Frozen shoulder is the short and common name for periarthritis of the shoulder joint. It is also called “frozen shoulder”, “frozen shoulder”, “shoulder coagulation” and so on. There are many different names, but the common denominator is that they all have something to do with the inability to move, so they use words like “frozen” and “frozen”. Periarthritis is a chronic, non-specific inflammation and degeneration of the shoulder capsule and surrounding soft tissues, characterized by pain and limited movement of the shoulder joint. It is also known as “fifty shoulder” because it occurs around the age of 50. Studies have shown that people over the age of 45 who brake their shoulder joints for 2 weeks for various reasons can develop symptoms of frozen shoulder to varying degrees. In clinical practice, it is common to see people who are bedridden due to illness, or who have had arm injuries, fractures, or surgeries, wearing a triangular scarf for protection. After a few weeks, you may find that the shoulder joint becomes painful and “unliftable” even though it has not been injured or operated on. This is commonly referred to as secondary frozen shoulder. This is when an injury elsewhere develops and then leads to frozen shoulder! The cause of frozen shoulder is not clear, but generally speaking, regardless of the cause, as long as there is a local inflammatory response, or the shoulder joint is not moving with braking, or the activity is reduced, the symptoms of frozen shoulder will occur over time. It is generally considered to be a degenerative change in the soft tissues surrounding the shoulder joint. Specifically, due to the lack of activity in the shoulder joint, the metabolism and circulation of the shoulder joint becomes impaired, and the blood and lymphatic circulation and reflux decrease, resulting in degenerative lesions around the joint such as the joint capsule, rotator cuff, biceps tendon, and rostro-humeral ligament. There is inflammatory exudation and cellular infiltration (similar to various types of chronic inflammation), followed by fibrosis and adhesions, and eventually the joint becomes immobile. （Frozen shoulder is more common in middle-aged and elderly people, especially in women than in men, and may be triggered by minor trauma or cold before the onset of the disease. The main symptom of frozen shoulder is localized pain in the shoulder joint, which is usually worse at night when sleeping. In severe cases, you cannot sleep on the affected side because of the pain, and you can only lie flat or on the side that does not hurt, which is very painful. Because of the pain, the arm does not dare to do abduction and internal and external rotation at first, and if the pain is severe or persistent, the movement of the shoulder joint in all directions will be reduced, and it is obviously restricted. At the same time, the muscles of the shoulder (especially the deltoid muscle) may become atrophied (see the previous blog post on muscle atrophy for the specific mechanism). This causes a lot of inconvenience in life, such as not being able to lift the arm, so you can’t wash your face or comb your hair; not being able to extend your hand behind your back because you can’t rotate it internally, so you can’t wash your back in the shower, and you can’t even lift your pants when you go to the bathroom. Without treatment and systematic rehabilitation exercises, the symptoms will worsen and the movement of the shoulder joint will become more and more restricted, making the function and quality of life even worse. Personally, I think that the entire course of frozen shoulder can be divided into three stages from the point of view of symptoms and function as well as treatment priorities. The acute phase, the adhesive phase and the remission phase. This is easier to remember and analyze. These three phases have different clinical manifestations, different pathological changes, and different ways and means of treatment and rehabilitation functional exercises. I. Acute stage: In the acute stage, that is, the stage when the pain first starts. The symptoms are mainly pain around the shoulder joint at irregular points. Sometimes the pain is in a large area, or even in the whole shoulder. In some cases, it may also involve radiation to the large arm and small forearm. Due to this and other pains, the first thing that happens is that you are afraid to move around to protect yourself, and the painful stimulation also causes muscle spasms and tightening of the soft tissues around the shoulder joint. This causes varying degrees of shoulder joint movement restriction, that is, the fear to move and the aggravation of pain when moving. Therefore, the focus of treatment at this stage is to eliminate the inflammation and relieve the pain through various methods so that the symptoms can be relieved at the root. At the same time, it is necessary to use appropriate rehabilitative exercises to maintain the mobility of the shoulder joint in all directions to avoid the pain and the risk of adhesions in the shoulder joint. Of course, the amount of activity should be strictly controlled, as clenching your teeth at this time will only increase the irritation, inflammation and aggravate the pain. Second, the adhesion period: After a period of acute pain development, you will enter the adhesion period. The pain will be relieved at this stage, but don’t think that the frozen shoulder is getting better, rather it is entering a more troublesome stage. This is because although the symptoms of pain may be significantly relieved, hyperplasia and adhesions within the shoulder joint are the main pathological processes at this point. The joint movement in all directions of the shoulder joint will start to become more and more obviously restricted, especially the abduction and external rotation of the shoulder joint is usually the most obvious restriction. Therefore, continued anti-inflammatory analgesia is necessary during this phase. However, it is more important to maintain and improve the mobility of the shoulder joint. Not only do you need to practice more on your own, but if necessary, you need to undergo a special “joint release” technique in the hospital by a rehabilitation therapist to avoid joint adhesions, stiffness and immobility. At this time, if you are too “heartbroken”, can not suffer a little bit, tolerate a little pain, you miss the opportunity to practice mobility, joint adhesions will further aggravate, and later want to practice will have to pay a greater price. Third, the remission period: Finally, the remission period. During this period, there will be a significant improvement in both the pain and the limited movement of the shoulder joint. However, the relief of inflammation and pain usually comes at the cost of some loss of mobility. That is, not much pain, but always also some direction, no more effort to lift up, not as high as the healthy side of the arm, not as big angle. If the correct treatment and exercises are not given in time, the basic function of the shoulder joint may be restored, but there will still be some functional impairment left behind, which will affect certain daily life movements, especially sports.