I. Introduction
Periarthritis of the shoulder is a common disease among middle-aged and elderly people, mainly manifesting as shoulder pain and shoulder movement disorders. The disease is common in women and often occurs around the age of 50, also known as “fifty shoulders”; Chinese medicine believes that this disease belongs to the category of paralysis, mostly due to wind and cold in the shoulder, called “shoulder wind”; after the disease, the shoulder joint is often stiff and unable to move, as if frozen. Therefore, it is also called “frozen shoulder” and “shoulder condensation”.
Incidence
It mostly occurs after middle age, with a peak incidence between 50 and 60 years old. According to foreign statistics, about 1 in 50 people suffer from frozen shoulder every year, and the incidence of frozen shoulder accounts for 2%-5% of the total population. The incidence is slightly higher in women than in men. The incidence appears to be higher on the left side than on the right side, with about 12% of the total incidence of frozen shoulder occurring bilaterally. About 40% of patients with periarthritis on one side will also develop periarthritis on the opposite side within 5-7 years.
III. Etiology.
1. Chronic injury
The main cause is the chronic injury caused by long-term overactivity of the shoulder and poor daily posture.
2. Joint fixation sequelae
After a long period of shoulder immobilization after upper limb trauma, atrophy of the tissues around the shoulder occurs.
3.Dysfunction after injury
After acute contusion or strain of the shoulder, no timely and effective treatment is given, which affects joint function recovery.
4.Involvement of other diseases
Diseases of the heart, lungs, biliary tract, etc. cause prolonged traction pain in the shoulder, which then transforms into true frozen shoulder.
5.Endocrine disorder
Frozen shoulder mostly occurs around the age of 50, but the incidence decreases beyond this age. Therefore, this disease is caused by endocrine system disorders during menopause and old age.
IV. Clinical manifestations
The whole course of frozen shoulder can be divided into: the beginning period, the freezing period, and the thawing period.
1.Beginning period
The duration is 10-36 weeks. The shoulder joint is uncomfortable and has a binding sensation. The pain is limited to the anterolateral aspect of the shoulder joint and may also extend to the resisting point of the deltoid muscle. The shoulder joint gradually becomes stiff and painful.
2.Freezing phase
It lasts for 4-12 months, or several years in severe cases. The pain can be mild or severe, and it is characterized by aggravation at night and affects the patient’s sleep. When the shoulder joint moves, it can cause strong pain and muscle spasm, so that the movement of the shoulder joint can be completely restricted, as if the hand is frozen.
3.Thawing period
The duration is 5-26 months. The pain is very mild, the shoulder joint starts to relax gradually, and the glenohumeral joint gradually resumes more activities, but in some cases, the function of the shoulder joint is only partially restored or is tonic and cannot move.
V. Differential diagnosis
1. Supraspinatus tendonitis.
(1) Pain mainly at the greater tuberosity of the acromion, which may radiate to the neck, shoulder and upper extremity. The pain is particularly acute during shoulder abduction, so the patient often avoids this movement.
(2) Restriction of shoulder joint movement, which is mainly characterized by pain when the shoulder joint is abducted to 60°-120°, but not when it is greater or less than this range and other shoulder joint movements are not restricted.
(3) Pressure pain is often present at the greater tuberosity of the supraspinatus muscle or at the subacromial peak where there is obvious pressure pain, and it moves with the rotation of the humeral head.
2. Biceps long head tenosynovitis.
(1) Pain in the front of the shoulder joint, often with pain in shoulder supination or posterior extension, difficulty in dressing and undressing.
(2) Restricted and painful shoulder joint abduction, posterior extension and rotation activities.
(3) Painful pressure near the intertrochanteric groove and rostral process of the biceps muscle.
(4) Positive biceps resistance test: The patient flexes the elbow at 90°, the doctor holds the patient’s elbow with one hand and the wrist with the other, and asks the patient to flex, abduct and rotate the elbow with force, the doctor gives resistance, and if there is pain at the inter-nodal groove, it is a positive sign.
VI. Treatment.
1.Conventional acupuncture therapy
Acupuncture, moxibustion, infrared radiation, electroacupuncture, cupping therapy, etc.
2.Floating needle therapy
Floating needle therapy is the use of disposable floating needles, in the limited pain (mostly myofascial trigger points) around or adjacent to the limbs of the subcutaneous superficial fascia to sweep the scattering technique of acupuncture activities, is an acupuncture treatment method. Its main indications are limited pain, with convenient operation, quick effect, precise curative effect, safe and painless.
3.Transcutaneous acupoint electrical stimulation therapy
Using Han’s transcutaneous nerve stimulator, 2 pairs of output electrodes are pasted on the affected side of the shoulder anterior and shoulder s (or shoulder k and Yu), and on the external guan and hegu respectively. The total effective rate of transcutaneous acupoint electrical stimulation for preadhesive and adhesive stage frozen shoulder reached 96.6% and 96.9%, respectively, as verified by the State Administration of Traditional Chinese Medicine (National Chinese Medicine Section 2000ZL18). The “Percutaneous Acupoint Electrical Stimulation for Periarthritis of Shoulder” technique has the advantages of non-invasive, obvious analgesia, easy operation and not easy to be infected, which is easily accepted by patients and doctors. In 2006, this technique was listed as “the first batch of Chinese Medicine Clinical Appropriate Technology Promotion Project of the State Administration of Traditional Chinese Medicine”.