Совет экспертов: хроническая боль в области плечевого сустава как мультидисциплинарная проблема
https://doi.org/10.14412/1996-7012-2023-3-111-120
Аннотация
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.
Об авторах
А. Е. КаратеевРоссия
Каратеев Андрей Евгеньевич,
115522, Москва, Каширское шоссе, 34А
А. М. Лила
Россия
115522, Москва, Каширское шоссе, 34А;
кафедра ревматологии, 125993, Москва, ул. Баррикадная, 2/1, стр. 1
Н. В. Загородний
Россия
127299, Москва, ул. Приорова, 10;
117198, Москва, ул. Миклухо-Маклая, 6
Л. И. Алексеева
Россия
115522, Москва, Каширское шоссе, 34А;
кафедра ревматологии, 125993, Москва, ул. Баррикадная, 2/1, стр. 1
С. В. Архипов
Россия
115522, Москва, Каширское шоссе, 34А
В. В. Арьков
Россия
105120, Москва, ул. Земляной Вал, 53
М. С. Макаров
Россия
115522, Москва, Каширское шоссе, 34А
А. П. Рачин
Россия
119361, Москва, ул. Большая Очаковская, 12
В. А. Широков
Россия
620028, Екатеринбург, ул. Репина, 3
М. Н. Хохлова
Россия
115522, Москва, Каширское шоссе, 34А
В. А. Нестеренко
Россия
115522, Москва, Каширское шоссе, 34А
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Рецензия
Для цитирования:
Каратеев А.Е., Лила А.М., Загородний Н.В., Алексеева Л.И., Архипов С.В., Арьков В.В., Макаров М.С., Рачин А.П., Широков В.А., Хохлова М.Н., Нестеренко В.А. Совет экспертов: хроническая боль в области плечевого сустава как мультидисциплинарная проблема. Современная ревматология. 2023;17(3):111-120. https://doi.org/10.14412/1996-7012-2023-3-111-120
For citation:
Karateev A.E., Lila A.M., Zagorodniy N.V., Alekseeva L.I., Arkhipov S.V., Arkov V.V., Makarov M.S., Rachin A.P., Shirokov V.A., Khokhlova M.N., Nesterenko V.A. Council of Experts: chronic shoulder pain as a multidisciplinary problem. Modern Rheumatology Journal. 2023;17(3):111-120. (In Russ.) https://doi.org/10.14412/1996-7012-2023-3-111-120