Introduction to frozen shoulder
Frozen shoulder is also known as periarthritis of the shoulder joint. It occurs in people around 50 years old, so it is also known as fifty shoulder; after the disease, the shoulder joint cannot move, as if it is frozen or frozen, so it is also known as frozen shoulder and shoulder condensation. It is a chronic and specific inflammation of the shoulder joint capsule and its surrounding ligaments, tendons and bursa, which is characterized by gradual pain in the shoulder, especially at night, and gradually worsens, with the function of shoulder joint movement being restricted and getting worse, gradually relieving after reaching a certain level, until finally recovering completely. Frozen shoulder is a common condition that is characterized by shoulder joint pain and limited mobility. The disease is more common in women than in men at the age of 50 and is more common in manual laborers. If not treated effectively, it may seriously affect the functional activities of the shoulder joint. There may be widespread pressure pain in the shoulder joint that radiates to the neck and elbow, and there may be varying degrees of atrophy of the deltoid muscle.
What is Frozen Shoulder?
The shoulder joint is the joint with the largest range of motion of any joint in the body. The joint capsule is relatively loose and the stability of the joint is mostly maintained by the strength of the muscles, muscles and ligaments around the joint. Because of the poor blood supply to the tendons and the degenerative changes that occur with age, and because the shoulder joint moves so frequently in life, the surrounding soft tissues are often subjected to friction and compression from various sources, making it susceptible to chronic strain injury.
The shoulder joint is prone to extensive aseptic inflammation, and there is no definite conclusion on its cause.
The shoulder joint is a complex of multiple joints, and these joints rely on the surrounding soft tissues such as ligaments, tendons and muscles to maintain their stability and overcome the gravity of the upper limb. For example, the area of the humeral head of the glenohumeral joint is larger than the area of the joint pelvis, and the humeral head needs to do multi-directional movement and sliding in the joint, and its stability is mainly maintained by the relaxed joint capsule. When lifting, pulling or carrying or lifting heavy objects, the joint capsule is subjected to the greatest force and is easily strained or degenerated by long-term fatigue stimulation, which eventually leads to chronic aseptic inflammation.
2, and bursa distribution characteristics of the shoulder joint around the distribution of numerous bursae, such as the subacromial bursa, subdeltoid bursa, rostral bursa and subscapularis, pectoralis major, latissimus dorsi, large round muscle and other bursae in the humerus between the large and small nodules on both sides of the groove, these bursae in the shoulder joint activities, easy to be extruded by external forces, collision, and when the shoulder joint frequent activities, its own tendons also on its bursa When the shoulder joint moves frequently, its own tendons also stimulate its bursa, and the accumulated wear and tear and stimulation will affect its lubrication mechanism, which eventually develops into chronic aseptic inflammation.
3, and muscle distribution characteristics of the shoulder distribution of rich muscles, in the shoulder joint around more and concentrated muscle stress points, forming a cap sleeve, such as the rostral process for the short head of the biceps, rostro-humeral muscle, pectoralis minor muscle attachment point, humeral tuberosity for the subscapularis, supraspinatus, infraspinatus and small round muscle stop, these parts are susceptible to super-strong external force, tearing or cumulative fatigue injury and degeneration, and eventually lead to aseptic inflammation.
4, and the nature of the joint function activities related to the shoulder joint movement flexible, large and frequent range of motion, in daily life and work, all the time in the coordination of movement. For example, when brushing teeth, washing face, combing hair, writing, lifting and carrying heavy objects, the soft tissues of the shoulder bear the main weight. When writing, on the surface, the shoulder and arm activities are not obvious, but in reality, the shoulder muscles are still responsible for different coordinated movements such as extension, flexion and rotation. These endless and frequent movements inevitably lead to strains or strains and degeneration of the soft tissues of the shoulder, which will eventually produce sterile inflammation.
In addition, in daily life and work, the shoulder joint has the most opportunities to be attacked by wind, cold and moisture. For example, when it rains, the shoulder is drenched first; when sleeping at night, the shoulder is often exposed outside the quilt and stimulated by the cold. The stimulation of wind, cold and damp will cause vasoconstriction in the local soft tissues, impaired blood circulation, and slowed metabolism, so that long-term stimulation will result in cumulative damage, accelerated degeneration of soft tissues, and eventually sterile inflammation.
What are the common symptoms of frozen shoulder?
1. Shoulder pain: At first, the shoulder is in paroxysmal pain, most of which is chronic, and later the pain gradually increases or stabbing pain, and is continuous. Most patients often complain of waking up with pain in the latter half of the night, unable to sleep, especially unable to lie on the affected side, which is more obvious in cases caused by blood deficiency; if the pain is caused by cold, it is particularly sensitive to climate change.
As the disease progresses, due to long-term disuse, adhesions of the joint capsule and soft tissues around the shoulder, muscle strength gradually decreases, and the rostro-humeral ligament is fixed in the shortened internal rotation position, so that the active and passive activities of the shoulder joint in all directions are limited. In severe cases, the function of the elbow joint can also be affected. When flexing the elbow, the hand cannot touch the ipsilateral shoulder, especially when the arm is extended backwards.
3. Fear of cold: The affected shoulder is afraid of cold, and many patients use cotton pads to wrap their shoulders all year round, and even in summer, the shoulder does not dare to blow.
4. Pressure pain: Most patients can feel obvious pressure pain points around the shoulder joint, mostly in the long head tendon groove of the biceps. The subacromial bursa, rostral process, supraspinatus attachment point, etc.
5.Muscle spasm and atrophy: Spasm of deltoid, supraspinatus and other muscles around the shoulder may appear in the early stage, and disuse muscle atrophy may occur in the late stage, with typical symptoms such as protrusion of the shoulder peak, inconvenience in lifting and unfavorable backbend, etc. At this time, pain symptoms are reduced instead.
6.X-ray and laboratory examination: most of them are normal. In the late stage, some patients can see osteoporosis, but there is no bone destruction, and calcification shadow can be seen under the shoulder peak. Laboratory tests are mostly normal.
What tests should be done for frozen shoulder?
For auxiliary examinations, X-ray and shoulder arthrography can be used for this disease.
I. X-ray examination: one of the purposes of taking X-rays when diagnosing frozen shoulder is as a differential diagnostic tool for shoulder fractures, dislocations, tumors, tuberculosis, and osteoarthritis, rheumatoid and rheumatoid arthritis. However, it is clinically found that about 1/3 of the patients show different characteristic changes on the x-ray film in different stages of frozen shoulder.
1. The characteristic changes in the early stage are mainly the blurring and deformation of the subacromial fat line or even its disappearance. The so-called subacromial fat line is the linear projection of a thin layer of fatty tissue on the subdeltoid fascia on the X-ray. When the shoulder joint is excessively internally rotated, the fatty tissue happens to be in the tangential position and shows a linear shape. In the early stage of frozen shoulder, when the shoulder soft tissue 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 blurred and distorted or even disappears.
2. In the middle and late stages, soft tissue calcification in the shoulder is seen on X-ray, and there are 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, hyperplasia of the joint end, or narrowing of the joint space can be seen in the acromioclavicular joint.
Shoulder arthrography: Shoulder arthrography is an auxiliary test that is performed by injecting a contrast agent into the shoulder cavity and taking an x-ray to locate and confirm the diagnosis of shoulder disease. Generally, 10 ml of 60% pantothenic glucosamine is diluted with 10 ml of 2% lidocaine and 0.5 ml of 1:1000 epinephrine hydrochloride is injected into the joint cavity, and one anterior-posterior standing shoulder internal rotation and external rotation film with the centerline tilted 20 degrees toward the head is taken, and one external rotation and abduction film with the centerline tilted 10 degrees toward the fixed end is taken. The radiographs may show
1. Reduction of the joint capsule, as shown below.
(1) Decrease in joint volume.
(2) Reduction or occlusion of the axillary saphenous fossa.
The subacromial bursa or the long head of the biceps tendon sheath is not visible.
2.Rupture of the joint capsule, the contrast agent spills out from the rupture and presents irregular lamellar or pocket shadows in the extra-articular axillary fossa.
3.Rupture of the subscapularis bursa, the overflowing contrast agent mainly accumulates in the subscapularis fossa and does not go beyond the glenoid margin of the joint.
4, The morphology and volume of the subacromial fluid bursa, the surface morphology of the supraspinatus muscle under the bursal wall, and the rotator cuff injury. It can reliably reflect the rupture of the rotator cuff and the retraction of the severed end, etc.
The main purpose of imaging in frozen shoulder is to understand the location of the lesion and the extent of the lesion before surgical treatment. Sometimes it is also necessary to do shoulder arthrography to accurately understand the condition and location of the disease when certain special conservative treatments are used.
How is frozen shoulder identified?
Frozen shoulder is a degenerative and chronic aseptic inflammation of the shoulder capsule and surrounding muscles, tendons, ligaments, and bursae, characterized by pain and limited movement in and around the shoulder joint, or even stiffness and straightness. Due to the anatomical and functional characteristics of the shoulder joint, some other shoulder pains of different nature often occur inside and outside the joint, which need to be differentiated from frozen shoulder to avoid failure and mismanagement, leading to adverse consequences.
Common clinical conditions associated with shoulder pain include: cervical spondylosis, shoulder dislocation, septic shoulder arthritis, shoulder tuberculosis, shoulder tumors, rheumatoid and rheumatoid arthritis, simple supraspinatus tendon injury, rotator cuff tear, biceps longus tendonitis and tenosynovitis. All of these conditions can be characterized by shoulder pain and limited shoulder joint function. However, because the nature of the disease varies and the location of the lesion varies, there are different concomitant disorders that can be identified. Combined with the different nature of the pain and the different characteristics of the functional activity limitation, and with reference to the auxiliary examination, the differential diagnosis is not difficult.
I. Differentiation of frozen shoulder and shoulder joint tuberculosis.
Shoulder joint tuberculosis is divided into synovial and bony type tuberculosis. Simple synovial type tuberculosis is very rare. Tuberculosis of the right shoulder joint is more common than that of the left. Bone type tuberculosis can be divided into two types: mycotic and dry type, and the symptoms vary according to the type of disease. The progression of the disease is slow, with symptoms appearing gradually. Pain and dysfunction are often the first symptoms. The pain often appears below the deltoid muscle, and it is more painful when abducting and externally rotating. The swelling of the deltoid muscle is most obvious. Sinus tract formation is a late stage manifestation, often penetrating in the weakest part of the joint capsule, i.e., easily in the axilla or near the anterior border of the deltoid. Bone atrophy is the initial radiographic sign of tuberculosis of the shoulder joint, especially in synovial tuberculosis, which can last for a long time. Total joint tuberculosis is the most common form of tuberculosis of the shoulder joint. Bone tuberculosis alone rarely results in impaired or mildly limited bone and joint motion.
Frozen shoulder, also known as periarthritis, occurs after the age of 50 and is characterized by chronic aseptic inflammation of the muscles, tendons, ligaments, bursae, and other soft tissues surrounding the shoulder joint. x-ray findings include osteoporosis of the shoulder joint, cystic degeneration, hyperplasia and sclerosis of the greater tuberosity or part of the shoulder opposite the acromion, and calcification of the surrounding soft tissues.
Early tuberculosis of the shoulder joint and frozen shoulder are not characteristic in terms of clinical manifestations or X-ray manifestations, so they are easily confused.
Differentiation between frozen shoulder and tumor around the shoulder.
Tumors around the shoulder will cause shoulder pain or shoulder arm dysfunction when they grow to a certain stage. The difference with frozen shoulder is that the shoulder pain in the affected area is gradually aggravated, and the painful area is gradually enlarged due to the growth of the tumor. Benign tumors have regular shape, soft texture and good mobility, while malignant tumors have irregular shape, hard texture and immovable. X ray performance varies according to the nature of tumor, growth site and duration of disease. Generally, soft tissue tumors do not appear on X-ray or only the outline is visible. If the tumor encroaches on bone tissue, the X-ray may show different degrees of bone destruction or even pathological fracture.
How is frozen shoulder treated?
Currently, most scholars believe that taking pain medication can only treat the symptoms and temporarily relieve them, but most of them will recur after stopping the medication. The surgical release method can easily cause adhesions after surgery. If the patient can adhere to the functional exercise, the prognosis is quite good.
Massage treatment for frozen shoulder
The steps and methods of self-massage are
1.Use the thumb or palm of the healthy side to massage the front and outside of the affected shoulder joint from top to bottom for about 1-2 minutes, and use your thumb to press the local pain points for a few moments.
2.Press and knead the posterior part of the shoulder joint with the 2nd-4th fingers of the healthy hand for 1-2 minutes.
3.Knead the upper arm muscles of the affected upper limb with the joint action of the thumb and the rest of the fingers on the healthy side, kneading from the bottom to the shoulder, for about 1-2 minutes.
4.You can also massage the affected shoulder in abduction and other functional positions with the above method, while massaging the shoulder joint in all directions.
5.Finally, use the palm of your hand to knead from top to bottom for 1-2 minutes. For the parts of the shoulder that cannot be massaged at the back, use the patting method introduced earlier for treatment.
Self-massage can be carried out once a day, adhere to 1-2 months, there will be better results.
How should frozen shoulder be prevented?
1.Strengthening physical exercise is an effective method to prevent and treat frozen shoulder. Strengthening the shoulder joint muscles can prevent and delay the occurrence and development of frozen shoulder. According to the survey, the chances of frozen shoulder attack decreased a lot among the people with developed shoulder joint muscles and high strength. Therefore, the exercise of strong ligaments and muscles around the shoulder joint is of great significance for the treatment and recovery of frozen shoulder.
2. Cold is often a trigger for frozen shoulder. Therefore, in order to prevent frozen shoulder, middle-aged and elderly people should pay attention to keeping their shoulders warm and cold, and do not let them get cold. Once you get cold, you should not delay treatment.
3.The following is the action for prevention and treatment of frozen shoulder: Eight Duan Jin for patients’ reference.
(1) Elbow bending and shaking – Patients stand with their backs against the wall or lie on their backs with their upper arms against their bodies, bending their elbows and using the elbow point as a fulcrum for external rotation activities.
(2) Finger climbing wall – the patient stands facing the wall, slowly climbing upward along the wall with the affected finger, making the upper limb as high as possible, to the maximum, making a mark on the wall, then slowly going back down to the original place, repeatedly, gradually increasing the height.
(3) Posterior hand pulling – the patient stands naturally, in the posture of internal rotation and backward extension of the upper limb on the affected side, the healthy hand pulls the affected hand or wrist, gradually pulling it toward the healthy side and pulling it upward.
(4) Spreading arm standing – the patient’s upper limb naturally drops, arms straight, palms down slowly abducted, lift upward with force, stop for 10 minutes after reaching the maximum, then return to the original position, repeatedly.
(5) Posterior extension of the spine – the patient stands naturally, in the posture of internal rotation and posterior extension of the affected upper limb, bend the elbow, flex the wrist, touch the spinal eminence with the finger of the middle finger, gradually move upward from the bottom to the maximum and then stay still, after 2 minutes and then slowly move downward back to the original position, repeatedly, gradually increasing the height.
(6) comb the head – the patient can stand or supine, the affected side of the elbow flexion, forearm forward up and rotate forward (palm up), try to rub the forehead with the elbow, that is, wipe sweat action.
(7) Head and pillow with both hands – the patient lies on his back, crosses the fingers of both hands, palms up, puts them on the back of the head (occiput), first makes both elbows inward as much as possible, and then extends as much as possible.
(8) Rotate the shoulder – the patient stands, the affected limb drops naturally, the elbow is straightened, and the affected arm circles from the front upward to the backward, the amplitude is from small to large, repeated several times.
The above eight movements don’t 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, more or less, as long as you are persistent, it will be beneficial to the prevention and treatment of frozen shoulder.
What are the misconceptions about the treatment of frozen shoulder?
Myth #1: Most people choose to put ointment on themselves, use bruising wine, or take painkillers at will. Painkillers or creams only provide temporary local relief or control of pain, but the root cause of the pain is still not properly treated, which is not the root cause of the problem, but can lead to chronic shoulder pain.
Myth 2: Many patients will stop physical rehabilitation or medication as soon as the pain is slightly relieved. The inflammation or injury at the lesion may have only partially recovered, and it is easy to recur in the short term.
Myth 3: Professional massage can indeed provide some relief, but it does not eliminate the root cause. Inappropriate techniques will only make things worse, easily aggravate the condition and even cause damage.