Treatment of frozen shoulder

  In China, many doctors and even patients are familiar with the name “frozen shoulder”, and unexplained shoulder pain and movement disorders are often attributed to “frozen shoulder”. In fact, the term “frozen shoulder” is not meant to be taken literally. The broad concept includes subacromial bursitis, supraspinatus tendinitis, rotator cuff rupture, biceps tendon and its tenosynovitis, rostral synovitis, frozen shoulder, acromioclavicular joint lesions, etc. The narrow concept only refers to frozen shoulder. The cause and pathogenesis of frozen shoulder is still unclear, but it is a very painful disease with a long course. Although the disease has a certain tendency to heal itself, it is difficult to restore the function of the affected shoulder joint to normal, which has a great impact on the patient’s daily life.  Patients with frozen shoulder have common symptoms, namely: ① pain in or around the shoulder joint, ② inability to lie on the affected side, and impaired shoulder movement, especially when lifting the arm and external rotation. Therefore, the symptoms of frozen shoulder should be considered when there is a long course of shoulder pain, atrophy of the periapical muscles, and significant impairment of shoulder abduction, external rotation, and posterior extension, or even stiffness.  The course of frozen shoulder is traditionally divided into three phases: the coagulation phase, the freezing phase, and the thawing phase. The early stage is the coagulation stage, during which the main symptom is severe pain in the shoulder, which is more pronounced at night and can affect sleep in severe cases. At the same time, the pain can cause protective spasm of the surrounding muscles, which can lead to limitation of joint movement; then it enters the freezing phase, when the pain starts to subside slowly, but the limitation of shoulder movement becomes heavier and heavier; after about 7~12 months, it gradually enters the thawing phase, when there is basically no pain in the shoulder, the local muscles, tendons and blood flow gradually improve, and the local adhesions are gradually absorbed, but many patients have difficulty in moving the shoulder joint. However, it is difficult for many patients to recover the function of the shoulder joint. If the limitation of shoulder joint activity gradually worsens, and the forward lift of the arm does not exceed 90 degrees and the abduction is less than 70 degrees, you should consider manual or surgical correction to return to normal quality of life.  The surgical correction of frozen shoulder includes open surgery and minimally invasive arthroscopic surgery. With recent advances in minimally invasive arthroscopic surgical techniques and equipment, arthroscopic release has gradually become an important tool in the treatment of frozen shoulder stiffness. Arthroscopic surgery is called “keyhole surgery or minimally invasive surgery” and is a major advancement in modern surgery and the future direction of surgery. Compared with the traditional open surgery, it has the following significant advantages: ① real minimally invasive surgery, small incision, about 0.4cm, less postoperative scars, in line with aesthetic requirements; ② clearer diagnosis, more delicate surgery, high safety, surgical results are significantly better than the traditional incision; ③ less tissue damage, fast recovery after surgery, usually the next day can walk and self-care; ④ short hospitalization time, an average of 2 to 4 days, can also be discharged within 24 hours; ⑤ medical treatment, the hospital can be discharged within 24 hours. The average hospital stay is 2-4 days, but can also be discharged within 24 hours; ⑤ The total medical cost is low.  Arthroscopic release of frozen shoulder mainly includes excision of the inflamed synovial membrane at the rotator cuff space, release of the superior glenohumeral ligament, rostro-humeral ligament and anterior joint capsule, release of the subscapularis tendon, and separation of the subacromial joint capsule, which is effective in relieving the pain of frozen shoulder and restoring joint mobility.  In conclusion, frozen shoulder is a relatively common disease characterized by shoulder pain and limitation of motion, which usually heals spontaneously. In the early stages of the disease, a combination of analgesics, intra-articular steroid injections and physical therapy can be used. Most patients can be controlled with early treatment, but arthroscopic release is a good treatment for some patients who are concerned about the quality of life and want to shorten the natural healing process, or for patients with frozen shoulder whose conservative treatment is ineffective.