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The most common diseases of the upper limb are osteoarthritis (OA) of the joints of the hands, lateral epiconlitis, tendinitis of the shoulder muscles, adhesive capsulitis. OA of the shoulder and acromioclavicular joints is less common. The development of acute and subacute pain in the elbow and shoulder joints in the vast majority of cases is determined by the pathology of soft tissues: muscles, ligamentous apparatus and related synovial bags, making it difficult to diagnose. A clinical and radiological heterogeneity of OA of the joints of the hands is a very complex pathology for the study, and also to create a unified algorithms for therapy. Therapy nonsteroidal anti-inflammatory drugs are effective in the short term, but it has several side effects. Despite a variety of attempts at therapy with successful and unsuccessful outcome, the attention of researchers for several decades converted to the injection therapy with hyaluronic acid. The article presents the data of studies demonstrating the anti-inflammatory effect of hyaluronic acid in the treatment of OA, as well as the results of clinical trials and data system of meta-analysis demonstrating the effectiveness of intra-articular and extra-articular therapy tendinopathy of the upper limb. Most of the cited studies demonstrated the efficacy and good tolerance of 1% sodium hyaluronate. In the domestic market it is presented in the drug Flexotron Forte. The authors provide the results of the study results, demonstrating the efficacy and safety of using Flexotron Forte to clinical practice.

Chronic shoulder pain (CSP) is one of the most common reasons for seeking medical care. Identifying the specific cause of CSP is necessary to determine the treatment strategy.Objective: to determine which pathology of the musculoskeletal system is the main cause of CSP.Subjects and methods. A study group consisted of 151 patients (49.7% females; mean age, 49.8±18.8 years), who experienced shoulder joint pain that persisted when taking nonsteroidal anti-inflammatory drugs (NSAIDs) and after local administration of glucocorticoids. They underwent clinical and instrumental studies (radiography, magnetic resonance imaging, and ultrasound). The investigators assessed pain intensity using a visual analogue scale (VAS), and functional impairment with the American Shoulder and Elbow Surgeons (ASES) Assessment Scores and the Constant Score (CS).Results and discussion. The mean CSP intensity at rest and during movement was 56.1±21.7 and 67.3±19.1 mm VAS. The degree of functional disorders was 55.5±17.6 ASES scores and 54.1±14.5 CS scores. Tendonitis that is an injury to the tendon of the supraspinatus muscle (74.8%) was most common. There was shoulder osteoarthritis (OA) in 31.7%, acromioclavicular (AC) OA in 19.2%, rotator cuff tendon injury concurrent with shoulder OA in 25.2%, that with AC OA in 16.6%, and that with shoulder OA and AC OA in 9.2%. The intensity of pain with only rotator cuff tendon injury and that concurrent with shoulder OA and/or AC OA did not differ and that averaged 57.2±20.2 and 54.6±18.6 mm at rest, respectively, and 68.3±22.4 and 65.4±19.2 mm during movement (p>0.05 in both cases).Conclusion. The main cause of CSP is tendonitis of the rotator cuff, primarily of the supraspinatus muscle. Moreover, more than half of patients have rotator cuff tendon injury concurrent with biceps tendon injury, shoulder OA and/or AC OA.

Asymptomatic acromioclavicular osteoarthritis (AC-OA) is a frequent finding in shoulder magnetic resonance imaging (MRI). Its natural course is unknown. Therefore, the question arises whether a resection should be performed simultaneously with shoulder surgery for another reason to prevent future pain and reoperation. The purpose of this study was to investigate the mid-term course of asymptomatic AC-OA. Overall, 114 asymptomatic AC-OA diagnosed on MRI were followed for 7 years between 2011 and 2018. At baseline, MRI signal enhancement in the clavicle and acromion, OA grade, physical demand as well as the parameters (1) Constant Score Visual Analogue Scale, (2) pain on AC-joint compression, and (3) cross-body adduction test were measured. All patients were followed up after 7 years by interview, and in case of symptoms by clinical examination. The endpoint "deterioration" was reached if 2 of the 3 parameters turned worse. Asymptomatic AC-OA remained asymptomatic in 83% of cases, 7% turned better, 10% turned worse. Physical demand and osteoarthritis grade increased the risk of deterioration, whereas MRI signal enhancement in the clavicle or acromion had no influence on outcome. During follow-up, the frequency of pain on AC-joint compression increased from 11% to 16% (P =.24), the frequency of a positive cross-body adduction test increased from 6% to 20% (P =.017), and the mean Constant Score Visual Analogue Scale increased from 10 to 13 points (P <.001) indicating less pain. Asymptomatic AC-OA remained asymptomatic in 90% over 7 years. A simultaneous resection of an asymptomatic AC-OA during shoulder surgery for another reason is not indicated in every patient. [ABSTRACT FROM AUTHOR]

The most common diseases of the upper limb are osteoarthritis (OA) of the joints of the hands, lateral epiconlitis, tendinitis of the shoulder muscles, adhesive capsulitis. OA of the shoulder and acromioclavicular joints is less common. The development of acute and subacute pain in the elbow and shoulder joints in the vast majority of cases is determined by the pathology of soft tissues: muscles, ligamentous apparatus and related synovial bags, making it difficult to diagnose. A clinical and radiological heterogeneity of OA of the joints of the hands is a very complex pathology for the study, and also to create a unified algorithms for therapy. Therapy nonsteroidal anti-inflammatory drugs are effective in the short term, but it has several side effects. Despite a variety of attempts at therapy with successful and unsuccessful outcome, the attention of researchers for several decades converted to the injection therapy with hyaluronic acid. The article presents the data of studies demonstrating the anti-inflammatory effect of hyaluronic acid in the treatment of OA, as well as the results of clinical trials and data system of meta-analysis demonstrating the effectiveness of intra-articular and extra-articular therapy tendinopathy of the upper limb. Most of the cited studies demonstrated the efficacy and good tolerance of 1% sodium hyaluronate. In the domestic market it is presented in the drug Flexotron Forte. The authors provide the results of the study results, demonstrating the efficacy and safety of using Flexotron Forte to clinical practice.

Osteoarthritis of the acromioclavicular joint is a frequent cause of shoulder pain and can result in significant debilitation. It is the most common disorder of the acromioclavicular joint and may arise from a number of pathologic processes, including primary (degenerative), posttraumatic, inflammatory, and septic arthritis. Patients often present with nonspecific complaints of pain located in the neck, shoulder, and/or arm, further complicating the clinical picture. A thorough understanding of the pertinent anatomy, disease process, patient history, and physical examination is crucial to making the correct diagnosis and formulating a treatment plan. Initial nonoperative management is aimed at relieving pain and restoring function. Typical treatments include anti-inflammatory medications, physical therapy, and injections. Patients who continue to exhibit symptoms after appropriate nonsurgical treatment may be candidates for operative resection of the distal clavicle through either open or arthroscopic techniques. [ABSTRACT FROM AUTHOR]