The chronic aseptic inflammation of the muscles, tendons, bursae, ligaments, joint capsule and other soft tissues around the shoulder joint caused by degenerative changes in old age, trauma, strain and other factors, results in a group of clinical manifestations with pain and dysfunction of the shoulder joint as the main symptom, which is a multi-site, multi-bursal lesion called periarthritis, also known as frozen shoulder.
Frozen shoulder occurs in people around 50 years old, so it is also known as “fifty shoulder”. It is more common in women (3:1 male to female ratio), more on the left side than on the right side. In the early stage, pain is the main cause, and the pain is mild at night; in the late stage, dysfunction is the main cause, and the limitation of abduction, external rotation and posterior extension is the most obvious.
Causes of frozen shoulder.
The local causes are degenerative lesions of the connective tissue and myofascia around the joint. Subacromial bursitis is the cause of this disease; tenosynovitis of the long head of the biceps muscle is the cause of shoulder pain, muscle weakness and joint braking.
It is caused by degeneration and instability of the cervical intervertebral disc.
Associated pain due to tuberculosis and gastrointestinal disorders or facet diseases involving lesions of the tissues surrounding the shoulder joint.
Hypertension and metabolic disorders that cause congestion and abnormal tension in the tissues surrounding the shoulder joint.
Sympathetic hypertension type.
Overwork, cold, fatigue, mental stimulation and trauma are also causative factors.
Its clinical manifestations and signs are.
Pain: Gradual onset and aggravation of periapical pain, characterized by aggravation after activity, aggravation at night, interfering with sleep, and may wake up in the middle of the night with pain. The pain may spread to the neck, back and upper arm, but most of them do not exceed the elbow joint, and the pain is persistent. There is a relatively fixed pain point. (There are many pressure points around the shoulder joint, mainly at the attachment points of tendons and bone tissues, bursa and tendons, such as the rostral process, inter-nodal groove, subacromial, deltoid stop, infraspinatus muscle group and its joint tendons, etc.)
Functional impairment: The mobility of the shoulder joint on the affected side gradually decreases. Patients feel that the shoulder is stiff, so that it is difficult to perform daily activities such as combing hair, dressing, undressing or wearing a belt.
Muscle atrophy: Abduction, external rotation and arm elevation of the affected shoulder are significantly limited and the pain is aggravated.
Diagnostic criteria.
There is typical periapical pain and significant restriction of shoulder joint movement, the pain of biceps tendon is increased when increasing tension position, X-ray plain film excludes other diseases, and the diagnosis can be made when the age is generally above 50 years. The difference between cervical spondylosis and cervical spondylosis is that cervical spondylosis has typical cervical degeneration signs on radiographs, and periapical pain may also be present, but activity is generally not limited, mostly accompanied by numbness, and the pain may spread to the forearm. Tuberculosis of the shoulder joint and malignant tumor of the upper humerus can be identified on radiographs. Rheumatoid arthritis and gouty arthritis have manifestations of sequential or simultaneous involvement of other joints throughout the body.
There are several treatment methods.
Frozen shoulder can heal on its own, but it can take a long time, even up to several years. Early treatment can reduce the pain and significantly shorten the duration of the disease.
General treatment: Oral anti-inflammatory and analgesic drugs, external pain relief creams, safflower oil, Fotonin emulsion, etc. In the acute stage, ice can be applied to the affected area and braking with a sling to avoid severe pain caused by involuntary activities.
Local lesion and intra-articular injection therapy: inject 1% lidocaine and glucocorticoid 2-5ml at the pressure point, 2-3 times a week. If the inflammation spreads to the joint cavity, intra-articular injection of the shoulder cavity is feasible, and the puncture point is below the rostral process.
Nerve block: It can be preferred for those with unclear pressure points around the shoulder, and can also be applied alternately with local lesion injection. Commonly used nerve blocks include suprascapular nerve block, axillary nerve block, stellate ganglion block, etc. In combination with cervical spondylosis, stellate ganglion block and paracervical muscle injection can be alternately applied.
Small needle knife therapy: under local anesthesia, a small needle knife is stabbed into the painful spot where hard knots and cords can be palpated, and the adhesions are peeled off and released in the direction of the muscle fibers.
Instrument therapy: After the acute period, physical therapy such as transcutaneous electrical stimulation, linear polarized light near infrared, ultrasound and magnetic therapy can be used.
Other therapies: extracorporeal shock wave therapy can be used for old, calcified tendonitis with good results.
Health care tips.
Pay attention to the local warmth of the shoulder joint, add or remove clothes at any time with the climate change, avoid cold and wind, and live in a humid place for a long time.
Avoid overexertion, heavy lifting and local warmth.
Strengthen the activities of all joints and outdoor exercise, pay attention to safety and prevent accidental injury.
The elderly should strengthen nutrition and take calcium supplements, such as milk, eggs, soy products, etc., or take oral calcium supplements.
Frozen shoulder precautions.
When doing upper limb lifting or backward rotation, you should rub and press the shoulder with small angle swing first to make the shoulder muscles relax before performing the action, so as not to strain the shoulder tissues.
When doing the upper limb lift or back rotation, you should first rub and press the shoulder and swing at a small angle to relax the shoulder muscles before performing the movement, so as not to strain the shoulder tissues.
Usually you can choose to do some auxiliary upper limb (shoulder) exercise activities, but the intensity should not be too large, and should be gradual, so as not to cause muscle strain.
1.Finger climbing wall – stand facing the wall, use the affected finger to slowly climb up along the wall, make the upper limb as high as possible, to the maximum, make a mark on the wall, and then slowly go back down to the original place, repeatedly, gradually increase the height.
2.Spinning shoulder action – stand, the affected limb naturally drops, elbow straight, the affected arm from the front upward backward circle, the amplitude from small to large, repeated several times.
3.Pull the hand behind the body – stand naturally, in the posture of internal rotation and backward extension of the affected upper limb, the healthy hand pulls the affected hand or wrist, gradually pulling it toward the healthy side and pulling it upward.
4, head and pillow hands – supine position, both hands crossed fingers, palms up, placed on the back of the head (occipital), first make the two elbows as far as possible inward, and then as far as possible outward.
5, combing action – standing or supine can be, the affected side of the elbow flexion, forearm forward up and rotate forward (palm up), try to use the elbow to rub the forehead, that is, sweat action.
6, posterior extension touch spine – natural standing, in the affected side of the upper limb inward rotation and posterior extension of the posture, flex the elbow, flex the wrist, middle finger finger touch spinal spine, from the bottom gradually up to the maximum after staying still, 2 minutes and then slowly back down to the original place, repeatedly, gradually increase the height.
Please note that the above 6 movements do not have to be done every time, you can choose to exercise alternately according to your specific situation, 3-5 times a day, generally do each movement about 30 times, as long as you are persistent, it will be very beneficial to the prevention and treatment of frozen shoulder.
The dangers of frozen shoulder.
(1) When it develops, you cannot work normally and your life will be affected, and it will cause nerve damage and numbness in your hands due to long-term nerve compression.
(2) Long-term compression of blood vessels can lead to poor blood flow in the shoulder and hand, which can lead to muscle atrophy in severe cases.
(3) Due to the extensive adhesions around the joint, the movement of the joint in all directions is obviously restricted, and even causes stiffness of the joint, resulting in “frozen shoulder”.
What should be noted during massage and exercise?
(1) You must be persistent and progressive in order to get results.
(2) According to the individual’s physical strength, age difference, the severity of the disease and other different situations, choose a different exercise mode.
(3) The time, frequency and amount of exercise should vary from person to person. The amount of exercise from small to large, gradually increase, not too hasty.
(4) exercise time should be based on personal circumstances, to the morning and before bedtime is preferred.
(5) the force should be soft and gentle, do not force too hard. That is, the movement is moderate, to try to make the whole body muscles, joints are exercised.