The key to a good or poor outcome of frozen shoulder treatment is a clear diagnosis. The first step is to rule out the presence of incomplete rotator cuff tears, calcific tendonitis, biceps tendon synovitis and acromioclavicular joint hyperplastic arthritis. Treatment is mainly conservative. Deng Lei, Department of Traumatology, Xiyuan Hospital, Chinese Academy of Traditional Chinese Medicine
I. Non-surgical treatment
1. The principle of treatment is to stop pain, release muscle spasm, suspend brake with triangular towel, use sedative pain-relieving and muscle relaxing drugs.
2. The most important thing is to exercise the upper arm regularly, which can be started from the supine position, with the goal of restoring the normal mobility. Start by raising the arm over the head, externally rotating the upper arm, internally rotating the upper arm (placed behind the back) and coronal abduction. Exercise should be both active and within the range of painlessness, with regular activity of the shoulder-humeral joint rhythm. The pain and muscle spasm subsides after a few days of 10 to 12 times per hour, with pendulum-like activities without resistance to gravity. As the condition improves, static and resistance activities are added, and stretching activities are added at the end of each exercise. Pain relief and sedatives can be applied simultaneously, and moist heat packs are effective for symptom relief. The duration of exercise varies from person to person, as the patient is encouraged to adhere to the exercise program until the purpose is achieved, regardless of the duration. 3.
3. 1% lidocaine 3~5ml can also be applied as cervical sympathetic block, suprascapular nerve closure and stellate ganglion block if necessary. Hydrocortisone acetate 1ml can also be injected into the biceps tendon sheath with appropriate amount of procaine, all of which can significantly reduce pain and muscle spasm.
4. Make appropriate functional exercises under the condition of pain relief to prevent the aggravation of joint contracture. Under the condition of pain relief and physiotherapy, do some gentle passive or active functional exercises, as well as massage of the muscles around the shoulder. Bending the back and hanging the arms to do back and forth, left and right pendulum exercises can help to achieve the above purpose.
5. After the pain is basically relieved, then focus on joint function recovery and strengthen the active training of joint function.
6. Some patients who do not have good results after the above treatment enter the chronic stage and need further application of manipulation or surgery.
II. Manipulation under anesthesia
The ideal manipulation should allow the biceps tendon and the lower part of the fibrocartilage capsule to be fully released and minimize trauma to other tissues, so as to achieve the purpose of pain relief and restoration of joint movement. Although the operation takes only a few minutes, it should be performed under general anesthesia.
Third, surgical treatment
There are two indications, one is for early cases, where non-surgical treatment is ineffective and the main manifestation is biceps tendon involvement. The other is late stage patients, where non-surgical treatment is ineffective or where manipulation has been used to release the tendon, without success.
A postoperative neck and wrist sling is applied. Activities without resistance to gravity are started on the first day, and the drill program is as after the closed manipulation. The cervical wrist sling is removed on day 5 and mobility is gradually increased to the extent tolerated by the patient, and daily activities are encouraged after 3 weeks. Satisfactory function can usually be restored in 3~4 months.
4. Arthroscopic treatment
Patients with frozen shoulder can be diagnosed and treated with arthroscopy, which belongs to the minimally invasive category. The damage to local tissues is greatly reduced and the functional recovery is faster.
Arthroscopic treatment should include: arthroscopic resection of the rotator cuff space, the middle glenohumeral ligament, the subscapularis bursa, the anterior bundle of the inferior glenohumeral ligament, the posterior part of the joint capsule, the posterior bundle of the inferior glenohumeral ligament and the axilla; if necessary, subacromial bursal resection and decompression; and examination of the rostro-humeral ligament and its separation if necessary.
Arthroscopic surgical release is suitable for those with severe joint contracture and dysfunction in the freezing stage. The surgery is less invasive and can provide more thorough release and cleaning treatment, with short postoperative recovery time and satisfactory functional recovery. Compared with surgical incision and release, it is currently a recommended minimally invasive treatment.
In summary, frozen shoulder is a specific disease of the shoulder capsule, not a generic term for unexplained pain around the shoulder joint, but more accurately named as “frozen shoulder” or “adhesive capsulitis”. Since the etiology and pathogenesis of frozen shoulder are still inconclusive, further research on the epidemiology, pathophysiology, and treatment of frozen shoulder is needed.