General concept of periarthritis of the shoulder joint
Periarthritis is a degenerative or chronic aseptic inflammation of the soft tissues surrounding the shoulder joint. In Chinese medicine, it is known as periarthritis of the shoulder, locking shoulder, shoulder coagulation, rostral synostosis, frozen shoulder, old age shoulder, 50th shoulder and so on. It is mostly caused by wind and cold and trauma, mostly occurs in middle-aged and elderly people, and is more common in women. It is often triggered by weather changes and exertion, and the pain worsens at night. It is often difficult to fall asleep because of the pain or wake up with pain just after falling asleep, and cannot lie on the affected side. The onset of periarthritis is mainly unilateral, but occasionally bilateral involvement is seen. Due to contracture, hyperplasia, hypertrophy and adhesion of the soft tissues around the shoulder joint after the inflammatory phase, the shoulder joint is severely limited in its activities such as supination, abduction, internal rotation and dorsiflexion. There are varying degrees of pressure pain in the anterior, lateral and posterior aspects of the shoulder joint. In the later stage, the shoulder joint is stiff and active and passive activities are limited. Muscle atrophy may occur. Some patients may recover from the disease without medical treatment, and there are few sequelae after treatment. X-rays are often not abnormal during the disease.
1.What causes periarthritis of the shoulder joint?
The shoulder joint is the joint with the largest range of motion of any joint in the body. The joint capsule is loose, the fluid supply to the joint is poor, and degenerative changes occur as we age.
2.How is periarthritis of the shoulder joint classified in China?
There are different international classifications of periarthritis of the shoulder joint. Based on the reference of foreign classifications and the actual situation of domestic cases, experts and scholars in China classify it according to the location, nature and clinical manifestations of the disease as follows.
(1) Frozen shoulder.
(2) Rotator cuff lesion.
(3) Rotator cuff lesions: including supraspinatus tendinopathy (supraspinatus tendinitis, calcific supraspinatus tendinitis, supraspinatus tendon rupture), infraspinatus tendinitis, and small round tendinitis.
(4) Long head biceps tendinitis and tenosynovitis.
(5) Subacromial subacromial bursitis (also known as subdeltoid subacromial bursitis).
(6) Acromioclavicular joint lesion.
(7) Sternoclavicular arthritis.
(8) Shoulder instability (including instability of the shoulder joint due to developmental or injury-induced defects in the bone structure, glenoid labral lesions, excessive laxity of the joint capsule or ligaments, and paralysis of the muscles surrounding the shoulder.
(9) Fibrous tissue inflammation of the shoulder.
(10) Other periapical lesions (including shoulder contusion, subacromial impingement syndrome, suprascapular nerve entrapment syndrome, deltoid tendonitis, etc.).
3.Diagnostic basis of periarthritis of shoulder joint
(1) Chronic strain injury, trauma to the tendons and bones, lack of qi and blood due to wind, cold and dampness.
(2) The age of onset is around 50 years old, the incidence is higher in women than in men, more in the left shoulder than in the right shoulder, mostly in manual laborers, and mostly chronic.
(3) Pain around the shoulder, more so at night, often triggered by weather changes and exertion, and shoulder joint dysfunction.
(4) Shoulder muscle atrophy, pressure pain in the anterior, posterior and lateral shoulder, limitation of abduction function, and the typical “abductor shoulder phenomenon”.
(5) X-ray examination is mostly negative, and osteoporosis can be seen in those who have had the disease for a long time.
4.What are the symptoms of periarthritis of the shoulder?
Frozen shoulder is a condition that is characterized by unilateral or bilateral shoulder joint pain and movement limitation. In the early stage, the pain is paroxysmal, often triggered by weather changes and exertion, and it worsens at night. Further development of the pain is characterized by functional restriction, with the shoulder and arm on the affected side being stagnant together, and activities such as abduction, extension, flexion and rotation of the shoulder joint being significantly restricted, more often on the left side than on the right, and occasionally both sides are involved at the same time. The pain is diffuse and is more common in women than men. Resting pain is also a characteristic feature of the disease, which is mild during the day and heavy at night, and may be relieved by a little movement of the shoulder joint in the morning. There is pressure pain in the anterior, lateral and posterior parts of the shoulder joint, with the most obvious pressure pain in the long head of the biceps tendon. There is also pressure pain at the subacromial and deltoid stops. The shoulder joint is stiff and active and passive activities are limited. Some patients heal spontaneously without any treatment. This self-healing phenomenon seems to be related to the stabilization of the endocrine system through self-regulation after menopause.
5.What are the treatments for periarthritis of the shoulder?
(1) Medication: It can only stop the pain, but not cure it. Long-term use is prone to dependence and toxic side effects, which are not only unhelpful but also stimulate the stomach and intestines and damage the liver and kidneys. The above-mentioned western medicine is very common, and the domestic Lizheng pain relief patch is also selling very well, and the clinical effect is very good in major hospitals, and the response is also good in curing frozen shoulder patients.
(2) Traction therapy: Long-term clinical trials in the medical field have proven that traction therapy can only relieve pain for most patients.
(3) Physiotherapy: Physiotherapy includes electric therapy, infrared radiation, heat therapy, etc. All patients who have undergone physiotherapy know that they will be more comfortable when doing physiotherapy, and will be the same as before after not doing it.
(4) Tui Na treatment: The purpose is basically the same as that of physical therapy. It is to relieve the patient’s clinical symptoms mainly, rather than the root cause of the means.
(5) Closed therapy: commonly known as “closed injection”, it is to inject drugs directly into the spinal canal or around the nerve roots to achieve local anesthesia for pain relief. The symptoms will return immediately after the effect of closure.
(6) Surgical treatment: Due to the strict requirements of indications, less than 5% of the population is clinically suitable for surgery, plus the high cost, trauma, long recovery period and easy recurrence, so it cannot be fully promoted.
6.How to prevent the occurrence of periarthritis of the shoulder in daily life?
(1) Pay attention to the cold and keep warm, especially when sleeping to avoid the shoulder getting cold.
(2) Prevent trauma to the shoulder joint and arm.
(3) Avoid living or working in dark and humid places for a long time.
(4) Strengthen functional exercises, especially rotational movements of the shoulder joint.
(5) Avoid chronic strain and accumulative injury caused by long-term poor posture.
(6) 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.
7.What is the matter with shoulder joint popping?
Some people often hear a “rattling” sound in the shoulder joint when they work or exercise. Although it is not painful, the shoulder joint is not very flexible when it moves. In most people, this sound is not obvious, while in some people it sounds clear. Most joint popping is physiologic. When a joint moves, there is always friction between the joint surfaces, between the cartilage pads and the joint surfaces, between the tendons and the joint capsule, etc., and a sound is made. The sound does not cause discomfort in other parts of the body and is not harmful to the body and does not require special treatment. However, some people may experience pain, swelling, and other symptoms when their joints are rattling, so they need to go to the hospital for detailed diagnosis and treatment.