Here are some of my feelings in the process of soft injuries clinic, in fact, soft injuries in the clinical classification is more inclined to musculoskeletal dysfunction, that is, neck, shoulder, back and leg pain. Seems simple, the actual problem is a lot. First, the diagnosis of soft injuries 1, the audit of the patient’s complaints: in many cases, the complaints of patients with soft injuries is vague, indistinguishable from the site, nature, duration and pain patterns, such as the patient complained of numbness in the upper extremities, when further in the region of the complaints of pain and temperature sensation, muscle and other neurological examination did not have an abnormal finding. In addition some patients will exaggerate the nature of the range of pain, for example, the patient said that the pain is very strong, wherever the pain, further inquiries sleep well, there is no waking up from sleep dreams of pain in the condition, but also a moderate amount of exercise. Sometimes can also be compared by body language and complaints, in diagnostic science does have to believe the patient’s complaints, but it must be screened and verified in order to further guide our diagnosis. 2, the localization of the source of pain: musculoskeletal-induced pain is not distributed according to the somatic segments of the nerves; each muscle has its own different pattern of pain, as do the bones and ligaments. Need to be familiar with the corresponding musculoskeletal dysfunction of the symptomatology characteristics, such as the palmaris longus muscle can be caused by the tingling of the palm surface of the hand, frozen shoulder patients caused by waking up in the middle of the night pain in the muscle is often the supraspinatus muscle, etc., patients with cervicogenic headache, the sternocleidomastoid muscle can be caused by the temporal side of the headache can be accompanied by the visual gradual bright or dark changes. In the process of physical examination, the importance of the trigger point examination. 3, the establishment of logical diagnosis: outpatient soft injury patients to the clinic, the condition has often experienced a long period of evolution, less than a few weeks, more than half a year or more. Therefore, the diagnosis is often a set of pain syndromes, requiring the doctor to repeat logical reasoning about the condition. For example, frozen shoulder tends to evolve according to the following processes: (1) activation and strain at the trigger point of the subscapularis muscle, subscapularis bursitis (2) activation of the trigger point of the vastus lateralis and latissimus dorsi muscles. (3) Trigger point activation in the supraspinatus and teres minor muscles and the development of subacromial bursitis. (4) Adhesive capsulitis, suprascapular nerve entrapment formation, and shoulder pump failure. (5) Local braking, nociceptive sensitization, increased sympathetic excitability (similar to complex regional pain syndrome), and frozen shoulder formation. Second, the treatment of soft injuries Take the frozen shoulder as an example, as mentioned above, because of the rapid activation of trigger points in the deep and superficial muscle groups of the shoulder, the superimposition of the pain patterns of the various muscles, it is difficult to distinguish a single muscle, in addition to the accompanying nerve entrapment and microcirculatory disorders. and a range of neuroendocrine mechanisms triggered by pump failure. Nerve blocks and manipulative mechanical corrections alone are difficult to reverse this condition. What is needed is a systematic treatment program, and it must be pointed out to the patient that the treatment process is longer and requires active cooperation. 1. Immediate treatment: (1) Focus on de-activation of large trigger points. Because trigger points are due to increased excitation of motor endplates and impaired local energy metabolism, oral muscle relaxants and nonsteroidal anti-inflammatory drugs reduce the conditions for trigger point formation. At the same time, improve local blood perfusion to remove metabolites and increase oxygen and energy supply. Warmth is important, as moisture and cold can trigger trigger point activation and lower the threshold for myofascial pain syndrome. Reducing trigger points increases muscle ergonomics. Reduces the ripple effect of frozen shoulder. It also facilitates the finding of critical and central trigger points. (2) Control of adhesive capsulitis is a critical step in reversing the progression of frozen shoulder. Once adhesive capsulitis forms in the shoulder joint, shoulder joint movement will be significantly limited and it is capable of inducing significant nocturnal pain and thumb tenderness. Joint capsule expansion and irrigation are generally used. (3) Slow release of local braking. Local braking is the body’s protective response to the injured area, but the braking stress response can lead to complex regional pain syndrome (severe muscle contracture, osteoporosis, abnormal sweating, and nociceptive sensitization). A stellate ganglion block is usually used. (4) Effective analgesic therapy increases patient compliance. Additionally reduces reciprocal inhibition of the same muscle functional unit by pain. (5) Injection therapy to key trigger points outside of the shoulder musculature and to the central trigger point of the shoulder musculature, the subacromial bursa, improves coordination and stability of the shoulder joint. Promote the thawing of frozen shoulder. 2.Long-term treatment (1) Adjustment of endocrine metabolism, adjustment of blood sugar, blood lipid metabolism, and improvement of blood rheology of the whole body. The incidence of myofascial pain syndrome is significantly higher in patients with hypothyroidism, diabetes mellitus, micronutrient iron deficiency and vitamin B deficiency. (2) The release of joint dysfunction can be performed daily after suprascapular nerve block for full active range of function training, gradually increasing the range of motion. (3) Treatment of bone injuries, tendon injuries are mild, bone injuries are serious. Especially the combination of bone and tendon is easy to be injured, which can be treated by local injection of platelet-rich plasma (PRP), and it is necessary to increase the anti-osteoporosis treatment for the elderly patients to improve the bone quality. (4) Restoration of joint coordination and stability, restoration of compensation is easy and stabilization of compensation is difficult. (5) Adjustment of head forward extension, shoulder closing body posture, eliminating the persistent factor of myofascial pain. In summary, the treatment of soft injuries involves all aspects and requires a complete, systematic and comprehensive treatment to cure the disease. Not only the visualization of the therapeutic effect at the time, but also a good prognosis in the long term.