often caused by extraarticular rheumatism. Extraarticular rheumatism of the shoulder includes: subacromial impigement syndrome, subacromial bursitis, calcific tendinitis, rotator cuff tear and adhesive capsulitis. All of them are characterized by similar symptoms such as pain and limited range of motion. Diagnosis is based upon past medical history, clinical presentation and physical examination. If there is any doubt about diagnosis, imaging techniques, such as ultrasound or magnetic resonance, can help. Treatment usually begins with physical therapy supported by medication. If conservative therapy is not succsesfull, patients can undergo surgery