Indications and contraindications] In addition to general contraindications, frozen shoulder is an indication for needle knife closed type surgical treatment as long as the physical condition permits. Body position] Due to the different parts of the closed-type needle knife surgery, the side lying position, supine position, prone position and other positions can be used. The position should be convenient for operation and comfortable for the patient. The acromion is the lateral extension and outermost point of the scapular ridge, covering the upper part of the greater tuberosity of the humerus. It is the attachment point of ligament and muscle, but there is no muscle spanning the bone surface, so the acromion is located subcutaneously. The acromion is easily palpated along the scapular ridge in a lateral direction, and the outermost point of the scapular ridge is the acromion, which is easy to palpate. The inferior point of the acromion, i.e., the inferior point of the bony convexity, is fixed. The rostral prominence is 25 mm anteriorly and inferiorly to the junction of the middle and outer 1/3 of the clavicle, and a rounded bony convexity can be felt. It can also be touched along the axillary deltoid muscle, pectoralis major interosseous groove upward, and the bone convexity at the top of the interosseous groove is the bone convexity. The superior lateral end of the humerus of the greater tubercle is directly below the acromion. The bony convexity of the small tubercle below the acromion medially and the large tubercle medially is the bony convexity. The inter-nodal sulcus is between the large and small nodes, and a large tendon can be detected. The following points can be targeted depending on the lesion: (1) 1 point below the acromion to loosen the adhesion of the subacromial bursa and the adhesion of the joint cavity. (2) The rostral point should be fixed at 1 point to release the adhesion of the short head of the biceps, the rostro-humeral muscle and the subacromial bursa. (iii) The tuberosity of the humerus was fixed at 1 point to release the contracture and adhesion of the subscapularis tendon and the subacromial bursa. (iv) The greater tuberosity point of the humerus is set to release contractures and adhesions of the supraspinatus, infraspinatus, lesser rounded tendon, and the infraspinatus capsule. ⑤ The interjunctional sulcus point is set at 1~2 points to release the transverse humeral ligament, i.e., the tendon sheath of the long head tendon of the biceps brachii. (6) Set 1~2 points at the crest of the lesser tubercle of the humerus to loosen the stop of the latissimus dorsi tendon. (7) Set 1~2 points at the crest of the greater tuberosity of the humerus to release the stop of the tendon of the pectoralis major muscle. (8) The starting point of the small round muscle is set at 1 point, that is, the middle 1/3 of the back of the lateral border of the scapula, and the contracture of the small round muscle tendon is loosened. (9) The starting point of greater trochanter is fixed at 1 point, i.e., the lower 1/3 of the back of the lateral border of the scapula, and the contracture of the tendon of greater trochanter is loosened. ⑩Supraspinatus, infraspinatus, scapularis, rhomboid muscle and other painful points, the treatment method is the same as muscle injury. [Needle knife operation] ① Subacromial point (Fig. 4-080) is in the depression between the acromion and the humeral head, equivalent to the area of the subacromial bursa. The knife line is parallel to the longitudinal axis of the humerus, the knife body and the humeral stem is about 110 ~ 130 ° angle stabbing, straight to the acromion bone surface, longitudinal sparing and transverse peeling 2 ~ 3 knife; slightly lift the knife blade, turn the knife line 90 °, to the direction of the articular space stabbing the articular cavity about 20 mm, line through the peeling of the 2 ~ 3 times. The knife is discharged after a feeling of loosening under the knife. ② ③ ④ ⑤ For the operation of the rostral eminence, the greater tuberosity, the lesser tuberosity, and the points of the intertrochanteric sulcus, please refer to the treatment of relevant muscle injuries. (6) The point of the tuberosity crest, the stopping point of the latissimus dorsi muscle, is at the lower and posterior part of the tuberosity of the humerus. The cut line is parallel to the longitudinal axis of the limb (almost perpendicular to the muscle fiber of the latissimus dorsi muscle), the cut body is stabbed perpendicularly to the skin surface, and it reaches the bone surface, and it is done to loosen the hard and tough tendon bundles at the attachment point of the tendon of the tuberosity of the posterior axillary crease, and it is incised with 3-5 cuts, and the longitudinal loosening and transverse stripping are performed, and there must be a sense of loosening under the knife. (7) The point of the crest of the greater tuberosity of the humerus is the stopping point of the pectoralis major muscle. The cut line is parallel to the longitudinal axis of the limb (almost perpendicular to the direction of the pectoralis major muscle fibers), the knife body and the skin surface of the perpendicular stabbing, straight to the bone surface, to do the longitudinal sparing, transverse peeling 2~3 cuts. If the tendon is very tense and tough, cut and peel several knives, there must be a loose feeling under the knife. (8) The starting point of the teres minor muscle is the pressure point of the middle 1/3 of the dorsal surface of the lateral border of the scapula. Cutting line parallel to the muscle fiber of the small round muscle, the knife body and the axillary skin surface at an angle of 75 ° piercing, up to the outer edge of the scapula bone surface, to do longitudinal sparing and transverse stripping, can also be reversed to cut the cutting line parallel to the edge of the scapula, cut the tendon 1 ~ 3 knives, knife there is a sense of looseness under the knife out of the knife. The starting point of the large round muscle is the pressure point of the lower 1/3 of the back of the outer edge of the scapula. The incision line is parallel to the muscle fibers of the large round muscle, and the body of the knife is stabbed at an angle of 75° with the skin surface of the axilla to reach the bony surface of the lateral border of the scapula, and do longitudinal evacuation and transverse stripping, and can also be reversed to parallel the line of the knife with the edge of the scapula and cut the tendon for 1-3 times, and then come out of the knife when there is a sense of looseness under the knife. The pain points at ⑩ supraspinatus, infraspinatus, scapularis, rhomboid muscle, etc., which are the common muscle injury points in frozen shoulder. All the pain points are treated according to each muscle injury. There are many kinds of manipulative operations for frozen shoulder, but the simple, effective, safe and less painful methods should be chosen, so the “Push and Bounce Manipulation” is recommended. The operation method is as follows: ①Loosen the axillary folds and let the patient lie down on the treatment bed, with the affected limb abducted and the doctor standing on the foot side of the abducted upper limb. The operator first massages the shoulder muscles 2~3 times to relax the shoulder muscles. Then, the thumbs of both hands are inserted between the axilla and the posterior axillary crease, and the four fingers of the remaining two hands are supported on the skin surface of the latissimus dorsi and deltoid muscles. At the same time, the operator’s hip joint part should be against the patient’s inner side of the arm. The operator uses both hands (including the hip and the whole body) in a rhythmic movement to distribute the deltoid muscle belly, and then distributes the supraspinatus, infraspinatus, teres major, teres minor in the humerus to make sure that the posterior axillary crease of the tendons to be distributed. At the same time, the hip is moved forward to increase the abduction of the upper extremity. Sometimes the tearing sound of the adhesion can be heard, and the adduction of the affected limb should be improved. ②Loosen the anterior axillary folds and then let the patient lie on the treatment bed supine with the same posture as before. Ask the patient to fully relax, the doctor’s hands in the same way into the anterior axillary fold. First, the deltoid abdominal parting away, and then the pectoralis major tendon parting away, the pectoralis major muscle from the direction of the chest wall parting away, sometimes you can hear the adhesion tearing sound. At this time, the affected limb can be increased by 30~50° than the original degree of abduction and supination. Let an assistant stand on the patient’s head side (the head side of the adductor arm) and hold the affected limb with both hands to assist in adduction. The doctor’s hands to support the affected limb, asked the patient to try to abduct the affected limb, when the maximum limit is reached, can not be lifted again, the doctor’s hands violently upward a pop (about 0.5 seconds). At the same time, the assistant uses the body to block the excessive abduction of the affected limb, to ensure that the shoulder joint abduction does not exceed 120°. This maneuver should not be disclosed to the patient in advance to ensure that it is done without the patient’s defense. Pushing and bouncing movements are painful, but generally can be tolerated. Precautions 1. About the diagnosis of frozen shoulder. The frozen shoulder can only be diagnosed as periapical tissue disease with shoulder joint dysfunction. However, the cause of shoulder joint dysfunction should be sought. In the clinic, it is found that some patients with frozen shoulder are not cured for a long time, and after detailed examination, the patients suffer from more serious cervical spondylosis (the patients do not have symptoms such as neck pain), and such patients should be recognized. If the frozen shoulder treatment is ineffective, the patient should be carefully examined for cervical spondylosis, and if so, the patient should be treated according to cervical spondylosis. Some patients who have been treated for frozen shoulder for a long time have been treated for cervical spondylosis once by acupuncture, and their frozen shoulder will be cured. 2.Frozen shoulder lesions involve more tissues, and the treatment should be carried out in a planned and patient manner. 3, frozen shoulder needle knife operation is not dangerous, but must be operated in place. The point of needle knife on the back of the shoulder should reach the scapula or rib surface, do not enter the pleural cavity by mistake, so as not to cause pneumothorax.