Совет экспертов: хроническая боль в области плечевого сустава как мультидисциплинарная проблема

Хроническая боль в области плечевого сустава (ХБОП) – клинический синдром, связанный с воспалительным и дегенеративным поражением структур скелетно-мышечной системы, характеризующийся персистирующей в течение не менее 3 мес болью в области плечевого сустава (ПС), возникающей или усиливающейся при функциональной активности в данной области. Частота ХБОП в современной популяции достигает 20–33%, это одна из ведущих причин серьезных страданий, утраты трудоспособности и обращений за медицинской помощью.

Основными причинами ХБОП являются синдром сдавления ротаторов плеча (субакромиальный импинджмент-синдром), кальцифицирующий тендинит, адгезивный капсулит, остеоартрит ПС и акромиально-ключичного сустава. Точная диагностика этих заболеваний необходима для правильного выбора тактики лечения. Дифференциальная диагностика осуществляется с использованием тестов, оценивающих функцию ПС и мышц вращающей манжеты плеча (тесты Нира, Спида, Хокинса и др.), а также инструментальных методов исследования (ультразвуковое, магнитно-резонансное, рентгенологическое). При ХБОП необходимо исключить септические, онкологические, висцеральные, системные ревматические и другие заболевания, а также скелетно-мышечную патологию шейного отдела позвоночника, верхней части груди и спины, которая может быть причиной боли в области ПС.

Терапия заболеваний, вызывающих ХБОП, должна быть персонифицированной и комплексной, направленной на максимально полный контроль боли и восстановление функции. С этой целью используются нестероидные противовоспалительные препараты, локальная инъекционная терапия глюкокортикоидами, гиалуроновой кислотой, обогащенной тромбоцитами плазмой. В ряде случаев показаны миорелаксанты, антидепрессанты, антиконвульсанты, локальные инъекции ботулотоксина типа А. Принципиальную роль в лечении ХБОП играют методы физиотерапии и медицинской реабилитации.

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