Periarthritis of the shoulder joint
It is also known as frozen shoulder, frozen shoulder, fifty shoulder, adhesive shoulder arthritis, etc. It is a chronic injury caused by soft tissue lesions around the shoulder joint. It is a chronic injury caused by soft tissue lesions around the shoulder joint that causes adhesions inside and outside the shoulder joint, resulting in shoulder pain and activity dysfunction. It is more common in women over 40 years old, and the ratio of female:male is 3:1, with more left shoulder than right shoulder.
It is characterized by shoulder pain and shoulder joint dysfunction. Supination and posterior extension are important. The symptoms are mild and severe. After a certain period of time, the pain disappears from heavy to light and heals itself.
Etiology: The etiology is not very clear, but it is generally believed that:
1. Degenerative changes in the soft tissues of the shoulder make it less able to withstand external forces. For example: subacromial bursitis, supraspinatus tendinitis, biceps longus tendinitis, joint tendon (the most stressed, also known as rotator cuff), etc.
2.On the basis of degeneration, the shoulder is overactive, producing chronic injury.
3.The shoulder and upper extremity are braked for too long for various reasons, and the periapical tissues adhere and atrophy.
4.Acute injury to the shoulder, improper treatment.
5.Other diseases that can cause shoulder pain, long-term failure to heal, persistent spasm and ischemia of shoulder muscle tissue.
Pathology :Generally divided into three stages:
Early stage – coagulation stage: The shoulder is located in the shoulder joint capsule tightness, adhesions occur between the long head tendon of biceps and tendon sheath.
Mid-stage – frozen stage: In addition to the severe contracture of the joint capsule, all the tissues around the joint are involved in progressive degeneration, the synovial membrane is congested and edematous, thickened, the tissues lose elasticity, the periapical ligaments and tendons are contracted, and the shoulder joint movement is limited.
Later stage – thawing stage: ①After about 7-12 months, the inflammation subsides, the pain disappears, the shoulder joint function gradually recovers, and the frozen shoulder tends to improve. ②If the adhesions are heavy, the pain disappears. However, it is more difficult to recover the joint function.
Clinical manifestations:
1.Most of them have no history of trauma, a few have a history of minor trauma, or a history of cold after exertion, and it is more common in women over 40 years old.
2. The pain is mainly in the shoulder, and the shoulder joint activity is impaired. The pain is mostly located in the front and outside of the shoulder, and can radiate to the middle part of the upper arm and the scapular area. The pain increases at night and affects the sleep. The pain is often caused by turning over and waking up, and the activity of the shoulder joint can induce severe pain, especially when abducting and rotating and extending.
On physical examination, there is atrophy of the shoulder muscles, and there is pressure pain at the stopping point of the deltoid muscle under the shoulder peak in front of and behind the shoulder, and the pressure pain is most obvious at the long head of the biceps tendon.
4. x-ray: early stage may be abnormal, shoulder arthrography may show joint capsule contracture, later stage may see osteoporosis
In later stages, osteoporosis or calcification of the supraspinatus tendon and subacromial bursa may be seen.
Differential diagnosis :
1, cervical spondylosis: cervical spondylosis can induce frozen shoulder, cervical spondylosis exists with neural localization signs, abnormal nerve reflexes and cervical signs.
2. Shoulder tumor: x-Ray films should be taken to exclude bone lesions and soft tissue lesions. Pain and laboratory tests for tumor.
Treatment :
1.Physiotherapy, acupuncture, tui-na, massage, manual relaxation under anesthesia.
2.Local seal.
3.Anti-inflammatory and analgesic drugs such as ibuprofen tablets, and herbal medicines to relax the tendons and activate the blood such as stretching tablets.
4.Functional exercise. This is very important, it plays an important role in the functional recovery of the shoulder, and should be adhered to.
5.Treatment of the original disease
6.Cut the contracted rostro-humeral ligament.