Frozen shoulder
Frozen shoulder is commonly referred to as “frozen shoulder” or “fifty shoulder”. It is a chronic and specific inflammation of the shoulder capsule and its surrounding ligaments, tendons and bursa. In layman’s terms, the capsule is the equivalent of a band wrapped around the bony structure of the shoulder joint, with many important ligaments attached to it. The symptoms are gradual pain in the shoulder, especially at night, and progressive aggravation. The shoulder joint movement is restricted, especially the internal and external rotation, and the active and passive activities are restricted. The symptoms will be relieved automatically in 6~18 months after the onset of the disease, and about 50% of patients can recover on their own.
The term “frozen shoulder” is so popular that middle-aged and elderly patients tend to attribute their shoulder joint problems to frozen shoulder, thus delaying treatment. In fact, the real frozen shoulder only accounts for 10%-15% of shoulder pain patients. Here, I suggest that patients should always go to a professional doctor for help. Clinically, many diseases are easily confused with frozen shoulder, such as rotator cuff injury, acromioclavicular impingement, biceps longus tendonitis and tenosynovitis, cervical spondylosis, shoulder instability, septic shoulder arthritis, shoulder tuberculosis, shoulder tumor, rheumatic and rheumatoid arthritis, etc., which need to be differentiated by experienced shoulder specialists. Conservative treatment is first used for frozen shoulder. Oral anti-inflammatory and analgesic drugs, physiotherapy, local closure of painful spots, massage, self-massage and other comprehensive therapies are used. At the same time, joint function exercises are performed, including active and passive abduction, rotation, extension and flexion, and circular rotation exercises. If the shoulder stiffness does not improve after about 6 months of conservative treatment, arthroscopic release is feasible to restore the range of motion of the joint. However, the research team led by Prof. Wang Zimin found that manual release can easily lead to tears of the rotator cuff, glenoid labrum and other important structures, and may even lead to humeral fracture.
Rotator cuff injury
The rotator cuff refers to the supraspinatus, infraspinatus, teres minor and subscapularis muscles, which wrap around the anterior, superior and posterior glenohumeral joints and play an important role in the function and stability of the shoulder. In addition to occurring in athletes who play primarily upper extremity sports, rotator cuff injuries are more common in older adults over the age of 60, and the prevalence increases with age. Lifting and pulling heavy objects, falls, etc. are often the causes of rotator cuff injuries in older adults. The causes of rotator cuff injuries can be divided into traumatic and non-traumatic. Non-traumatic rotator cuff injuries can be caused by age, wear and tear or blood supply factors.
Note the differentiation from frozen shoulder.
The clinical manifestation of rotator cuff injury is mainly shoulder joint pain with weakness in lifting, and the pain is obviously aggravated at night in the lateral lying position on the affected side. The pain is distributed in the front of the shoulder joint and the deltoid area, and the abduction and supination of the affected shoulder joint is difficult, and atrophy of the supraspinatus, infraspinatus and deltoid muscles may occur in those with a long history of the disease.
Some of the history of misdiagnosed frozen shoulder, many of which are non-traumatic rotator cuff injuries. It is characterized by shoulder pain, inability to lift the arm, especially pain during external rotation, extensive pressure points around the shoulder, and poor passive activity.
Treatment and rehabilitation.
When a superficial rotator cuff injury does not involve the main part of the tendon and has no obvious effect on movement, treatment is mostly attempted with non-surgical comprehensive treatment. If the comprehensive non-surgical treatment still cannot basically restore the abduction of the shoulder joint, or if the rotator cuff tear occurs in the full or deep layers, the self-repair ability of the tendon tear is very limited and the abduction and forward flexion of the upper extremity is affected, then surgical treatment is necessary. At present, the mainstream surgical method is rotator cuff repair under shoulder arthroscopy. The domestic first-class treatment team led by Prof. Wang Zimin of Changhai Hospital has developed techniques such as partial rotator cuff repair through the tendon on the joint side, arthroscopic nerve release combined with giant rotator cuff repair and autologous tendon strengthening for giant rotator cuff injury, overcoming several technical hurdles. We have been able to help patients with rotator cuff injuries to resume their normal lives.
Subacromial impingement syndrome
Subacromial impingement syndrome is a condition in which the humeral head and greater tuberosity repeatedly impinges on the anterior border of the acromion and subacromial structures during shoulder abduction, causing local bone growth and sclerosis and compression of the subacromial bursa, resulting in shoulder pain, shoulder weakness and limited movement. The common clinical feature is a pain arc during active abduction of the shoulder joint, i.e. the pain can be obvious within the range of 60°~120° of shoulder abduction, while the pain is reduced during passive activities.
X-ray plain radiographs are a simple and effective diagnostic tool, while MRI plain radiography is a non-invasive examination with superior soft tissue contrast, provides a large amount of information, and can directly and clearly show signs such as tendon tears and loss of the surrounding fatty band.
Early non-surgical, rehabilitative treatment aims to eliminate edema and congestion and relieve local pain. Physical factor therapy, manual therapy, and passive exercise therapy can be applied. If conservative treatment fails to improve the shoulder discomfort, early hospitalization for arthroscopic acromioplasty decompression of the shoulder should be performed.
Calcific tendonitis
The etiology and pathogenesis of calcific tendonitis remain unclear, but it is thought to be related to degenerative changes in the rotator cuff, lack of vascularization of the rotator cuff, metabolic disorders, and cellular interventional responses. Calcification usually occurs in the supraspinatus tendon (about 80%), but can also involve other muscles of the rotator cuff. Not all individuals with foci of rotator cuff calcification present with clinical symptoms. When the calcium deposits are small and dispersed and have not yet irritated the subacromial bursa, they may be clinically asymptomatic and may only be seen on radiographs, called asymptomatic rotator cuff calcification. After trauma or exertion, the inflammatory reaction around the calcium deposit under the base of the subacromial bursa is caused. If the tension of the calcium deposit is high, the inflammatory reaction of the surrounding tissues and the bursa is also high, and the clinical manifestation is an acute attack.
In some patients, a fixed mass with extremely pronounced pressure pain can be palpated around the large nodule. Shoulder joint movement is severely limited by pain, mostly shoulder abduction and supination. A positive shoulder impingement test may be performed, and the calcification may be clearly visible on x-ray, usually in the area of the supraspinatus adjacent to the greater tuberosity, or in the tendons of the subscapularis, infraspinatus, or lesser trochanter.
There are many ways to treat calcific rotator cuff tendinitis, including nonsteroidal anti-inflammatory drugs, physical therapy, steroidal closure therapy, coarse needle puncture therapy, shock wave therapy, and surgery. For cases where conservative treatment is ineffective, patients with long duration of intractable pain where conservative treatment is ineffective or patients with severe local pain should be treated surgically. Arthroscopic removal of calcified foci is recommended and toothpaste-like or cheese-like calcified deposits are found in the calcified foci during surgery, and if the rotator cuff defect is large, the rotator cuff can be sutured at the same time with satisfactory surgical results.
Glenoid labrum injury
The shoulder joint is a typical ball and socket joint with a large head (humeral head) and a shallow fossa, resulting in a large range of motion. A soft tissue called the glenoid labrum surrounds the circumference of the fossa, increasing the depth of the fossa by 50%, which allows for a better match between the humeral head and the fossa, thus increasing the stability of the glenohumeral joint. In addition, the glenoid labrum is the attachment point for a number of ligaments.
Acute injury to the shoulder joint or repeated joint wear can easily cause labral tears, such as direct violence, sudden pulling, and throwing movements.SlAP injury is an injury to the glenoid labrum of the superior joint and its anterior and posterior glenoid lips, and can also include the long head tendon of the biceps. Avulsion of the anterior inferior aspect of the scapular glenoid includes injury to the inferior glenohumeral ligament also known as a Bankart injury. Glenoid labrum injuries are often combined injuries, such as those that occur with shoulder dislocation.
Conservative treatment may include nonsteroidal anti-inflammatory analgesics, rest to reduce shoulder symptoms, and the development of shoulder rehabilitation exercises. If these measures are ineffective, shoulder arthroscopy should be considered. Depending on the intraoperative situation, the injured glenoid labral fragment may be cleaned up under see arthroscopy, while the combined injury is addressed. If there is separation of the long head tendon or tendon of the biceps muscle in the injury crisis and instability of the shoulder joint, anchor staple sutures may be considered to repair or reconstruct the injured tissue.
Habitual dislocation of the shoulder joint
Case 1: Xiao Chen loves sports. 3 years ago, his right shoulder joint was dislocated after a fall while playing soccer, and he went to the hospital for reset treatment. He felt that his shoulder joint was like a part of a robot that could be “disassembled” at any time. He feels that his shoulder joint is like a robot part that can be “disassembled” at any time.
Case 2: Ms. Li is a housewife, usually normal, but because she has epilepsy, her whole body jerks when she has a seizure, and her joints move abnormally. Gradually, the work like drying clothes and lifting heavy things can only be done by others.
Habitual dislocation of the shoulder joint often occurs after trauma. The first dislocation causes the ligaments that maintain the stability of the shoulder joint to tear away. At the time of resetting, the joint is reset, but the avulsed ligament tissue is often difficult to recover, thus the shoulder joint lacks an important stabilizing structure in front of it. Thereafter, each time the joint is moved to an angle where it is more likely to dislocate, it will dislocate due to the lack of the necessary blocking structures in front of it, which results in habitual dislocation of the shoulder joint.
Modern research suggests that whether a shoulder dislocation becomes recurrent is closely related to the patient’s age at initial dislocation. If the first dislocation occurs in a young person, say before the age of 30, the majority of these patients will become recurrent dislocations because they tend to have a good recovery of shoulder mobility after repositioning, and the patient usually has a greater range of motion in the shoulder joint. If the first dislocation occurs in a middle-aged or older person, such as someone over the age of 40, the range of motion of the shoulder joint is often difficult to restore to the level before the dislocation, so the chances of recurrence are relatively low.
Trauma causes “habitual shoulder dislocation” because of tears in the ligaments and glenoid of the shoulder capsule caused by the dislocation. Since this tear is difficult to heal through conservative treatment, the dislocation occurs repeatedly and becomes “habitual”. If the dislocation is not treated effectively for a long period of time, it will cause damage to the cartilage and bony structures in addition to the aforementioned avulsion injury, making treatment more difficult. Repeated dislocations can also significantly aggravate the degenerative changes of the affected shoulder, causing osteoarthritis of the shoulder joint to appear earlier. Therefore, for young patients with shoulder dislocations due to trauma, early surgery should be recommended to repair the torn shoulder capsule ligaments and glenoid labrum to effectively prevent the occurrence of “habitual dislocations”. Once the dislocation has become habitual, early surgery is recommended, as recurrent dislocations can lead to severe bone defects in the shoulder joint and secondary osteoarthritis. The surgical team led by Professor Wang Zimin uses the most advanced international arthroscopic minimally invasive techniques to treat such patients, including arthroscopic bone grafting and rostral transposition surgery, combined with post-operative rehabilitation in stages to help patients regain their confidence in sports and get rid of the nightmare of recurrent dislocations.
Synovial chondromatosis of the shoulder joint
Synovial chondromatosis is not a real tumor, but a rare benign lesion with unknown pathogenesis. The pathogenesis is unknown. It is thought to be formed by reactive proliferation of synovial membrane after trauma or inflammatory stimulation. Chondrocytes are deposited in the synovial membrane, and more blood vessels grow into the synovial membrane, turning into an ossification center, which grows continuously in the form of a long polyp and is attached to the synovial membrane.
The disease is the same as chronic arthritis and intra-articular free body, but the course of the disease is slow, most patients may be asymptomatic in the early stage, lasting for months, years, or even decades, the affected joints gradually appear pain, swelling, functional limitations, foreign body sensation and locking phenomenon when moving the joint, and sometimes can be found in the active mass. The disease is more common in adults (20-40 years old), mostly women.
X-rays show multiple round or oval opaque shadows in the joint area, which may be homogeneous or peripheral in density. The joint space and joint surface generally remain normal. In advanced cases, degenerative degeneration of the bony edges of the joint surfaces can be seen, and CT and MRI can also provide a clear diagnosis.
In patients with significant symptoms, hospital admission is recommended for arthroscopic removal of subacromial chondromas.
Nerve entrapment in the neck and shoulder
Nerve entrapment is caused by a segment of the peripheral nerve or a point or points in the anatomical pathway that has narrow, tough wall structures that both restrict the nerve’s own movement and mechanically compress the nerve, resulting in peripheral nerve injury.
Common cervical and shoulder entrapment syndromes include: 1. Suprascapular nerve entrapment syndrome This condition occurs in males and is more common in the dominant hand. Most patients have a history of direct or indirect trauma to the shoulder. Local examination may reveal atrophy of the supraspinatus and suprascapular muscles, possible disuse atrophy of the deltoid muscle, deep pressure pain in the supraspinatus fossa and pressure pain in the infraspinatus muscle. Abduction, extension, and forward flexion resistance movements of both upper limbs may induce or exacerbate shoulder pain. 2. Scapulodorsal nerve entrapment syndrome is a painful discomfort in the neck, shoulder, back, axilla and lateral chest wall after the scapulodorsal nerve is entrapped, which is easily confused with cervical spondylosis of neurogenic type. The syndrome is caused by compression of the brachial plexus and subclavian vessels around the thoracic outlet surrounded by the 1st rib on both sides. The symptoms of nerve compression include pain, abnormal sensation and numbness, often located in the ulnar nerve distribution area of the fingers and hands, and may also radiate to the upper extremities; in advanced stages, there is loss of sensation, motor weakness, and atrophy of the interosseous and interosseous muscles.
Nerve entrapment is not easy to diagnose, all the more reason to seek expert help and not to take it lightly.
Traumatic/degenerative/infectious arthritis of the shoulder
Any traumatic factor that causes damage to the shoulder cartilage, degenerative factor that causes wear and tear of the shoulder joint surface and narrowing of the joint space, infectious factor (bacterial infection or specific infection such as tuberculosis) or other factor (developmental or autoimmune factor) that causes damage to the joint surface can eventually cause damage to the joint surface of the shoulder joint, decreased joint mobility and significant pain (with or without fever), i.e., arthritis. This is the manifestation of arthritis. These patients are usually older and have weaker joint mobility than younger people, so treatment options can be individualized according to individual disease characteristics, such as conservative, minimally invasive surgery or arthroplasty.
Conclusion
Dear patients, I believe that after the introduction of this article, you must have a more comprehensive understanding of shoulder joint disease. Therefore, when you have such and such shoulder discomfort, don’t take it for granted, don’t listen to hearsay, and don’t try the so-called “prescriptions” and “experience” indiscriminately. The sports injury and arthroscopy team led by Prof. Wang Zimin at Changhai Hospital has been focusing on the treatment of shoulder joint diseases for dozens of years, and countless patients have received satisfactory treatment and recovery here, making it a professional medical institution you can trust.