Frozen shoulder of cervical origin is a disease mainly characterized by shoulder and arm pain and shoulder joint movement disorder, which is a common disease in orthopedics and traumatology. Since 2005, the authors have been using quadruple therapy, such as sensitive point release, internal Chinese medicine, manual rehabilitation and functional rehabilitation exercises, with satisfactory results, as reported below.
1. General information
1.1 Clinical data This group of 98 cases, 38 males and 60 females, aged 36-78 years old, average 48.7 years old. There were 72 cases of right shoulder and 26 cases of left shoulder. The duration of the disease was within three months in 20 cases, 3-6 months in 46 cases, and 6 months-1 year in 32 cases, with an average of 3.8 months.
Symptoms and signs: all patients had painful shoulder joint activities, 38 cases had dull pain at rest, aggravated at night, 19 cases had radiating pain, 70 cases had significant local pressure pain, abduction, supination and posterior extension were limited to different degrees. 25 cases had significant limitation in forward flexion, 14 cases had significant limitation in internal rotation, 12 cases had significant limitation in internal retraction, and 23 cases had mild deltoid atrophy. In 23 cases, there was osteoporosis of the shoulder.
1.2 Diagnostic criteria Refer to the diagnostic criteria of frozen shoulder in the Diagnostic and Efficacy Criteria of Chinese Medicine Evidence formulated by the State Administration of Traditional Chinese Medicine in 1994.
① Chronic strain, traumatic injury to tendons and bones, deficiency of qi and blood, and repeated exposure to wind, cold and dampness;
(2) The age of onset is around 50 years old, the incidence is higher in women than in men, the right shoulder is more than the left shoulder, it is more frequent in manual laborers, and it is chronic;
③ Pain around the shoulder, more so at night, often triggered by weather changes and exertion, shoulder joint dysfunction;
(4) Shoulder muscle atrophy, pressure pain in the anterior, posterior and lateral shoulder, limitation of abduction function, and typical “shoulder carrying” phenomenon;
⑤ X-ray examination is mostly negative, and osteoporosis can be seen in those with long duration of disease.
2.Treatment methods and steps
2.1 Relaxation of sensitive points
①Prescription of relaxation solution: 50 mg of trimethoprim injection, 5 ml of 2% lidocaine injection, 100 mg of vitamin B1 injection, 0.5 mg of vitamin B12 injection, 10 ml of saline injection.
②Location of sensitive points: point A was the groove between the long head nodes of the biceps brachii; point B was the subacromial peak; point C was about 1M above the greater trochanter; point D was the pressure pain of the supraspinatus fossa; point E was the pressure pain of the infraspinatus fossa; point F was the pressure pain of the lesser round muscle; point G was the pressure pain of the deltoid muscle. 3-5 pressure points were selected from the above sensitive points and injected with 3-5 ml of drug in a radial pattern.
ml, once a week, 4 times as a course of treatment.
2.2 Self-designed decongestant soup is based on 15g of thorny mustard, 10g of windbreak, 15g of qiangwu, 15g of doklam, 20g of kudzu, 10g of angelica, 30g of astragalus, 10g of cinnamon stick, 15g of white peony, 20g of chicken blood vine, 15g of wujiapi, 10g of ginger, 10g of cow’s knee, 10g of safflower, 10g of hedgehog, 10g of licorice, and can be reduced according to the condition. Take warm.
2.3 The patient should be seated with both upper limbs hanging down naturally, the operator should stand behind the patient, the patient’s back should lean on the operator, the operator should put one hand on the affected shoulder, hold the distal end of the upper arm of the affected limb with the other hand, slowly rotate the upper arm of the affected limb outward, forward, inward and backward, and do the release of the shoulder joint in different directions. The release action should be gentle and consistent, and should not be rough to avoid tearing the biceps tendon or even fracturing the surgical neck of the humerus.
The release can be repeated several times, so that the restricted shoulder abduction, forward flexion, internal contraction and posterior extension can reach the normal range as far as possible.
2.4 Rehabilitation exercises
(1) Forward flexion and wall climbing method: The patient should stand with feet naturally apart, shoulder-width apart, toes against the wall, and climb the wall with the fingers and palm roots on the affected side, gradually from low to high, so that the shoulder and arm muscles have a sore and painful involvement;
(ii) Outward ear grasping method: the patient sits or stands, the healthy hand supports the affected elbow, so that the affected hand goes through the top of the head to grasp the healthy side of the ear, gradually reaching the cheek;
③Internal shoulder method: the patient sits or stands, the affected elbow is flexed, the healthy hand supports the affected elbow and touches the healthy side of the chest to the shoulder, gradually reaching the middle of the upper scapula;
④Back stretching and back grasping method: the patient sits or stands, the affected hand passes through the affected side of the waist, uses the fingers to grasp the healthy side of the waist and back, gradually reaches the upper middle of the healthy side of the scapula, this action is more difficult, can ask their family members to help practice; ⑤Bending and circling method: the patient stands with the feet naturally apart, slightly bending, tying a weight of about 2-3K to the affected shoulder and wrist, relaxing the shoulder and upper arm, using the shoulder joint as the central axis for circling action. Active exercise is functional exercise and should be adhered to 3-5 times a day, with each activity gradually increasing. Patients are advised to exercise at their own discretion, gradually and persistently, and are sure to get good results.
3.Treatment results
3.1 Efficacy evaluation criteria: Cured: shoulder pain disappeared, shoulder joint function completely or basically recovered; Improved: shoulder pain reduced, activity function improved; Not cured: symptoms did not improve.
3.2 Evaluation of efficacy All cases were treated for one course of treatment (30 days) and were followed up systematically for 6 to 18 months, with an average of 12 months. 79 cases were cured, accounting for 80.61%, 17 cases were improved, accounting for 17.35%, and 2 cases were not cured, with an overall effective rate of 97.96%.
4. Discussion
Cervicogenic “periarthritis” is caused by trauma, strain and other causes of cervical small joint misalignment and the development of long-standing osteophytes.
It is called cervicogenic “frozen shoulder” when one or more muscles in the innervated area of the cervical nerve spasm due to stimulation, pulling or compression of the cervical nerve on one or both sides, resulting in pain.
It is a nerve root type of cervical spondylosis, but the pain is limited to the shoulder joint. In the early stage, the pain and discomfort in the neck and shoulder are slightly relieved by activities; in the middle stage, the symptoms are aggravated by persistent pain, which can cause severe pain when moving the shoulder, limited shoulder joint activities and obvious tenderness; in the late stage, although the pain is relieved, the shoulder joint activities are severely limited, the muscles around the shoulder are atrophied, the affected area is afraid of wind, cold, soreness and weakness, and in severe cases, sleep is affected. All the cases in this group were in the middle or late stage.
The formation of cervicogenic “frozen shoulder” is either due to trauma, wind, cold and dampness, or the loss of maintenance of tendons in old age, resulting in inflammation of the soft tissues around the shoulder, which eventually leads to a vicious cycle of “inflammation-pain-restricted movement-adhesion and contracture-inflammation and pain-aggravation of dysfunction”. process. Therefore, the “Three Causes Formula” says: “three qi invade the meridians”, “in the bone is heavy and does not lift, in the veins is blood condensation does not flow, in the tendons is flexion and not God, in the meat is not benevolent, in the skin is cold, when cold is urgent”.
The inflammation and adhesion contracture of the shoulder capsule is the crux of the disease, “if it is not loosened, it hurts, if it is loosened, it does not hurt”, so the treatment of this disease focuses on releasing the inflammation and adhesion contracture of the shoulder capsule. In this method, the soft tissue inflammation and adhesion contracture are treated by the sensitive point release method, in which [3] point A is the site of biceps long head tenosynovitis, which affects shoulder abduction and flexion and rotation; point B is the site of subacromial bursa, which affects shoulder abduction and external rotation; point C is the site of supraspinatus tendon calcification, which affects shoulder abduction and shoulder lift and internal rotation;
Point D is the starting point of supraspinatus, which affects shoulder abduction; point E is the starting point of infraspinatus, which affects shoulder abduction and adduction; point H is located below infraspinatus, which can limit shoulder external rotation; point G is the stop point of deltoid, which can limit shoulder abduction forward flexion and back extension. Because of the good anti-inflammatory and analgesic effect of the sensitive point release solution, not only can the inflammation and pain be well controlled, but also create favorable conditions for the implementation of manipulation.
The key is to release the adhesion contracture of the joint capsule and return the humeral head to its original anatomical position. The operator uses the technique to drive the affected shoulder to adduction, abduction, forward flexion and extension and rotation, so that the adhesion contracted tendons and ligaments can be fully released. At the same time, the patient was instructed to perform functional rehabilitation exercises, so that the adhesions and contractures of the soft tissues around the shoulder joint could be loosened in all aspects, and supplemented with anticoagulant soup, which has the effect of activating blood circulation, removing blood stasis and relieving pain, to facilitate the absorption of inflammation and consolidate the therapeutic effect.
In conclusion, the aseptic inflammation of soft tissues is relieved through the release of sensitive points, the adhesions and contractures of tendons and ligaments are solved through manipulation and functional rehabilitation exercises, and the treatment is complemented by the blood circulation, blood stasis, and pain relief of the channels and meridians with Xie Ning Tang to consolidate the therapeutic effect. In short, the treatment of frozen shoulder with quadruple therapy is worthy of clinical promotion because of its reasonable formula, scientific approach, cooperation between doctors and patients, and the ability to address the disease mechanism.