It is a chronic aseptic inflammatory disease caused by injury and degeneration of the shoulder capsule and the soft tissues surrounding the joint, with shoulder pain, motor dysfunction and muscle atrophy as the main clinical manifestations. It is also known as “fifty shoulder”, “shoulder coagulation” and “frozen shoulder”. It is more common in manual workers and is more common unilaterally.
Causes
1. Shoulder causes
(1) The disease mostly occurs in middle-aged and elderly people over 40 years old, with degenerative soft tissue lesions and weakened ability to withstand various external forces.
(2) Chronic injurious forces resulting from long-term overactivity, poor posture, etc.
(3) Prolonged shoulder immobilization after upper extremity trauma, secondary atrophy and adhesion of periapical tissues.
(4) Improper treatment after acute contusion or strain on the shoulder, etc.
2.Extra-shoulder factors
Cervical spondylosis, heart, lung and biliary tract diseases occur in the shoulder involvement pain, because the original disease does not heal for a long time so that the shoulder muscle persistent spasm, ischemia and the formation of inflammatory lesions, transformed into the real frozen shoulder.
Clinical manifestations
1.History of shoulder trauma, strain injury or feeling wind and cold.
2.Shoulder pain
(1) Shoulder pain is often felt at the beginning, the pain can be acute, and is mostly chronic often triggered by exertion and weather changes.
(2) The pain is paroxysmal at the beginning, but gradually develops into persistent at the later stage, and gradually worsens, with lighter days and heavier nights, even unable to sleep.
(3) The pain can be severe after the shoulder is strained or collided.
(4) The pain may spread to the neck or elbow.
3.Dysfunction
(1) The function of the shoulder joint can be limited in all directions.
(2) Mostly due to pain in the early stage, but mostly due to extensive adhesions in the later stage.
(3) Restriction of abduction, internal rotation and posterior extension.
(4) The phenomenon of “anti-shoulder” appears.
(5) In severe cases, the function of the elbow joint is also limited, and the flexed elbow cannot touch the opposite shoulder, making it difficult to complete combing hair and washing face.
(6) In the later stage, the scapular band muscle and upper arm muscle group atrophy to different degrees, the shoulder joint activity is severely restricted and the pain is reduced.
4.Pressure pain
Most of the patients can feel obvious pressure points around the shoulder joint, mostly at the long head biceps tendon groove, subacromial bursa, rostral process, supraspinatus attachment point, etc.
5. Fear of cold
Many patients use cotton pads to wrap their shoulders all year round, and even in the summer, they are afraid to blow the wind on their shoulders.
Examination
X-ray and MRI examination of the shoulder joint are mainly used for this disease.
1.X-ray examination
(1) The characteristic change in the early stage is that the subacromial fatty line is blurred and deformed or even disappears. The subacromial fatty line is the linear projection of a thin layer of fatty tissue on the subdeltoid fascia on the X-ray film. When the shoulder joint is excessively internally rotated, the fatty tissue is in a tangential position and shows a linear shape. In the early stage of frozen shoulder, when the soft tissue of the shoulder is congested and edematous, the contrast of the soft tissue on the X-ray film decreases, and the fatty line under the shoulder peak is deformed or even disappears.
(2) In the middle to late stage, soft tissue calcification in the shoulder is seen, and the X-ray shows calcified spots of light and uneven density in the joint capsule, synovial bursa, supraspinatus tendon, and long head tendon of biceps. In the advanced stage of the disease, the calcification shadow is dense and sharp on X-ray, and in some cases, large nodular osteophytes and bone redundancy can be seen. In addition, osteoporosis, joint end hyperplasia or bone redundancy or narrowing of the joint space can be seen in the acromioclavicular joint.
2.MRI examination of shoulder joint
MRI examination of the shoulder joint can determine whether the signal of the structures around the shoulder joint is normal and whether there is inflammation, and can be an effective method to determine the location of the lesion and differential diagnosis.
Diagnostic basis
1. It occurs mostly in middle-aged and elderly people, with chronic onset or obvious history of trauma.
2.Soreness and dull pain in the shoulder, generally unable to complain of a fixed site of arthralgia, which may radiate to the ipsilateral upper arm in severe cases, with obvious nocturnal pain, which may be relieved in later stages.
3.Active and passive activities of the shoulder joint are limited, mainly abduction, supination and internal rotation, but no pain during pulling movements.
4. There is at least one or more pressure pain outside the acromion, in the groove between the humeral tuberosities of the external rostral process in front of the shoulder, in the acromion and behind the acromion, with deltoid atrophy at a later stage, without joint impingement pain.
5.X-ray examination: early negative, older or longer duration of disease, X-ray plain film can see the shoulder osteoporosis, or supraspinatus tendon, subacromial bursa calcification signs, joint gap becomes
Narrowing/widening of the joint space. In atypical cases, MRI of the shoulder joint can be completed to clarify the diagnosis.
Treatment
At present, the main treatment for frozen shoulder in rheumatology is conservative. For example, oral anti-inflammatory and analgesic drugs, rehabilitation therapy, local closure of painful spots, small acupuncture, massage and massage, self-exercise and other comprehensive therapies. At the same time, functional exercises of the joint, including active and passive abduction, rotation, extension and flexion, and circular rotation exercises are performed. When the shoulder pain is significantly reduced but the joint is still stiff, the joint can be released by manipulation under general anesthesia in orthopedics to restore the range of motion of the joint.