Most of the shoulder pain is not frozen shoulder New Business News February 4, 2008 54-year-old Mr. Wang two years ago right shoulder pain, severe when tortured to sleep. At first he thought it was a cold or a muscle strain, so he took some painkillers and plasters and got better. Gradually, the range of motion of his right shoulder decreased significantly, and he was afraid to raise his arm above his head, and even had some difficulty lifting his pants and brushing his teeth and washing his face. When he went to the hospital, the doctor diagnosed him with frozen shoulder and suggested him to do “wall climbing” and other treatments, but the pain not only did not improve, but became more intense. Mr. Wang went to the hospital again with the expectation of a new treatment for “frozen shoulder”, but the professor diagnosed him with “shoulder impingement syndrome” after some examinations and suggested Mr. Wang to receive surgery. Wang Weiming, a sports medicine specialist at Zhongshan Hospital of Dalian University, pointed out that shoulder impingement syndrome and rotator cuff injury are the main causes of shoulder pain, not necessarily frozen shoulder, which is a chronic inflammation of the tendons, tendon sheaths, bursa and joint capsule around the shoulder joint. Frozen shoulder is a chronic inflammatory adhesion of the tendons, tendon sheaths, bursa and joint capsule around the shoulder joint, which restricts the movement of the shoulder joint and causes shoulder pain and impaired movement. Many doctors in the clinic do not have enough experience in shoulder surgery and often diagnose frozen shoulder as “frozen shoulder” when they see a patient with shoulder pain. In fact, the clinical incidence of frozen shoulder is not high, accounting for only 10% to 15% of shoulder pain. Many patients also think it is frozen shoulder when they have shoulder pain, and they do functional exercises and self-rehabilitation at home. This has led to a large number of patients with shoulder pain being misdiagnosed and mistreated, and even causing further deterioration of their condition. In fact, most of the causes of shoulder pain are not frozen shoulder. With the booming development of orthopedic sports medicine and shoulder arthroscopic surgery, the understanding of shoulder joint disorders is becoming more and more advanced. The most common disorders that can be confused with frozen shoulder are impingement syndrome, rotator cuff injury, glenoid labral injury, biceps tendon injury or inflammation, etc. These disorders have significant differences in treatment and prognosis. Shoulder impingement syndrome is one of the causes of shoulder pain of which shoulder impingement syndrome and rotator cuff injury are the most important causes of shoulder pain. According to statistics, acromion impingement is one of the most common causes of shoulder pain in middle-aged and elderly people, far more than the traditionally considered frozen shoulder. For example, Mr. Wang, who came to our outpatient clinic for a radiograph, could see obvious bone formation under the acromion, and combined with his medical history and a few special physical examinations, he could be clearly diagnosed with acromion impingement. How to distinguish frozen shoulder from impingement and make a correct self-diagnosis? Prof. Wang Weiming said that generally speaking, the pain of shoulder impingement has the following characteristics: pain in the shoulder, which can even radiate from the shoulder to the neck or upper arm and forearm, complaining of pain at night, waking up in pain and affecting sleep. Patients have difficulty pinpointing a specific area of pain, and often have difficulty raising their hands above their heads because they cannot fully abduct their shoulders. Frozen shoulder has a tendency to be self-limiting and can recover within 1.5 to 2 years with a series of targeted treatments. Frozen shoulder is caused by friction and impingement between the acromion and the greater tuberosity of the humerus, so the methods used for frozen shoulder will not work for frozen shoulder, but will increase the patient’s pain. The active and passive mobility of the shoulder joint is significantly reduced in patients with frozen shoulder, and the mobility of the shoulder joint is significantly reduced in all directions compared to the opposite side, especially the external rotation of the shoulder joint is significantly limited. In contrast, the active or passive shoulder abduction is significantly limited in the shoulder impingement sign, and may be accompanied by some degree of shoulder internal rotation. Clear diagnosis and symptomatic treatment is especially important. Professor Wang Weiming reminds us that in order to obtain the correct diagnosis and treatment for shoulder pain patients, it is important to seek a specialist shoulder surgeon or orthopedic sports medicine doctor for a clear diagnosis. An experienced shoulder surgeon will be able to make a more accurate diagnosis by taking a medical history and performing a physical examination. If shoulder pain is clearly diagnosed and treated symptomatically, the results can be very significant. If you blindly follow the treatment of frozen shoulder, you are bound to miss the best time for treatment, which will eventually lead to stiffness of the shoulder joint and even leave a lifelong disability. The main purpose of treatment for shoulder pain is to relieve pain, restore joint mobility and rebuild the strength of shoulder muscles. Some patients with shoulder pain can be relieved by taking oral anti-inflammatory drugs and physical therapy, but if oral drugs do not work, local closure therapy can be considered. The closure therapy for shoulder pain is different from the traditional painful point closure, but it is targeted at the primary lesion, because there is no obvious painful point for the subacromial impingement and other diseases. The closure therapy injects drugs with anti-inflammatory effect into the lesion, and some patients can obtain effective relief. Surgery can be considered when conservative treatment is ineffective, said Prof. Wang Weiming, adding that patients like Mr. Wang, for whom conservative treatment is ineffective, should consider surgery. Clinically, advanced international orthopedic sports medicine concepts and arthroscopic techniques can be applied. The surgical approach mainly involves removing the primary lesion causing the pain; releasing the shoulder capsule to relieve stiffness; repairing the rotator cuff to restore muscle strength, etc. Most of the arthroscopic surgeries can be done within a very small incision, which is less invasive, faster recovery and more effective. Mr. Wang told us that his right shoulder felt easier immediately after the surgery, and he was originally nervous that he would suffer a bit the night after the surgery, but to his surprise, he did not feel any pain at all at night and was able to do many activities within his ability.