Pathology of the shoulder joint and soft tissues: clinical variants, current capabilities of pathogenesis-directed therapy

Pain syndrome in the shoulder occurs in every 5th adult and is the 2nd most frequent reason for seeking primary medical care among all musculoskeletal disorders. Group of local causes of pain syndrome in the shoulder area. The starting point for differential search is patient’s age. For persons younger than 40, the most common causes are joint instability (dislocations / subluxations), as well as mild damage of the rotator cuff muscles due to injury. Patients older than 40 have an increased risk of severe chronic disorders of the above-mentioned muscles, adhesive capsulitis, and osteoarthritis of the shoulder joint. Treatment of shoulder joint and soft tissue pathology is nosological in nature and has to be justified by pathogenesis. Chondroreparants are a new class of pharmaceuticals based on hyaluronic acid modified by low molecular weight compounds using solid-phase stabilization. During physical stabilization (mechanosynthesis) of hyaluronic acid, chemical crosslinkers are not used, which leads to high tolerability and safety. Modified hyaluronic acid in Hyalrepair formulas has a number of structural features leading to its slower biodegradation in the tissues. Chondroreparant Hyalrepair-10 consists of hyaluronic acid, ascorbyl phosphate, zinc, cysteine, and glutathione; Hyalrepair- 2 consists of hyaluronic acid, ascorbyl phosphate, L-proline, L-lysine, and glycine. Use of intra-joint and periarticular injection of hyaluronic acid can be an effective approach in combination pathogenesis-directed therapy of the shoulder and soft tissues.