Comprehensive treatment, combination of Chinese and Western medicine, and equal emphasis on maintenance and treatment
For fresh and relatively small rotator cuff ruptures, non-surgical treatment is extremely effective. Generally, if the shoulder muscle strength and the degree of abduction can be increased after 3~4 weeks of non-surgical treatment, surgery can be unnecessary and treatment should be continued for 2 months. If the muscle strength and active abduction are not satisfactory after 4~6 weeks of strict non-surgical treatment, surgical treatment can be considered.
In the acute phase of complete rupture, after 4-6 weeks of non-operative treatment, the acute inflammation and edema of the rotator cuff subsides, and the tendon stump that fails to heal forms a harder scar tissue, which is also conducive to tendon repair and stop point reconstruction.
The two main problems of rotator cuff injury are pain and functional impairment.
Therefore, conservative treatment is also directed at these two aspects.
① Firstly, for pain, oral NSAIDs and herbal medicines can be taken to activate blood circulation and remove blood stasis.
②Early, rest, triangular towel suspension and braking should be paid attention to for 2 to 3 weeks.
③Ice packs: ice packs should be applied for 15 minutes during the acute phase of pain or after each activity.
④Physical therapy: when the swelling and pain increase, fresh medicine should be applied externally or Chinese medicine should be sealed, and after 48 hours, microwave, medium-frequency medicine penetration and warm treatment such as Chinese medicine hot baking, Chinese medicine waxing, Chinese medicine fumigation, etc.
⑤ Acupuncture and Tuina: relax the muscles and improve the blood circulation to prevent muscle atrophy and restore the function of the shoulder joint (contraindicated in the acute stage).
(6) For severe pain, 1% lidocaine plus corticosteroid can be used for subacromial bursa or pain point injection and intra-articular sodium vitreous acid injection.
(7) After the pain is relieved, functional rehabilitation of the shoulder joint should be started.
Acupuncture: milli-needle, electric needle, Mitsubishi needle, fire needle
Moxibustion: moxibustion, warm needle moxibustion, moxa stick moxibustion, moxa column moxibustion
Tui-na: Chinese medicine tui-na, Chinese herbal oil, Chinese herbal hot amenity kit
Chinese herbal medicine external treatment: fresh medicine external application, Chinese herbal medicine sealing package, Chinese herbal medicine hot baking, Chinese medicine directional medicine penetration, Chinese herbal medicine fumigation, Chinese herbal medicine wax therapy, Chinese herbal medicine bath
Physical therapy: microwave, ultra-short wave, semiconductor laser, infrared light therapy
Injection therapy: painful spot injection, ozone injection therapy, intra-articular sodium vitreous acid injection therapy
Chinese medicine surgical treatment: small needle knife release, silver needle heat conduction
Pain point block is a common clinical treatment modality to relieve patients’ pain and reduce local soft tissue inflammation to facilitate functional exercise. However, the recovery time for shoulder joint movement restriction is long, and improvement usually starts after 2-4 weeks of treatment, and functional exercise only progresses significantly after 1-3 months. It is clinically observed that painful point block alone cannot solve the shoulder mobility problem. And it affects the confidence of some patients in treatment and exercise.
Sodium vitrate injection has been shown to be effective in the treatment of osteoarthritis and rheumatoid arthritis when applied. Sodium vitrate covers and protects joint tissues and improves joint lubrication. After injection, it acts as a lubricant, barrier and pressure cushion in the joint cavity, which can improve joint mobility.
During treatment, it was observed that patients who received both pain point block and sodium vitrate injection into the joint cavity had more efficient pain relief and more rapid recovery of shoulder motion impairment than those who used pain point block alone.
Recommended regimen: Pain point block combined with intra-articular sodium vitreous acid injection in the shoulder joint once a week for 3 times.
(i) Anterior approach.
The upper limb is mildly abducted and externally rotated, and the elbow joint is flexed in the regional position. The needle is inserted vertically from the midpoint of the tuberosity of the humerus and the rostral process of the scapula, or 1~50px below the tip of the rostral process, and the needle is inserted about 75px into the joint cavity. If there is no fluid or blood in the retraction, the drug can be injected. If there is fluid in the retraction, the joint should be pumped clean, and then injected.
(B) Lateral approach (shoulder k point)
The patient’s shoulder joint is abducted so that the upper limb is 90 degrees from the trunk, and the lateral part of the deltoid muscle is contracted to form two fossae on the shoulder joint, with the front one located between the acromion and the greater tuberosity of the humerus, which is equivalent to the shoulder k point. inferior bursa, supraspinatus muscle, through the joint capsule, into the joint cavity, aspirate without effusion and return of blood can be injected.
(C) posterior approach (Yu point)
The patient is in a sitting position, with the upper arm tucked in, the head of the posterior axillary stripe straight up, and the lower edge of the scapular gland, with hand pressure with an indentation for the needle entry point, and the skin is routinely disinfected. The skin is routinely disinfected. The needle is inserted directly with a No. 5 needle, and the needle enters the joint cavity by 2 to 75 px: the needle is inserted forward into the skin, subcutaneous tissue, and subscapularis muscle. The suprascapular nerve and artery are located in front of the needle. The needle is continued into the shoulder joint cavity. No blood and no fluid can be injected by backdrawing.