Frozen shoulder is a common condition characterized by shoulder joint pain and limited mobility. The disease is more common in women than in men and is more common in manual laborers. If not treated effectively, it may seriously affect the functional activities of the shoulder joint and hinder daily life. In the early stage of the disease, the shoulder joint pain is paroxysmal, often triggered by weather changes and exertion, and then gradually develops into persistent pain, which gradually worsens, with light day and heavy night, unable to sleep at night, unable to lie on the affected side, and limited active and passive activities of the shoulder joint in all directions. When the shoulder is stretched, it can cause severe pain. There may be widespread pressure pain in the shoulder joint that radiates to the neck and elbow, and there may be different degrees of atrophy of the deltoid muscle.
Causes
Shoulder causes
1. The disease mostly occurs in middle-aged and elderly people over 40 years of age. Degeneration of soft tissues and weakening of the ability to withstand various external forces are the basic factors.
2.Chronic injury-causing forces resulting from long-term overactivity and poor posture are the main excitation factors.
3.The shoulder has been fixed for too long after upper limb trauma, and the periapical tissues have secondary atrophy and adhesions.
4.Acute contusion and strain of the shoulder after improper treatment, etc.
Extra-shoulder factors
Cervical spondylosis, shoulder entrapment pain occurring from heart, lung, and biliary tract diseases, and persistent spasm and ischemia of the shoulder muscle due to long-term failure to heal the original disease, resulting in the formation of inflammatory lesions that transform into true frozen shoulder.
Treatment
The principle of treatment is to take appropriate measures for different periods of frozen shoulder, or for the severity of its symptoms. The treatment of frozen shoulder should be mainly conservative. Generally speaking, if the diagnosis is timely and the treatment is appropriate, the course of the disease can be shortened and the motor function can be restored early.
1. In the early stage of frozen shoulder, i.e. the pain phase, the patient’s pain symptoms are heavy. Therefore, the main purpose of treatment is to relieve pain and prevent joint dysfunction. To relieve pain, we can use sling braking method to give the shoulder joint sufficient rest; or rest with closed therapy, inject prednisolone at the most obvious local pressure pain; or use intermittent electric therapy, warm compresses, cold compresses and other physical therapy methods to relieve pain. If necessary, take anti-inflammatory and analgesic drugs internally and apply topical drugs such as antispasmodic and analgesic tincture externally. In the acute stage, it is generally not advisable to use massage and massage methods too early to prevent the pain symptoms from worsening and prolonging the course of the disease. Generally, you can take some active exercises to maintain the mobility of the shoulder joint, and only after the acute period, you can use massage to improve blood circulation and promote local inflammation.
2. During the frozen phase of frozen shoulder, joint dysfunction is the main problem, and pain is often caused by joint movement disorders. The treatment focuses on restoring joint movement function. The treatment used can be physical therapy, Western-style manipulation, massage, medical sports and other measures to release adhesions, expand the range of motion of the shoulder joint, and restore normal joint movement function. For the symptoms of dysfunction, severe frozen shoulder patients can be torn apart from the adhesions if necessary by using a large push-up under anesthesia. During this phase, functional exercises of the shoulder joint should be adhered to. In addition to passive exercises, the patient should actively cooperate and carry out functional training of active exercises, which is an extremely important part of the whole treatment process.
3. During the recovery period of frozen shoulder, the elimination of residual symptoms should be the main focus, and the main principle is to continue to strengthen functional exercises to enhance muscle strength, restore the scapular band muscles that have undergone waste atrophy in the earlier stage, and restore the normal elasticity and contraction function of deltoid muscles and other muscles to achieve comprehensive recovery and relapse prevention.
4. In addition to taking different treatment measures for different disease processes, treatment measures should also be considered for the severity of the frozen shoulder condition. In this regard, the foreign opinion is that the severity of the condition can be determined by the limitation of movement and end sensation due to pain in the passive motion test and guide the treatment. If the patient’s pain occurs before the end sensation during passive motion, then the frozen shoulder is often acute and active motion therapy is not appropriate.
Prevention and treatment measures
1.Pay attention to prevent cold and keep warm
Due to the natural climate change, cold and moisture constantly invade the body, which can make muscle tissue and small blood vessels contraction, muscle contraction for a long time, can produce more metabolic products, such as lactic acid and pain-causing substances gathered, so that muscle tissue stimulation and spasm, a long time to cause muscle cell fibrous degeneration, muscle contraction dysfunction and cause a variety of symptoms. Therefore, it is very important to pay attention to prevent cold and keep warm in daily life, especially to avoid the shoulder from getting cold, in order to prevent frozen shoulder.
2.Strengthen functional exercise
For frozen shoulder, it is especially important to pay attention to the movement of the joint. You can often play tai chi, tai chi sword, gateball, or do exercises at home such as hanging with both arms, using tensioners, dumbbells and swinging with both hands, but pay attention to the amount of exercise so as not to cause damage to the shoulder joint and its surrounding soft tissues.
3.Correct bad posture
Correct bad posture. For people who often work with their shoulders in abduction, they should pay attention to adjusting their posture to avoid chronic strain and accumulative injury caused by long-term bad posture.
4.Pay attention to related diseases
Pay attention to related diseases that can easily cause secondary frozen shoulder, such as diabetes, cervical spondylosis, shoulder and upper limb injuries, thoracic surgery and neurological diseases. People with these diseases should closely observe whether they have shoulder pain symptoms and whether the range of motion of the shoulder joint is reduced, and should carry out active and passive exercises of the shoulder joint in order to maintain the mobility of the shoulder joint.
5.Actively prevent for the healthy side shoulder
For patients who have developed frozen shoulder, in addition to actively treating the affected side, prevention should also be carried out on the healthy side. Some studies have shown that in 40% of patients with frozen shoulder, 5-7 years after the disease, frozen shoulder will occur on the opposite side; in about 12% of patients, bilateral frozen shoulder will occur. Therefore, targeted preventive measures should be taken for the healthy side as well.
6.Functional exercise methods
(1) Wall climbing exercise
Facing the wall, use both hands or the affected hand to slowly climb up along the wall to raise the upper limb as high as possible, and then slowly go back down to the original place, repeatedly.
(2) Pulling hands behind the body
Hands backward, pull the wrist of the affected limb with the healthy hand, gradually pull upward to pick up, repeatedly.
(3) External rotation exercise
Stand with your back against the wall, make a fist with both hands and bend your elbows, do external rotation of the upper arms, try to make the back of the spine close to the wall, and repeat.
(4) Shake the bladder
(5) Bow and arrow stance
Cross your waist with one hand, hold an empty fist with the other hand close to your waist and do a back and forth circular shaking, from small to large amplitude and from slow to fast movements.
Simple rehabilitation therapy
1.In the acute stage or early stage, it is better to take some fixation and analgesic measures to relieve the patient’s pain, such as suspension with a triangular towel, and treatment such as hot compress, physiotherapy or closure of the sick shoulder.
2. The chronic stage is mainly characterized by shoulder joint dysfunction. At this time, functional exercise and massage are the main treatment, together with physical therapy. The main method of rehabilitation for frozen shoulder is medical gymnastics.
(1) Gymnastic exercises: Hold the gymnastic stick with both hands, in front of the body, straighten the arms, and then repeatedly lift them upward with force, extending them as far as possible to the back of the head; behind the body, hold the stick with both hands and lift them upward with force.
(2) finger wall climbing exercises: side or front standing, lift the affected side of the forearm, with the index and middle fingers against the wall, and then slowly along the wall up for wall climbing exercise.
(3) The affected side of the arm up, repeatedly touch the back of the head; the sick side of the hand behind the body, up to touch the back. If the affected arm has difficulty moving, use the healthy hand to help the affected hand to lift.