1. Definition and overview: Frozen shoulder, adhesive capsulitis, “fifty shoulder”, etc. are also known as frozen shoulder. It is caused by soft tissue lesions around the shoulder joint, resulting in shoulder joint pain and motor dysfunction. It is commonly referred to as frozen shoulder, and is more common in patients over 40 years of age, with more women than men (about 3:1), more left shoulders than right shoulders, and some patients are bilateral. In the same age group, those with heart disease, lung disease, diabetes, and cervical spine disease are higher than healthy people. Clinically, it is divided into primary and secondary.
2. Clinical manifestations: It is clinically characterized by pain, stiffness, and limited motion, which affects normal daily life (e.g., driving, dressing, sleeping) and work. The clinical course is inconsistent, but all patients are able to terminate spontaneously. Some get better in a few months, others take years and are often unpredictable. However, recurrence after cure is rare.
3. Pathology and clinical staging: The pathological process of periarthritis of the shoulder is divided into 3 phases: the coagulation phase, the freezing phase and the thawing phase. In the coagulation phase, adhesions occur in the loose parts of the shoulder capsule, and adhesions occur in the biceps tendon and tendon sheath; subsequently, fibrosis of the adhesions leads to contracture, and the folds of the joint capsule disappear due to mutual adhesions. The main clinical manifestation is pain. Freezing stage: In this stage, in addition to the severe contracture of the joint capsule, the soft tissues around the joint are involved, and the degenerative changes are intensified, with congestion and thickening of the synovial membrane and lack of elasticity of the tissue. The shoulder joint movement is severely restricted, with persistent pain, which is aggravated at night, and the restriction of Monohumeral joint movement reaches its peak. Thawing period:After a freezing period of six months to one year, the fibrotic individual tissues remodel, the tendons change their attachment points on the bone, and the contracted tissues regain their original length due to pathological tearing, manifesting as gradual improvement of shoulder joint function and pain relief.
4. Diagnosis: Primary frozen shoulder is a disease whose etiology is not yet clear. Patients with secondary frozen shoulder can recall specific triggers for the disease, usually related to overuse and injury of the shoulder joint. Combining the etiology, the clinical manifestations described above and the clinical staging, the diagnosis is generally not difficult. Most x-rays of frozen shoulder are not abnormal.
Treatment methods.
Surgical treatment: Those who have been ineffective by longer-term comprehensive non-surgical treatment should consider, surgical treatment, the main surgical methods are as follows.
1. Biceps long head tendon fixation or transposition: It is suitable for early cases, if the non-surgical treatment is ineffective and the long head of biceps is involved, biceps long head tendon fixation or transposition can be done. If the long head of the biceps tendon is not significantly degenerated, it can be cut from the attachment of the supraspinatus node, withdrawn from the joint, and fixed to the rostral process. If the tendon has undergone severe degeneration, it will be fixed in the intertrochanteric sulcus of the humeral tuberosity and the acromioplasty will be done at the same time.
2.Rostral humeral ligament cut: It is suitable for late stage cases, which are not effective by comprehensive non-surgical treatment and manual release, etc.
3.Hydraulic dilatation of the joint cavity: The pressure of the fluid injected into the joint is used to loosen the adhesions around the joint.
4.Arthroscopic joint capsule release.
Non-surgical treatment: The purpose of non-surgical treatment is to relieve pain and restore the motor function of the shoulder. Currently, most scholars advocate the combined use of several treatment methods for frozen shoulder, believing that they can complement each other’s strengths and improve the efficacy.
Different treatments are performed according to the different stages of frozen shoulder, but each stage has its own focus. In the coagulation phase, anti-inflammation and pain relief are the main treatments; such as ultrashort wave, microwave, transcutaneous electrical nerve stimulation, sinusoidal modulated medium frequency electricity and functional exercise. During the freezing period, pain relief and adhesion release are the mainstays, such as manipulation under anesthesia, massage, local painful nerve block, small acupuncture and functional exercise. Thawing period restoration of function is the main; such as freehand exercises and apparatus exercises.
1.Pharmacological treatment.
1) Steroid hormones and local anesthetics: This is the current drug of choice for shoulder pain. The hormones are dexamethasone, methylprednisolone, tretinoin and other drugs, mixed with lidocaine, bupivacaine and other local anesthetics for nerve block therapy.
(2) Non-steroidal anti-inflammatory drugs and muscle relaxants: Although local nerve block therapy has obvious effects on relieving pain, the duration of action lasts <12h, so in the acute pain period with oral ibuprofen, anti-inflammatory pain, clozoxazone and other drugs to reduce or relieve pain, relax the tense or spastic muscles, reduce the muscle pull at the local lesion, and promote the repair of the local injury lesion.
2.Physical therapy.
(1) low and medium frequency pulse electrotherapy: transcutaneous electrical nerve stimulation, sinusoidally modulated medium frequency electricity and other therapies have significant analgesic effects. 2.2 High frequency electrotherapy: mainly using ultra-short wave and microwave therapy, ultra-short wave and microwave have a direct anti-inflammatory effect on the nerve root, and can improve nerve nutrition and functional improvement, so that the excitability of the inflammatory lesion is reduced and the vicious cycle of pathological impulses is blocked or reduced.
(2) magnetic therapy: there are dynamic magnetic field for acute pain and static magnetic field for chronic pain, the magnetic field can reduce the excitability of nerve endings, accelerate the dissipation of inflammatory exudates, so as to achieve the effect of eliminating pain.
3.Chinese medical treatment.
1）Tui na massage: The purpose is to improve the blood and lymph circulation of the affected limb, eliminate edema, relieve pain and maintain the function of shoulder joint movement. After the pain is reduced, active movement can be increased.
2）Acupuncture: Modern research has also proved that acupuncture can reduce the concentration of pain-causing substances in the peripheral blood, such as 5-hydroxytryptamine, potassium ion, histamine, etc. It can also affect the changes of prostaglandin and cyclic monophosphate II, thus improving the pain threshold and the effectiveness of acupuncture.
(3) Manipulation under anesthesia: For those who have severe freezing, which has affected their work and life, and who have not been treated with various treatments, the soft tissue around the shoulder joint can be released by manipulation under the anesthesia of brachial plexus nerve block in the interosseous groove, which has the effect of restoring the function of the shoulder joint immediately. The ideal technique should fully loosen the lower part of the biceps and fibrocartilage and minimize the damage to other tissues, thus reducing pain and restoring joint movement.
4. Self-care and exercise therapy.
The various treatments mentioned above can be combined, but the most important and effective treatment for patients with frozen shoulder is self-exercise. Adhering to correct and effective exercise can prevent and release adhesions, relax tendons and blood, improve local blood circulation, prevent muscle twinning, enhance and improve muscle function, and have obvious curative effects on the treatment of frozen shoulder. Generally, you should exercise at least once a day for about 30 minutes each time, with the shoulder joint moving as much as it takes to cause tolerable pain. The specific methods commonly used are manual exercises and apparatus exercises.
Manual exercises: ① Climbing method: The patient faces the wall upright, raises both hands upwards and slowly climbs up along the wall. ②Hold the neck with both hands: both shoulders are abducted, hold the neck with both hands, and then do shoulder abduction and inward movement, repeatedly. ③Shoulder rotation method: take the shoulder joint as the center, do small rapid inward rotation movement, then do external rotation, alternately. ④Shoulder hitching method: cross the arms left and right and then hold them in front of the chest. ⑤ Auxiliary method of the healthy limb: the healthy side hand holds the affected side finger elevation over the shoulder and behind the back side cross up movement.
Apparatus exercises: ① Gymnastic stick: standing position, holding the stick with both hands in front, the distance between the hands depends on the degree of shoulder activity disorder, the lighter the same shoulder width, the heavier relatively wider. Do front planks, left and right pendulum movements. Then do the left and right swing and upward movement behind the body. In addition, the rod can be placed behind the back, the affected limb hand holding the lower end, the healthy hand holding the upper end and shaking outward to do push and pull action. ②Hanging ring: Through the pulley, the healthy limb pulls the affected limb to do abduction and forward flexion. ③Shoulder joint activator: a comprehensive training device for the shoulder, shoulder and wheel axis flat, adjust the handle to the upper limb completely straight, and then make circular movements. ④Tensioner; mainly for training shoulder related muscles.