Misconceptions about chronic shoulder pain.
For a long time, due to misconceptions about shoulder injuries, people are used to classify many shoulder-related diseases as “frozen shoulder”, not knowing that in many cases, “rotator cuff tear” is the real “culprit “In many cases, rotator cuff tears are the real culprit. Due to the lack of knowledge and wrong diagnosis, many patients are further and further down the road of treatment.
The shoulder joint is the connection between the upper extremity and the trunk, and is the basis for the functional activities of the upper extremity. As the most flexible moving part of the body, the shoulder has the widest range of motion and allows the hand to touch any part of the body itself. It is because of its flexibility and importance that there is a diversity of conditions that are subject to injury.
Although the majority of shoulder patients are middle-aged and elderly, there is a trend toward younger shift in the incidence of rotator cuff tears and glenoid labral injuries, mainly due to occupational habits, exercise, and improper protection. Many people lack proper knowledge of shoulder joint diseases and categorize shoulder pain as “frozen shoulder”, so they do not pay enough attention to it and think it can be cured by itself or take the wrong treatment, thus delaying the condition.
It is important to make a clear diagnosis of shoulder joint injury as soon as possible. Some shoulder injuries are originally “rotator cuff tears” but are diagnosed as frozen shoulder and are treated with physiotherapy and local injections; many people do not take shoulder pain seriously and still engage in inappropriate exercises, or carry heavy objects or pull the upper limb violently, thinking that they will get better with activity. These misconceptions can lead to larger and larger rotator cuff tears, which can seriously affect function and daily life.
The first cause of shoulder pain is rotator cuff tear, the second is rotator cuff instability, there is also osteoarthritis in the shoulder joint, and the last is frozen shoulder, which is frozen shoulder. Of course, there are also some tendon diseases in the shoulder joint, such as calcific tendonitis, but these account for a very, very small percentage.
The majority of shoulder disorders in young people are shoulder instability, or in the extreme case, shoulder dislocation. Some patients may not show dislocation, but may feel discomfort or pain when the shoulder joint is in a certain position. The incidence of this type of shoulder dislocation is relatively low, but the recurrence rate is related to age. When a dislocation occurs for the first time, many people think it will be fine if it is reversible, but many times it produces subsequent instability symptoms, referred to as recurrent dislocation. If the dislocation is caused by a traumatic injury, such as being hit while playing basketball and causing a dislocation, it is called a traumatic recurrent shoulder dislocation. Another type of dislocation is when there is no obvious trauma, such as a small action like swatting a mosquito, which results in a dislocation of the shoulder joint without obvious trauma. This is a non-traumatic shoulder dislocation. If left untreated, some patients may suffer from bone loss at a later stage, and when they turn over at night, their shoulder will fall off, which increases the complexity of surgery.
Some young people who enjoy sports such as “raising their arms above their heads” may also develop rotator cuff disease because they often do one movement over and over again, which can cause rotator cuff damage.
In addition, white-collar workers who work long hours should also consider that shoulder pain is sometimes caused by cervical spondylosis. The site of neck and shoulder pain is in the trapezius muscle, above the shoulder, which is the area between the neck and the shoulder joint. Patients with shoulder pain, on the other hand, mostly present with pain on the outside of the arm downward from the shoulder joint, and should be differentiated.
Rotator cuff disease is easily misdiagnosed as frozen shoulder
In fact, the name frozen shoulder is not very accurate, and the concept used to be misleading to doctors and patients. In the past, when doctors looked at shoulder pain, they diagnosed it as frozen shoulder and told patients to do physical therapy and exercise. So when people mentioned shoulder pain, they thought it was frozen shoulder.
Frozen shoulder is commonly known as periarthritis of the shoulder joint, but now the diagnosis can be refined to include what? Biceps longus, subacromial bursitis, rostral synovitis, and arthritis of the shoulder capsule …… The treatment is different for inflammation in different locations.
But rotator cuff disease is different, it gets worse and worse and is progressively excessive from pain to limited movement to weakness. If rotator cuff disease is misdiagnosed as frozen shoulder, it can have more serious results because doctors will tell patients with frozen shoulder to “pull the rope” or “climb the wall with their hands” in the neighborhood, and this kind of arm over shoulder exercise will make the rotator cuff rupture even more. Just like making knee patients squat and run, it actually speeds up the process of the disease.
However, in the process, some patients may go for some physical therapy, acupuncture or massage, but these means do not shorten the course of the disease, but only slow down the pain and improve the mobility of the shoulder joint.
What is the rotator cuff?
The rotator cuff is the four muscles that surround the shoulder joint. These four muscles act like a cuff to stabilize the shoulder joint on top of the scapular pelvis so that our shoulder joint can move and not dislocate.
These four muscles are the supraspinatus, the subscapularis, the infraspinatus and the teres minor. The most problematic muscle is the supraspinatus, which is the muscle above the head of the humerus, and is located between the acromion and the head of the humerus. I often diagnose patients with acromioclavicular impingement, which is not caused by hitting something, but by two bones hitting together during activity – the head of the humerus is a bone, and on top of it is a hat-like bone called the acromion. The muscle between these two bones is the supraspinatus muscle. When we do shoulder lifting, it is easy to cause the greater tuberosity of the humerus and the acromion to collide, causing wear and tear on the supraspinatus muscle. If there is long-term wear and tear, the tendon may eventually rupture.
How to differentiate rotator cuff disease and frozen shoulder by yourself
Both diseases cause pain in the shoulder joint and both can lead to limited movement of the shoulder joint. However, in frozen shoulder, all active and passive range of motion is limited, which means that the shoulder joint cannot rotate in either direction. Patients with frozen shoulder often experience severe pain, especially at night.
The course of the disease is about two years. The first stage of the disease is about three to six months, and the pain gradually worsens, but the mobility is still possible, but gradually decreases; the second stage is about six months to one year, and the pain seems to be reduced, but the mobility is increasingly restricted; the third stage is about one to one and a half years, and the pain and mobility are better; the fourth stage is called the thawing stage, which is about one and a half years or two years, and then the patient slowly recovers. The fourth stage is called the thawing stage, and it will slowly recover in about one and a half to two years.
What does rotator cuff pain look like? The pain starts when the arm moves above head height. For example, when hanging clothes or holding something from a height. In the later stages of rotator cuff disease, the movement of the shoulder joint may be limited, but not in all areas. It may be limited in forward flexion, or it may be limited in external rotation, or some people may not be able to raise their arms or carry their hands with force.
How rotator cuff disease is diagnosed and treated
The examination of rotator cuff disease is similar to that of frozen shoulder, in that it requires a consultation with a medical doctor, a physical examination by a medical doctor, and an X-ray and an MRI. The difference is that the best treatment for rotator cuff disease is an MRI to determine the degree of rotator cuff rupture, the degree of degeneration of the tendons and muscles, and how effective the arthroscopic repair will be.
What are the treatment options for rotator cuff disease depending on the extent of the disease?
There are also conservative and surgical treatments for rotator cuff disease. Some patients who do not have a complete rupture of the rotator cuff, but only a partial rupture, can be treated conservatively.
If the pain can be relieved and maintained, surgery may not be necessary. But after conservative treatment has no effect, still pain, may need to take surgery. It is worth noting that most partial ruptures can develop into full ruptures.
Who should take surgical treatment?
The first is a traumatic rotator cuff rupture, which should be repaired as soon as possible.
Secondly, if conservative treatment has not worked for more than six months, surgical treatment should be considered regardless of whether the rupture is partial or total.
Thirdly, in elderly rotator cuff rupture, conservative treatment is not very effective in relieving the pain.
Is surgery scary?
Many people think that surgery is a scary thing, but currently it is mainly done through minimally invasive arthroscopic surgery, which is also the current trend in treatment, mainly through a minimally invasive incision in the shoulder. Under the arthroscope, the internal structure can be seen very clearly, and depending on the injury, the tear is closed with special suturing equipment. The procedure is minimally invasive, the damage is minimal, and the wound can be closed with or without stitches.
Delayed treatment of rotator cuff disease has serious consequences
What are the consequences of untreated rotator cuff disease?
After a rotator cuff rupture, it may lead to instability of the shoulder joint in advanced stages. Since the rotator cuff is meant to play a stabilizing role, a ruptured rotator cuff may cause the humeral head to move more in the direction of the rupture, and the cartilage surface will wear away, leading to osteoarthritis secondary to rotator cuff deficiency over time. At this point it is very difficult to repair the rotator cuff alone and a new shoulder joint is needed.
How far can I recover from a rotator cuff injury after surgical treatment?
In acute rotator cuff injuries, or in patients with relatively healthy tendons, the function of the shoulder joint can be restored by more than 90%. In chronic rotator cuff injuries with large ruptures and fatty tendons, it depends on the length of the disease and the repair during surgery.
Overall, regardless of the stage of the disease, the relief of shoulder pain with surgical treatment is definitely very clear, but whether the mobility of the shoulder joint can be restored to normal depends on the actual situation of each patient.
Maintenance considerations for patients with rotator cuff disease
Patients who do not have surgery can perform activities under the guidance of a professional rehabilitation doctor. Exercises for rotator cuff disease should not be done indiscriminately, otherwise it will increase the wear and tear.
First, you can do some gentle pendulum-like activities. Then, with the help of others, try to lift your arm, but rely on the external force of others, not your own active force.
How long does it take for a patient to recover after surgery? How do I recover?
There are three stages: the first stage is six weeks after surgery, you cannot actively lift your shoulder, you can only move passively during this period to ensure the healing of the tendon heel interface. Again, you can bend over and do pendulum-like activities, or use your other hand to gently support the post-surgical arm and lift it upwards, or move passively with the help of the rehabilitation doctor.
After six weeks, you can do some semi-active activities with some assistance, such as climbing the wall, lifting your hand upward little by little with the force of the wall. There is also the bamboo pole exercise – holding a bamboo pole in both hands and performing left and right activities to raise the operated arm through the support of the bamboo pole.
After the semi-active movement, we move to active movement, which is about six weeks later, adding up to three months.
After three months, you can train your muscles, such as stretching a rubber band, or practicing small dumbbells.
Prevention of shoulder injuries
Shoulder injury is a common sports injury during exercise. Inadequate preparation, inaccurate movements, excessive movements, overexertion, and excessive force can all lead to soft tissue injuries in the shoulder. For winter shoulder health care, how to avoid “rotator cuff tears”, in addition to pay attention to local warmth, young people who love sports should pay particular attention to the warm-up exercise before the activity.
The range of motion should not be too large. Excessive movement of the shoulder joint can cause injury to the tissues around the joint. For example, when doing the supine bird, the arms should not be lower than the torso: to do the bench press, in order to slow down the pressure and tension of the shoulder, push up should not “lock the shoulder”, bend the elbow when the scapula is not forward, to try to rely on the contraction of the pectoralis major, latissimus dorsi to complete the action.
Don’t overwork. The shoulder joint is frequently and heavily loaded, so the forging arrangement should be reasonable. To develop a scientific exercise plan, and strictly enforce it, in order to make the whole body all parts of the muscle to get balanced development. This is an effective guarantee to prevent sports injuries.