When people have shoulder pain and limited movement, they think they have “frozen shoulder”, and even some orthopedic surgeons often use the term “frozen shoulder” to diagnose shoulder pain in a general way. Therefore, the diagnosis of “frozen shoulder” is like a large family, which includes not only the scientific definition of “true frozen shoulder”, but also a variety of other diseases such as rotator cuff injury, subacromial impingement, shoulder instability, subacromial bursitis, intra-articular free body, osteoarthritis, etc. Other shoulder joint diseases. Studies have confirmed that the incidence of frozen shoulder is relatively low, and rotator cuff injury is the most prevalent shoulder disorder, followed by subacromial impingement and shoulder instability. The total incidence of these three disorders accounts for almost 70% or more of shoulder disorders. Due to the misconceptions and limitations of these diseases, there are many patients who are misdiagnosed as “frozen shoulder” and suffer from increased pain and treatment errors. We hope that after reading this article, readers will have a scientific understanding of shoulder disorders and treat them correctly, so that we can become stronger. Frozen shoulder Frozen shoulder, also known as “frozen shoulder”, is a primary stiffness of the shoulder joint, which is more prevalent in middle-aged and elderly people around 50 years old. Frozen shoulder is an inflammation of the shoulder joint muscles, tendons, ligaments, joint capsule, and other soft tissues that causes congestion and edema, resulting in aseptic inflammation. In addition to the generally accepted degeneration of the tissues surrounding the joint, the cause of frozen shoulder may also be related to diabetes, cervical spondylosis, and certain cardiovascular and neurological diseases. Those with a history of shoulder joint trauma are prone to develop frozen shoulder. Typical presentation: shoulder pain with limited active and passive movement “frozen shoulder”, a name that graphically describes the impaired active and passive movement of the shoulder joint in all directions in these patients. Patients often feel stiffness in the joint and limited mobility in rotating the arm backward and outward, making daily life affected, such as difficulty in combing hair and putting on and taking off clothes. Wise treatment: staging Patients with frozen shoulder in the acute stage are generally not suitable for massage and surgery. If the pain is intolerable, you can take oral anti-inflammatory and analgesic drugs and apply cold compresses to the affected shoulder. If necessary, local pressure and pain points can be closed. While giving the shoulder joint adequate rest, it should also be supplemented with moderate active exercise to maintain the mobility of the shoulder joint. Some patients with frozen shoulder may improve after a period of conservative treatment, and joint mobility will gradually return. A small number of patients with frozen shoulder can heal on their own. The chronic phase is based on functional exercises such as wall climbing exercises, stick exercises and physical therapy. If the patient’s condition does not improve significantly after 3 to 4 months of the above conventional treatment, surgery should be considered. Minimally invasive arthroscopic surgery is a safe and effective joint adhesion release procedure that has good long-term results in the treatment of frozen shoulder. Rotator Cuff Injury The rotator cuff tissue strengthens the stability of the shoulder joint and protects it, but at the same time, it is a tissue that is susceptible to injury and tear. Rotator cuff injury is a very common degenerative disease of the shoulder joint, and its occurrence is positively correlated with age. It is very common in older people over 60 years of age who have “shoulder pain”, with a prevalence rate of 70%, much higher than that of so-called “frozen shoulder”. In addition, athletes, people with a history of shoulder trauma and those who often lift heavy objects are also prone to rotator cuff injuries. Typical manifestations: waking up in the middle of the night with pain and weakness in lifting Rotator cuff injuries are divided into two types: acute lacerations and chronic strain injuries, with the latter being the most common. Patients with rotator cuff injuries have pain in the neck and shoulder area, with significant pain at night and even waking up in pain; pain when lifting the affected arm, and weakness when abducting or posteriorly extending. Wise treatment: surgical repair If patients with rotator cuff injuries continue to exercise such as “pulling the hoop” or forcibly loosening the shoulder joint, it may cause the rotator cuff tissue fracture to continue to expand, aggravating the condition and even causing disability in severe cases. Patients with a diagnosed rotator cuff injury can undergo an arthroscopic rotator cuff repair, in which several suture anchors are implanted to close the torn rotator cuff tissue. Subacromial impingement Subacromial impingement is a painful condition in the shoulder caused by impingement of the acromion and subacromial bursa tissue at an angle during shoulder abduction and supination. If left untreated, repeated impingement may also affect the rotator cuff attachment point, resulting in a rupture of the rotator cuff tissue, worsening the pain and seriously affecting the patient’s quality of life. Typical manifestations: dull shoulder pain and supination dysfunction Chronic dull shoulder pain that is aggravated by supination or abduction activities. Subacromial impingement is common in older people, people who frequently work with their upper extremities elevated, and sports enthusiasts. Exercises such as badminton, gymnastics, and swimming can lead to subacromial impingement if done improperly. Wise treatment: reduce shoulder activity and surgery if necessary Patients need to reduce shoulder extension exercises and be treated with anti-inflammatory and analgesic medication. Some patients also need minimally invasive arthroscopic surgery to eliminate the causative factors of subacromial impingement. Patients with subacromial impingement who are misdiagnosed as frozen shoulder and undergo certain inappropriate treatments are likely to aggravate the condition, delay treatment, and even cause rotator cuff impingement tear injury. Shoulder instability Professional analysis: Traumatic joint instability is common The shoulder joint is the most mobile and flexible joint in the human body, but its stability is relatively poor because of its large humeral head and shallow scapular fossa, and the weak restriction of the surrounding joint capsule. Traumatic shoulder instability is most common in the young, athletic population. When the shoulder is traumatized or the joint structure degenerates, there can be a symptomatic displacement of the humeral head relative to the shoulder pelvis, i.e., shoulder dislocation or subluxation occurs. If you do not pay attention to protection in later life and sports and often perform large arm movements, such as gymnastics, swimming, throwing, etc., you may develop recurrent shoulder instability, also known as habitual shoulder dislocation. Typical symptoms: shoulder pain, fear of shoulder movement Patients describe vague symptoms, such as shoulder pain in an unclear location, feeling certain abnormalities and discomfort when the arm is moved to certain positions, etc. Patients with recurrent dislocations harbor a fear of daily life and sports and are afraid to fully exercise the shoulder joint. If left untreated, bone defects may develop secondary to the dislocation, leading to bone defective shoulder instability with serious consequences. Wise treatment: Minimally invasive arthroscopic surgery is preferred for recurrence In general, patients with shoulder instability can undergo non-surgical treatment, but the recovery process is long, usually taking about 6 months. If the results are still poor, surgical treatment is required. For patients with recurrent shoulder instability, minimally invasive arthroscopic surgery is the treatment of choice, with a success rate of more than 95 percent. Patients with shoulder instability who are misdiagnosed with frozen shoulder and undergo the wrong rehabilitation treatment may be more prone to dislocation and aggravate their condition.