1.What is frozen shoulder and what are the clinical manifestations of frozen shoulder?
A: Frozen shoulder is an adhesive capsulitis, commonly known as “fifty shoulder”, which is caused by aseptic inflammation of the joint capsule and soft tissues around the shoulder joint, resulting in shoulder joint pain and activity dysfunction. It is more common in patients over 40 years old, more women than men (about 70%), and more left shoulders than right shoulders. It is characterized by a gradual increase in shoulder pain and shoulder joint dysfunction, and after several months or even longer, the pain gradually subsides and function slowly recovers.
However, in patients with frozen shoulder, due to adhesions in the glenohumeral joint and surrounding tissues, the mobility in all directions of forward flexion and supination, internal and external rotation is often limited, and the active mobility is basically the same as the passive mobility. Imaging: MR and joint ultrasound support the diagnosis.
2.What are the factors associated with the development of frozen shoulder?
A: Freezing shoulder is associated with a variety of factors.
(1) Female;
(2) Diabetes mellitus;
(3) Thyroid disease;
(4) Autoimmune diseases;
(5) prolonged braking;
(6) Trauma;
(7) Greater than 40 years of age;
(8) Myocardial infarction;
(9) Stroke.
3.What is the classification of frozen shoulder?
A: There are three types of frozen shoulder: primary frozen shoulder, secondary frozen shoulder and post-traumatic frozen shoulder. The exact cause of primary frozen shoulder is still unclear, some believe it is an autoimmune disease, while others believe it is related to systemic metabolic disorders and usually heals spontaneously. Patients with shoulder trauma, stroke, hemiplegia, and other lack of shoulder activity often develop frozen shoulder over time. Secondary frozen shoulder can be divided into systemic (diabetes, hypothyroidism or hyperthyroidism, etc.), iatrogenic (heart disease, lung disease, Parkinson’s disease, etc.) and endogenous (rotator cuff injury, calcific tendonitis, biceps tendonitis, etc.) depending on the cause.
4.How is frozen shoulder staged?
A: Frozen shoulder can be divided into three stages according to the progression of the disease.
(1) Acute stage, also known as the progressive stage of frozen shoulder. The onset of the disease is acute, with severe pain, muscle spasm, and limited joint movement. The pain worsens at night, making it difficult to sleep. The pain is widespread, with pressure in the rostral process, rostro-humeral ligament, inferior acromion, supraspinatus, long head of biceps tendon, and quadrilateral foramen. Arthroscopic observation shows (Figure 13-2) that the synovial membrane is congested, the villi are hypertrophic and proliferative, filling the joint space and the subacromial folds of the shoulder glenoid, and the joint cavity is narrowed with reduced volume. The long head of the biceps tendon is covered by vascular opacification. The acute phase can last from 3 to 10 weeks.
Figure Intraoperative arthroscopic presentation
(2) Chronic phase Also known as the freezing phase. At this time, the pain symptoms are relatively reduced, but the pressure pain is still widespread. The limitation of joint function caused by protective muscle spasm in the acute phase progresses to joint contracture dysfunction. The joint becomes stiff and it is difficult to comb the hair, put on clothes, lift the arm to support objects, and knot the belt backwards. Occasionally, the crest of the shoulder may be observed on x-ray, and the greater tuberosity is sparse and capsule-like. On arthrography, the intracavitary pressure is increased and the volume is reduced; subscapularis subacromial bursa atresia is not visible, the subacromial folds of the shoulder glenoid disappear, and the tendon sheath of the long head of biceps tendon is incompletely filled or atretic.
(3) Functional rehabilitation period The inflammation of glenohumeral joint cavity, subacromial bursa, biceps long head tendon synovial sheath and subscapularis subacromial bursa is gradually absorbed, blood supply is normalized, synovial fluid secretion is gradually restored, adhesions are absorbed, and joint volume is gradually restored to normal. In the process of gradual recovery of motor function, the blood supply to the muscles and neurotrophic function are improved. Most patients can return to normal or near normal shoulder joint function. Muscle atrophy requires a longer period of exercise to return to normal.
5.How is frozen shoulder treated?
A: The treatment plan is individualized according to the needs of the patient and the stage of the disease. In the acute stage, pain relief is the mainstay.
(1) Use non-steroidal anti-inflammatory and analgesic drugs, such as anti-inflammatory pain, Fotarim, Fenbid, etc., all have good anti-inflammatory and analgesic effects. The use of such drugs in the elderly must be careful not to use too large a dose and should not be applied for a long time, so as not to damage the liver and kidney function.
(2) Muscle relaxants such as fenaral, chiropractic, clozarizone, etc. can not only relieve muscle spasm, but also have an analgesic effect.
(3) Hormone treatment of intra-articular or local pressure pain point closure and braking with triangular towel lifting the affected limb have certain pain-relieving effects.
(4) After entering the chronic stage, you can do appropriate functional exercises for the shoulder to prevent the joint contracture from aggravating. Take the bending position and lower the affected arm to do backward and forward, left and right swinging or circling movements, and after the range of motion improves, use both hands to climb the wall to pull the shoulder up gradually.
(5) Physiotherapy, acupuncture, massage and massage, intra-articular injection (hormone + lidocaine) line pressure expansion (glenohumeral joint) joint capsule, all have certain effect.
(6) After the pain is basically relieved, strengthen the functional exercise of the shoulder and actively restore the function of shoulder movement.
(7) For a few patients with severe limitation of shoulder movement, the adhesions can be released by manipulation under anesthesia first, and then functional exercises of the shoulder should be carried out.
(8) Arthroscopic cleaning and loosening (Figure 13-3). In conclusion, although frozen shoulder has a tendency to heal itself, it is still necessary to actively perform functional exercises during the disease, otherwise, although the shoulder is no longer painful, it will still leave the shoulder joint movement disorder, and surgery can be considered if conservative treatment is ineffective for 6 months.