Modern concepts of periarthrytis humero-scapularis: clinical and electrophysiological researches
Dr. B.Livina - D.M.
Notwithstanding the fact that the first publications concerning periarthrytis humero-scapularis (PHS) were to be found more than 100 years ago, until now the meaning of the functional condition of the shoulder bone in the pathogenesis of this polyetiological disease has not yet been explored sufficiently.
Employing the methods of the bone chronaxymetry, bone pain sensitivity, bone receptive field adaptation and other methods associated with bone sensitivity determination, as well as the functional condition of the shoulder bone (proc. acromalis scapulae, tub. major humeri, proc.coracoideus scapulae, spine scapulae, ciavicula) and bone structure was evaluated before electroosteostunulatin (EOS), during 5 minutes of an irritation by electric current, as well as before and after every EOS treatment for 102 PHS patients from 18 to 78 years old. For 50 % of the patients the disease was determined as acute, and tot 50 % of patients it was determined as chronical, 51 % of the patients had right side PHS, 43 % of the patients had left side PHS, but 6 % of them had bilateral PHS; for 51 % of the patients the disease lasted for 3 months, for l8 % of them is lasted from 3 to 7 months, for l5 % it lasted from 7 months up to 1 year,. but for 17 % of the patients is lasted for more than 1 year (B. Livina, 1993).
Statistically credible correlation was discovered between relatively long chronaxy and high bone sensorial indications for proc.acromialis scapulae and tub. maior humeri, on the one hand, and rentgenologically expressed structural changes in the shoulder joint (up to 30° - 40°) accompanied by movement restrictions, on the other hand. It could be explained with the special role of the shoulder bones ensuring the movement action (B. Livina, 1993).
EOS optimum influence on the parameters of the functional state of shoulder bone was determined, and respective reducement of PHS clinical symptoms until total disappearance was observed: in 90.7 % of the cases the total movement possibility in the shoulder joint was reestablished, in 100 % of the cases the disappearance of the pains during night was observed, in 90.6 % of the cases the disappearance of the pains during movements was established. Under the influence of the irritation the strength of the affected arm was substantially increased according to the dynamometric parameters both after the first EOS and at the end of the EOS treatment course. Similarly, in 100 % of the cases the stabilization of the postural equilibrium, as well as the normalization of the cerebral homeostasis according to the electroencephalographic parameters was observed, Total restoration of the movement extent in the shoulder joint, the growth of the arm muscle strength, the stabilization of the postural equilibrium for PHS patients after EOS could be explained by the increase of the muscle volumes, which contributes to the formation of the osteoblasts and hinders the formation of the osteoclasts and to the close functional relationship and interaction of bone and muscle systems. We motivate the decrease and disappearance of the pains, associated with movements, as well as the pains during night, the normalization of the cerebral homeostasis under the -influence of EOS, with the experimentally discovered neurochemical alterations, evoked as a result of bone irritation (for instance, by neuromediators, such as serotonin, gamma aminobutyric acid, and others) in the cerebrum and, presumably, in the bone marrow.
Hence a possibility has arisen for us to enlarge and deepen the existing concept about the origination, development and clinical expression of PHS. An important role in this respect could be assigned to the functional condition of the bone: the functional potential of the shoulder joint has been determined not only by the condition of the periarticular tissues, but also by the functional condition of the shoulder bones.
The bone irritation, having effect on several PHS pathogenic factors, has to be regarded as a pathogenetic PUS monotherapy.