What Are the Treatments for Frozen Shoulder?

Periarthritis of the shoulder is referred to as periarthritis, commonly known as condensed shoulder and fifty shoulders. The shoulder pain gradually develops, which is worse at night, and gradually worsens. The mobility of the shoulder joint is limited and gradually worsens. It gradually relieves after reaching a certain level, until the complete recovery of the shoulder capsule and its surrounding ligaments, tendons, and Chronic Specific Inflammation of the Bursal. Periarthritis of the shoulder is a common symptom of shoulder pain and mobility problems. The prevalence of this disease is around 50 years old. The incidence rate is slightly higher in women than in men, and it is more common in manual workers. Without effective treatment, it may seriously affect the functional activities of the shoulder joint. The shoulder joint may have extensive tenderness and radiate to the neck and elbows. There may also be varying degrees of deltoid muscle atrophy.

Basic Information

nickname

Frozen shoulder, frozen shoulder, fifty shoulders, frozen shoulder

English name

Scapulohumeral periarthritis

Visiting department

orthopedics

Multiple people

Middle-aged and elderly women

Causes of Periarthritis of the Shoulder Joint

Shoulder cause

(1) This disease mostly occurs in middle-aged and older people over 40 years of age, with soft tissue degenerative lesions and weakened tolerance to various external forces;

(2) Chronic injury caused by long-term excessive activity and poor posture;

(3) The shoulder is fixed too long after trauma to the upper limbs, and the peripheral tissues of the shoulder atrophy and adhesion.

(4) Acute contusion of the shoulder, improper treatment due to stretch injury, etc.

2. Extra-shoulder factors

Cervical spondylosis, shoulder pain associated with heart, lung, and biliary diseases. Due to the long-term unhealed primary disease, the shoulder muscles continue to spasm and ischemia to form an inflammatory lesion, which turns into true shoulder periarthritis.

Clinical manifestations of periarthritis of the shoulder

Shoulder pain

At the beginning, the shoulder showed paroxysmal pain, most of which were chronic attacks. Later, the pain gradually increased or dull, or cut-like pain was persistent. The pain often worsened after climate change or exertion. The pain can be caused to the neck and upper limbs ( (Especially the elbow) spread. When the shoulder is accidentally bumped or pulled, it can often cause tear-like pain. Shoulder pain is a major feature of the day and night, and if the pain is caused by cold, then Particularly sensitive to climate change.

2. Limited shoulder movement

The movement of the shoulder joint can be restricted in all directions, and abduction, lifting, internal rotation and external rotation are more obvious. As the disease progresses, due to the long-term disuse, the joint capsule and soft tissue around the shoulder are gradually weakened. The upper beak-humeral ligament is fixed to the shortened internal rotation position and other factors, which limit the active and passive movements of the shoulder joint in all directions, especially combing hair, dressing, washing the face, akimbo and other movements are difficult to complete. In severe cases, the elbow joint function is also difficult. It can be affected. When the elbow is flexed, the hand cannot touch the shoulder on the same side, especially when the arm is extended backward.

3. Afraid of cold

Patients are afraid of cold shoulders. Many patients cover their shoulders with cotton pads all year round. Even in the summer, the shoulders dare not blow hair.

4. Tenderness

In most patients, obvious tenderness points can be touched around the shoulder joint, and the tenderness points are mostly at the tendon groove of the long head of the biceps brachii muscle, the scapulohumeral sac, the coracoid process, and the supraspinatus attachment point.

5. Muscle spasm and atrophy

The deltoid muscles, superior muscles, and other muscles around the shoulder can appear spasm in the early stage, and wasteful muscle atrophy can occur in the later stage, with acromion protrusion, inconvenience of lifting, and backward extension can not be typical symptoms. At this time, the pain symptoms are reduced.

Periarthritis examination

The disease mainly uses X-ray examination and shoulder MRI examination:

1. X-ray inspection

(1) The early characteristic changes mainly showed the fuzzy deformation of the fat line below the acromion and even disappeared. The so-called subacromial fat line refers to the linear projection of a thin layer of fat tissue on the deltoid muscle fascia on the X-ray film. When the shoulder joint is excessively internally rotated, the adipose tissue is just at the tangential position and shows a linear shape. In the early stage of periarthritis, when the soft tissue of the shoulder is congested and edema, the contrast of the soft tissue on the X-ray film decreases, and the fat line under the acromion is blurred and even disappears.

(2) In the middle and late stages, the soft tissue of the shoulder was calcified. X-ray films showed joints, synovial sacs, supraspinas tendons, biceps long tendons, etc. with uneven and uneven calcification. In the late stage of the disease, the X-ray film showed dense and sharp calcification, and in some cases, large nodule bone hyperplasia and osteophyte formation were seen. In addition, osteoporosis, joint end hyperplasia or osteophyte formation or joint space narrowing can be seen in the acromioclavicular joint.

2. Shoulder MRI

Shoulder MRI can determine whether the signal around the shoulder joint is normal and whether there is inflammation. It can be used as an effective method to determine the lesion location and differential diagnosis.

3. Other

Arthroscopy can find abnormalities such as fibrosis and thickening of the scapulohumeral joint capsule, which is one of the inspection methods for periarthritis of the shoulder.

Diagnosis of periarthritis of the shoulder

Diagnosable based on medical history and clinical symptoms. Routine radiographs are mostly normal. Osteoporosis can be seen in some patients in the later period, but there is no bone destruction. Calcified shadows can be seen under the acromion. In older patients or with longer disease course, plain radiographs of the shoulder can show osteoporosis of the shoulder, or calcification signs of the superior tendon and the acromion bursa.

Differential diagnosis of periarthritis of shoulder

Common clinical diseases associated with periarthritis of the shoulder include cervical spondylosis, dislocation of the shoulder joint, purulent shoulder arthritis, shoulder tuberculosis, shoulder tumors, rheumatism, rheumatoid arthritis, and simple supraganglar tendon injury , Rotator cuff tear, biceps tendonitis and tenosynovitis. These conditions can be manifested by shoulder pain and limited shoulder mobility. However, because the nature of the disease is different, and the location of the lesion is different, there are different companions to identify.

Periarthritis Treatment

At present, periarthritis of the shoulder is mainly treated conservatively. Oral anti-inflammatory analgesics, physical therapy, local closure of pain points, massage therapy, self-massage and other comprehensive treatments. Simultaneously perform joint function exercises, including active and passive abduction, rotation, extension and flexion, and circular movements. When the shoulder pain is significantly reduced and the joint is still stiff, it can be loosened under general anesthesia to restore the range of joint motion.

The steps and methods of self-massage are:

1. Using the thumb or palm of the healthy side, press the front and the outside of the affected shoulder joint from top to bottom for 1 to 2 minutes. You can click with your thumb for a moment at the local pain point.

2. Use the abdomen of the 2nd to 4th fingers of the healthy hand to rub all parts of the back of the shoulder joint for 1 to 2 minutes. If you find a local pain point during the rubbing process, you can also click with your fingers for a moment.

3. Knead the muscles of the upper arm of the affected upper limb with the joint motion of the healthy thumb and other fingers, and knead to the shoulder from bottom to top for 1 to 2 minutes.

4. In the case of shoulder abduction and other functional positions, use the above method to perform massage, and perform activities in all directions of the shoulder joint while massaging.

5. Finally rub the palms from top to bottom for 1 to 2 minutes. For areas that cannot be massaged on the back of the shoulders, you can use the tap method to treat them.

Self-massage can be carried out once a day and persist for 1 to 2 months, which will have better results. When the shoulder pain is reduced but the joint is still stiff, it can be treated with surgery and combined with manual release to restore the range of motion of the shoulder joint.