”Shoulder pain” is a common disease among the general population, and the first reaction is that I have “frozen shoulder”? But is that really the case? Auntie Huang, 58 years old, had pain and weakness in her right shoulder joint six months ago when she moved to a certain angle, and could not lift her arm. She often woke up at night with pain and could not lie on her side. Recently, the pain worsened in February, and she could not feel her back with her right hand, so she had difficulty even dressing and bathing. Auntie Huang went to many hospitals and was treated as “frozen shoulder”. She had taken western medicine, Chinese medicine, physiotherapy, massage, acupuncture and other treatments, and also did exercises such as climbing the wall and hanging rings, but she still did not see any improvement, and her condition even worsened and seriously affected her sleep. When he finally went to our specialist clinic, he realized that he had a rotator cuff injury, and that the condition was already serious.
In China, shoulder pain is often thought of as “frozen shoulder” and is treated by climbing the wall, manual release, acupuncture and physical therapy. However, the development of modern medicine tells us that the true primary “frozen shoulder” is less than 10%! The majority of shoulder pain is not “frozen shoulder”! Instead, it is caused by more than 10 kinds of diseases such as rotator cuff injury, acromioclavicular impingement, shoulder instability, shoulder bursitis, rotator cuff tendon calcification, acromioclavicular arthritis ……. For example, if you have pain when you lift your shoulder to a certain angle, but your mobility is normal, you may have “acromioclavicular impingement”; and when you have “pain, weakness in lifting, resting pain, night pain”, you may have “Rotator cuff injury. The two most common causes of shoulder pain are “acromioclavicular impingement” and “rotator cuff injury”, and both should be avoided in activities where the upper extremity exceeds the head, such as playing ball, swimming, pulling hoops, throwing arms, etc. The above activities may cause increased rotator cuff injury, or even cause rotator cuff tears requiring surgery. The above activities may cause the rotator cuff injury to worsen and even cause the serious consequences of rotator cuff tears requiring surgery! It is very common for people like Auntie Huang to be misdiagnosed with shoulder pain as “frozen shoulder”, leading to mis-treatment, blind exercise and deterioration of the condition. Therefore, it is important to find the right “root cause” of shoulder pain and not to blame “frozen shoulder”. Only by accurately diagnosing the cause of your shoulder pain can you be treated correctly and return your healthy shoulder!
What is frozen shoulder?
Frozen shoulder is a type of adhesive capsulitis that causes stiffness in the glenohumeral joint, which is characterized by pain around the shoulder joint, and is often found in people around 50 years old. It is a self-limiting disease, which means that it can be treated conservatively or some patients will heal on their own in six months to a year without treatment. However, if the pain is bad for a long time, even when sleeping, then these patients may have another very common condition: rotator cuff injury.
What is rotator cuff injury?
Rotator cuff injury is an important cause of shoulder pain and is a common clinical condition that causes sports injuries. Not only does it occur in young sports enthusiasts, but it is also very common in people over the age of 60 who present with a complaint of shoulder pain, with a prevalence rate as high as 70%, much higher than the so-called “frozen shoulder”.
The rotator cuff is actually composed of four tendons: the subscapularis tendon, supraspinatus tendon, infraspinatus tendon and small round tendon, which are wrapped around the humeral head of the shoulder joint like a cuff, protecting the shoulder joint and being responsible for the movement of the shoulder joint.
The mechanism of rotator cuff injury is divided into two types: acute lacerations and chronic strain injuries.
Acute lacerations are commonly caused by heavy lifting, shoulder support during a fall, or violent pulling from outside, such as a passenger standing on a bus holding a lever and losing his balance when he suddenly encounters an emergency brake, which may cause a rotator cuff laceration. Chronic strain injuries are commonly caused by falls, upper limb bracing or pulling heavy objects with force. It is also common in people who have been involved in sports for a long time, such as tennis, baseball, badminton, swimming, and mountain climbing, where the upper extremity is lifted above the head.
How to treat rotator cuff injury in shoulder joint?
This is the answer that every patient needs urgently. Each person’s condition is different, and so is their treatment. We will give the most appropriate treatment plan according to each case.
Clinically, we classify patients into four parts based on the functional status of the shoulder joint and the degree of pain.
The first part is painless functional rotator cuff injury: despite the rotator cuff injury, the shoulder joint lifting function is basically normal, the shoulder joint is not painful or occasionally slightly painful, and the patient can live a normal life with no obvious symptoms.
The second part belongs to the painful functional rotator cuff injury: these people can still have shoulder joint function, but because of shoulder joint pain, it will affect the quality of life to some extent. In terms of treatment, the first thing you can do is to take conservative treatment to stop the pain, you can take some anti-inflammatory and pain-relieving drugs, use Chinese medicine, etc. After the medication, some patients’ symptoms do not improve significantly, then you can consider minimally invasive surgery for shoulder arthroscopy. For such patients, the purpose of surgery is to remove the pain-causing factors. A rotator cuff injury, that is, a rupture in the rotator cuff, may not produce pain in the rupture itself. Most of the pain is caused by other factors, such as compression of the rotator cuff edge, impingement of the rotator cuff, subacromial bursitis, biceps tendonitis, acromioclavicular arthritis, etc. Of course, the surgeon will not leave the rotator cuff open during surgery and will repair it accordingly.
The third part is painless and non-functional rotator cuff injury: these patients do not have pain and discomfort in the shoulder joint, but they cannot lift it, which also affects the movement of eating, brushing teeth and combing hair. The reason for the limited movement of the shoulder joint is indeed caused by the rotator cuff rupture. To restore normal function of the shoulder joint, it is necessary to rely entirely on effective minimally invasive shoulder arthroscopic surgery to rebuild rotator cuff function. This particular type of rotator cuff injury is also known as pseudoparalysis, which means that the patient’s shoulder looks like he or she has had a stroke and is able to lift the bad hand with the help of the good hand, but the bad hand falls off when the good hand is released.
The fourth part belongs to the painful non-functional rotator cuff injury: this type of patient has the most serious rotator cuff injury because the patient not only has limited function, but also has severe pain in the shoulder joint when moving or resting, which has the greatest impact on daily life. Generally speaking, these patients benefit the most from minimally invasive shoulder arthroscopy because the reason for the dysfunction of the rotator cuff in these patients is that the rotator cuff is completely torn, and the second reason is that the pain is more intense and inhibits the residual function of the defective rotator cuff, which may be restored immediately after removing the pain-causing factors. Of course, repair of the rotator cuff at the time of surgery is also a guarantee of restoring the function of the shoulder joint.
Finally, a simple distinction: if the pain in this area (as shown below) is often caused by a disease of the shoulder joint.
If there is pain in this area (as shown below), it is often caused by a disease of the cervical spine.
What is minimally invasive arthroscopic surgery?
You may have heard of gastroscopy, colonoscopy, and laparoscopy, and by the same token, arthroscopy is a type of endoscopy. The surgeon observes the structures within the shoulder joint through the arthroscope and finds diseased tissues, such as rotator cuff, acromion, biceps tendon, glenoid lip, synovium, and free body, etc. He uses various special tools to perform operations such as cutting, suturing, fixing, and repairing the diseased tissues through the arthroscope.
A rotator cuff tear can be treated by minimally invasive arthroscopic surgery after diagnosis, which requires only a few small incisions in the shoulder joint (marked by the small circles in the picture below) to repair the rotator cuff and remove the bone spur under the arthroscope. The sooner the repair is done, the easier and less expensive it will be. Blind exercise only accelerates impingement wear and tear and tears the rotator cuff even more. Giving up on the repair can easily lead to wear and tear, aggravation of the bone spur, atrophy of the torn rotator cuff, and eventually a huge rotator cuff tear that is difficult to repair, which is not only difficult but also expensive and even impossible to repair.