In China, when people have shoulder pain and limited movement, they think they have “frozen shoulder”, and even some orthopedic and rehabilitation doctors often use the term “frozen shoulder” to diagnose shoulder pain in general. Modern medicine has shown us that most shoulder pain is not frozen shoulder! ”With the development of shoulder surgery, especially the clinical application of MRI and CT, doctors have realized that there are many diseases that cause shoulder pain, including rotator cuff injury, acromioclavicular impingement, rostral impingement, adhesive capsulitis (frozen shoulder), SLAP Injuries, shoulder instability, tendinopathy, calcific supraspinatus tendinitis, acromioclavicular joint disease, shoulder osteoarthritis, thoracic outlet syndrome, etc. The common people think of “frozen shoulder” as “adhesive capsulitis”, because it occurs in middle-aged and elderly people around 50 years old, and is commonly known as “fifty shoulder” in China. It has an incidence of about 2% to 5%, and is more common in women than men. Some studies have found that the incidence of rotator cuff injury and acromioclavicular impingement is the highest among elderly people over 60 years old who visit the doctor for shoulder pain, reaching 85%, which is much higher than the so-called “frozen shoulder” (frozen shoulder). Because the differential diagnosis of shoulder pain is inherently difficult, doctors without specialized training in shoulder surgery lack certainty in the diagnosis. The diagnosis of “frozen shoulder” has been abused for many years and is like a “garbage can”, where all shoulder pains that are not understood are thrown into the garbage can of “frozen shoulder”. This has led to many underdiagnosis, misdiagnosis and misdiagnosis, for example, some of the functional exercises for “acromioclavicular impingement” and “frozen shoulder” are opposite, and if one follows the exercises for “pulling the hoop, climbing high, and throwing the arm” as in the case of frozen shoulder, it may cause the shoulder to become frozen. For example, some functional exercises for “frozen shoulder” and “rotator cuff impingement” are opposite. There are different treatments for each disease, different exercise methods and contraindications. What are the main diseases that cause shoulder joint pain? (a) Rotator cuff injury Typical manifestations: shoulder pain, weakness in lifting, resting pain, being awakened by pain at night, inability to lie on the side. Wise treatment: surgical repair. If a patient with rotator cuff injury continues to perform exercises such as “pulling the hoop” or forcibly loosening the shoulder joint, it may cause the rotator cuff tissue fracture to continue to expand, aggravating the condition and even causing disability in severe cases. Patients who have been diagnosed with rotator cuff injury can have their rotator cuff repaired arthroscopically after regular conservative treatment has failed. (2) True frozen shoulder (frozen shoulder) Typical presentation: shoulder pain and limited active and passive activities. The incidence of true frozen shoulder is not very high, but it is an aseptic inflammation of the shoulder capsule due to congestion and edema, which can cause adhesions in severe cases. The scientific name for this condition is “frozen shoulder”, which is defined by the American Shoulder and Elbow Surgery Association as adhesive capsulitis. The natural course of frozen shoulder is usually 1-3 years and is divided into 3 phases: acute, chronic and recovery. Many patients with frozen shoulder can heal spontaneously, but about 50% of patients are left with shoulder joint dysfunction. Therefore, frozen shoulder also requires treatment. Wise treatment: In the acute stage, massage and surgery are generally not recommended. It can be treated with joint cavity closure, oral anti-inflammatory and analgesic drugs, and cold compresses on the shoulder. In the chronic stage, functional exercises such as wall climbing exercises, stick exercises and physical therapy are the main treatments. If the patient’s condition does not improve significantly after 3 to 4 months of the above conventional treatment, if the dysfunction seriously affects life and workers, arthroscopic minimally invasive treatment is the best treatment method recommended internationally at present. (iii) Subacromial impingement Typical presentation: chronic dull pain in the shoulder, which is aggravated during supination or abduction activities. Wise treatment: Patients need to have radiographs taken to show that curved and hooked shoulders are the main causes of subacromial impingement. Patients need to reduce exercises such as shoulder extension and overhead lifting, and to be treated with pharmacological anti-inflammatory and analgesic therapy. Some patients also need minimally invasive arthroscopic surgery to eliminate the causative factors of subacromial impingement. Patients with subacromial impingement who are misdiagnosed as frozen shoulder and undergo certain inappropriate treatments, such as pulling hoops and throwing arms, are likely to aggravate the condition, delay treatment, and even cause rotator cuff impingement tear injury. (iv) Shoulder instability Typical symptoms: shoulder pain, fear of movement in a certain direction of the shoulder joint, and in severe cases, dislocation of the shoulder joint. Wise treatment: Most patients can be treated non-surgically and their recovery process is long, usually taking about 6 months. If 6 months of physical therapy does not control the shoulder instability, surgical treatment is required. Minimally invasive arthroscopic surgical treatment has become the treatment of choice for habitual shoulder instability, with a success rate of over 95%. Patients with shoulder instability who are misdiagnosed with frozen shoulder and ignore the underlying causes such as glenoid labrum injury of their own causative shoulder, or even undergo wrong rehabilitation, may be more likely to trigger dislocation and aggravate their condition. (E) Upper glenoid labrum avulsion (SLAP injury): also known as “driving shoulder”. Typical presentation: pain, locking and popping when lifting the shoulder in external rotation and posterior extension. “Driving shoulder” is a new name for a condition that differs from “frozen shoulder” and is predominantly experienced by young female drivers. It can also occur when the same shoulder injury mechanism is present, such as pulling a sling in a bus emergency, or jerking the steering wheel while driving. Wise treatment: rest on the shoulder after the injury is diagnosed. Early on, you should not exercise the shoulder joint like freezing the shoulder, avoid movements that cause pain, and give the injured tendon a chance to repair itself. If conservative treatment does not work after a period of time, the situation is more serious and requires minimally invasive surgery under shoulder arthroscopy to repair the tendon. (vi) Other diseases causing shoulder pain Other diseases causing shoulder pain include subacromial bursitis, long head biceps tendonitis, long head tendon dislocation, calcific tendonitis of supraspinatus, rostral impingement, acromioclavicular joint disease, thoracic outlet syndrome, etc. Different diseases have different treatment methods. It is recommended that patients with shoulder pain and shoulder disorders first seek a clear diagnosis from a specialist sports medicine or shoulder surgeon before receiving different treatments.