As the weather turns cooler, the number of patients suffering from shoulder discomfort increases significantly. Most middle-aged and elderly people like to take care of their shoulders by throwing their arms in circles, rubbing and stretching their shoulders, etc. However, if the exercise method is not done correctly, it will not only fail to work out, but may also lead to more serious shoulder problems. Orthopedic doctors remind us that when shoulder pain occurs, we need to distinguish between “real and fake frozen shoulder”. The shoulder pain caused by shoulder impingement is different from frozen shoulder, so we should not treat it as frozen shoulder simply because of shoulder pain.
A. Shoulder pain
To distinguish between true and false frozen shoulder
Old Zhang is over 50 years old, he has been paying attention to exercise since he was young, and he especially likes to play table tennis, so his body rarely suffers from pain.
The actual pain in the right shoulder is a little bit painful after the recent game, and the ballplayer Chen said that it must be frozen shoulder, so that the old Zhang don’t “lazy”, to exercise more diligently. After a month of practicing with pain, Zhang’s shoulder suddenly stopped hurting, and when he thought the exercise was working, he found another problem: he couldn’t lift his hand at all. Family members to the old Zhang dressing massage for a month have not seen any improvement, even the usual simple end water rinsing mouth, eating chopsticks and other movements can not do, the whole right shoulder and crippled like. A checkup at the hospital revealed that the old man had a rotator cuff tear and long bone spur wear on his scapula, requiring surgery.
According to Prof. Wang Wen, director of the orthopedic department at Guangzhou Red Cross Hospital, Zhang’s case is not an isolated case, as many unexplained shoulder pains are often easily seen as “frozen shoulder”, resulting in many underdiagnosis, misdiagnosis and mistreatment. One of the most confusing shoulder pains is frozen shoulder and rotator cuff tears, which occur for different reasons and are diametrically opposed in terms of treatment points.
Shoulder pain is very common in daily life, and whenever shoulder pain occurs, it is often labeled as frozen shoulder, which leads to a wide range of shoulder motion, but the inappropriate movement of the shoulder joint causes the shoulder pain to linger and suffer from the disease for a long time. If a rotator cuff tear is originally misdiagnosed as frozen shoulder and the patient is allowed to perform functional exercises such as “wall climbing” or artificially forceful pulling, it may cause the tear in the rotator cuff to increase or even aggravate the injury.
It is important to note that rotator cuff tears are not just a sports injury, but also a manifestation of strain degeneration in the human body, so long-term upper extremity workers and the elderly are the main groups affected.
B. How to distinguish frozen shoulder from rotator cuff tears
Frozen shoulder pain is light during the day and heavy at night
”Many people’s first reaction to shoulder pain is that they have frozen shoulder, but there are actually many different causes of shoulder pain.” Professor Wang Wen introduced that frozen shoulder is medically called “adhesive capsulitis”, also known as “fifty shoulder”, folk also called frozen shoulder, frozen shoulder, etc. This is a good way to get the most out of your shoulder pain, and it can be caused by external factors such as weather changes, blowing on the air conditioner, or straining after lifting heavy objects.
According to Wang Wen, frozen shoulder has a characteristic —- shoulder pain light during the day and heavy at night. When the pain of frozen shoulder is severe, the patient will even be awakened by pain in the latter half of the night and cannot sleep peacefully, especially not to the affected side.
The pain is painful even when you sleep, be careful of rotator cuff injury
”But if the pain is bad for a long time, even when sleeping, then this part of the patient may be misdiagnosed with another very common disease, rotator cuff injury.” Wang Wen introduced the rotator cuff tear, then, as a disease belonging to the category of sports medicine, rotator cuff injury is the most common shoulder joint disease, and about 30-40 percent of shoulder joint diseases are eventually diagnosed as rotator cuff injury.
An experienced specialist can determine whether it is frozen shoulder or not by taking a medical history and a simple examination, and can further distinguish whether there are bone spurs by taking X-rays to check whether the shoulder pain is caused by inflammation due to wear and tear of bone spurs. Wang Wen reminded that the differential diagnosis of shoulder pain is very difficult and only orthopedic surgeons with special training in shoulder surgery must be sure of the diagnosis. It is recommended that you should go to professional sports medicine or shoulder surgery for diagnosis and treatment.
C. Different treatment methods for two types of shoulder pain
The treatment of frozen shoulder is “three parts medical and seven parts practice”.
Frozen shoulder is a self-limiting disease that usually lasts 1-2 years, which means that it can be treated conservatively or some patients will heal on their own in a year to six months without treatment. However, this does not mean that patients with frozen shoulder do not need to exercise for treatment.
Frozen shoulder is a progressive disease, and as the disease progresses the range of motion of the shoulder becomes more and more restricted and the patient’s shoulder becomes more and more painful. Many patients are afraid to move due to pain at the beginning of their frozen shoulder, and over time, the shoulder joint becomes tight and cannot move properly. In the beginning, the patient may not be able to unzip the button on his back, and then he may be restricted in lifting his pants, and finally he may not be able to wipe his buttocks with his hand.
The more painful your shoulder is, the more you have to move, and the more physical therapy exercises you can do. Therefore, proper wall climbing and stretching exercises can help treat frozen shoulder. Frozen shoulder can also be treated by physical therapy in a professional hospital, which can play the role of anti-inflammatory, analgesic, antispasmodic, improve blood circulation and relax muscles. In addition, cold is an important reason for the onset of frozen shoulder, so in order to prevent recurrence, patients must pay attention to the warmth of the shoulder, should avoid air conditioning vents blowing directly into the shoulder, also can be used to warm water bag compress shoulder.
Severe rotator cuff injury requires surgery
Clinically, rotator cuff injury should be considered according to the different causes of the disease and the degree of pain. According to Professor Wang, the initial conservative treatment: physical therapy, medication, etc. can improve the pain. If there is no sign of improvement after 3 to 6 months of conservative treatment, or even if some patients have an enlarged rotator cuff tear and muscle atrophy during MRI, they should undergo minimally invasive arthroscopic repair surgery. For rotator cuff injury caused by trauma, as long as it affects the patient’s function and daily life, arthroscopic rotator cuff repair should be performed as early as possible to reduce the sequelae.