Shoulder pain is not always frozen shoulder In China, people with shoulder pain and limited movement think they have “frozen shoulder”, and even some orthopedic surgeons often use the term “frozen shoulder” to diagnose shoulder pain in general. Therefore, the diagnosis of “frozen shoulder” is like a large family, which includes not only the scientific definition of “true frozen shoulder”, but also other diseases such as rotator cuff injury, impingement, shoulder instability, subacromial bursitis, intra-articular free body, osteoarthritis, etc. 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 acromioclavicular 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, they are often misdiagnosed as “frozen shoulder”, which aggravates the patient’s pain and causes treatment errors in many patients. 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.
The real frozen shoulder
Life example
Auntie Bao is 55 years old, retired from work, and rarely does physical exercise. Recently, she had difficulty in lifting her right arm to comb her hair. She thought it was due to her age, so she bought a cream for external use, but it did not improve. Her family thought it was because of the lack of exercise, so they told her to lift more and exercise more, but the more she practiced, the more painful it became. On the recommendation of a friend, she went to our hospital and was confirmed to have frozen shoulder, or frozen shoulder, after a physical examination and imaging tests. After a physical examination and imaging tests, she was confirmed to have frozen shoulder, which is also known as “frozen shoulder”. After the conservative treatment such as medication and rehabilitation exercises did not work, we performed an arthroscopic release of the frozen shoulder to completely release the joint capsule that was already adhered. After a period of rehabilitation, the joint mobility was gradually restored.
Professional analysis: the scientific name is “frozen shoulder”
Frozen shoulder is more common in middle-aged and elderly people around 50 years old, so it is commonly known as “fifty shoulder”, and it affects more women than men. The scientific name is “frozen shoulder”, which means primary shoulder stiffness. The American Shoulder and Elbow Surgery Society defines it as adhesive capsulitis.
Frozen shoulder is a condition in which the soft tissues of the shoulder muscles, tendons, ligaments and joint capsule become congested and edematous, resulting in aseptic inflammation and, in severe cases, adhesions, resulting in shoulder pain and severely restricted motion, which can seriously affect the patient’s quality of life.
In addition to the generally accepted degeneration of periarticular tissues, the etiology of frozen shoulder may also be related to diabetes, cervical spondylosis, and certain cardiovascular and neurological diseases. Studies have confirmed that patients with diabetes have three times the risk of developing frozen shoulder than the general population. There is also a pathological link between cervical spondylosis and the development of frozen shoulder. Those with a history of shoulder joint trauma are prone to develop frozen shoulder.
Typical presentation: shoulder pain with limited active and passive movement
The name “frozen shoulder” graphically describes the impaired active and passive movement of the shoulder joint in all directions in these patients. Patients often feel stiffness in joint movement, especially limited backward and outward rotation mobility of the arm, which makes daily life affected, such as difficulty in combing hair, putting on and taking off clothes, etc.
Wise treatment: staging
The natural course of frozen shoulder is usually 1 to 3 years and is divided into 3 phases, namely the acute phase, the chronic phase and the recovery phase.
Patients with frozen shoulder in the acute stage should not generally use massage and surgery. If the pain is intolerable, you can take oral anti-inflammatory and analgesic drugs and apply cold compresses on 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 exercises to maintain the mobility of the shoulder joint.
In the chronic phase, functional exercises such as wall climbing exercises, stick exercises and physical therapy should be the main focus. If, after 3-4 months of the above conventional treatment, the patient’s condition does not improve significantly and still shows signs of dysfunction such as joint stiffness and shoulder weakness, then surgery should be considered. Minimally invasive arthroscopic surgery is a safe and effective procedure to release joint adhesions, which has good long-term effects on the treatment of frozen shoulder. Some patients with frozen shoulder may improve after a period of conservative treatment, and the joint mobility will gradually recover and enter the recovery period. A small number of patients with frozen shoulder can heal on their own.
Rotator cuff injury
Life Example
Aunt Chen, a 52-year-old housewife, often felt pain in her left arm and could not lift it for a year. Later, the pain became more and more severe, and she often woke up at night with pain and could not lie on her side. She went to many hospitals for checkups and was treated as “frozen shoulder”, and had done manual massage, physiotherapy, closure, etc., but the treatment did not work for a long time. Despite various conservative treatments, he did not improve. She came to our department and after careful examination, we found out that she was not suffering from frozen shoulder, but from a left rotator cuff injury.
Professional analysis: rotator cuff – the tissue that is easily injured
The rotator cuff tissue is located between the acromion and the humeral head and consists of several tendons that wrap around the humeral head in a cuff shape in front, above and behind the shoulder joint (see anatomical diagram of the shoulder joint). The rotator cuff tissue enhances the stability of the shoulder joint and protects it, but it is also 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 elderly patients over the age of 60 who present with complaints of 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 frequently lift heavy objects are also prone to rotator cuff injuries.
Typical symptoms: 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 a patient with rotator cuff injury continues to exercise such as “climbing the wall” 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 severe rotator cuff injuries can undergo an arthroscopic rotator cuff repair, in which the torn rotator cuff tissue is sutured with a suture anchor.
Acromioclavicular impingement sign
Life Example
Mr. Zhang is 35 years old and loves fitness, especially strength training. In recent months, he felt significant pain in his shoulder during supination training, and the symptoms did not improve and affected his shoulder movement after suspending training. He went to a small clinic for several times for physiotherapy and closed treatment, but the results were not good. He went to our hospital and was diagnosed with acromioclavicular impingement after physical examination and imaging tests.
Professional analysis: related to long-term overuse of the shoulder joint
Shoulder impingement is a condition in which the shoulder peak and subacromial bursa tissues are impinged at a certain angle during shoulder joint abduction and supination, causing shoulder pain. If left untreated, repeated impingement may also affect the rotator cuff attachment point, resulting in a rupture of the rotator cuff tissue, which can worsen the pain and seriously affect the patient’s quality of life.
Typical presentation: shoulder pain and supination dysfunction
Chronic dull pain in the shoulder, aggravated by lifting or abduction activities. Shoulder impingement is common in older people, people who frequently work with their upper limbs elevated, and sports enthusiasts. Frequent popular sports such as badminton, aerobics, and even swimming, which is more often recommended by doctors, can lead to shoulder impingement.
Wise treatment: reduce shoulder activity, and if necessary, surgery
Once diagnosed, patients need to reduce shoulder extension exercises and use NSAIDs for anti-inflammatory and analgesic treatment, and some patients need minimally invasive arthroscopic surgery to eliminate the causative factors.
Patients with acromioclavicular impingement who are misdiagnosed with frozen shoulder and treated inappropriately are at risk of aggravating subacromial bursitis and delaying treatment.
Shoulder joint instability
Life Example
Xiao Wang is a college student who loves sports. When she took a bus and braked sharply, she accidentally injured her shoulder, and the pain was obvious. He went to a nearby hospital and had a plain film taken, but no obvious fracture was found. Some time later, Wang played basketball and with a beautiful basketball into the fence, Wang suddenly felt his arm fall off and the pain was unbearable, so he immediately went to the hospital for consultation and reset. Later, this situation was found several times. So much so that Xiao Wang is now afraid to participate in sports. Wang’s traumatic injury is typical of shoulder instability.
Professional analysis: Traumatic joint instability is common
The shoulder joint consists of the humeral head and the scapular glenoid. The humeral head is large while the scapular fossa is shallow and the surrounding joint capsule is weak, and the shoulder joint is the most mobile and flexible joint in the human body, so its stability is relatively poor (see anatomical diagram of the shoulder joint).
Anatomical diagram of the shoulder joint
Traumatic shoulder instability is most common in the young, athletic population. When the shoulder is traumatized or the joint structure degenerates, there can be symptomatic displacement of the humeral head relative to the shoulder pelvis, i.e., dislocation or subluxation of the shoulder joint occurs. If you do not pay attention to protection in later life and sports and often perform over-the-top sports, 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 pain in unclear shoulder position, and feeling certain abnormalities and discomfort when the arm is moved to certain positions. Patients with recurrent dislocations harbor a fear of daily life and sports and are afraid to use the shoulder joint fully for sports. If left untreated, bone defects may develop secondary to the dislocation, leading to bone defective shoulder instability with serious consequences.
Wise treatment: Arthroscopic minimally invasive surgery has become the treatment of choice
Most patients can undergo non-surgical treatment, which has a long recovery process, usually taking about 6 months. If 6 months of physical therapy does not control the shoulder instability, surgical treatment is required. Minimally invasive arthroscopic surgical treatment has become the treatment of choice for habitual shoulder instability, with a success rate of over 95%. Patients with shoulder instability who are misdiagnosed with frozen shoulder and ignore the underlying cause of their own causative shoulder joint, such as glenoid labral injury, or even undergo the wrong rehabilitation treatment, may be more likely to trigger dislocation and aggravate their condition.