Periarthritis is sometimes called “frozen shoulder”, “frozen shoulder”, “shoulder coagulation” and so on. There are many different names, but the common denominator is that they all have something to do with immobility, hence the use of words like “frozen” and “frozen”.
Periarthritis is a chronic, non-specific inflammation and degeneration of the shoulder capsule and surrounding soft tissues, characterized by pain and limited movement of the shoulder joint. It is also referred to as “fifty shoulder” because it occurs around the age of 50.
Of course, if you are over 50 years old, you have a higher chance of developing the disease. Studies have shown that people over the age of 45 who have been braking their shoulder joints for 2 weeks for various reasons will develop symptoms of frozen shoulder to varying degrees. In clinical practice, it is common to see people who are bedridden, or who have had injuries, fractures, or surgery on their arms, and who wear a tricot for protection. After a few weeks, the shoulder joint may become painful and “unliftable” even though it has not been injured or operated on.
The cause of frozen shoulder is not well understood, but generally speaking, regardless of the cause, if there is a local inflammatory reaction, or if the shoulder joint is not moving with braking, or if there is a decrease in activity, the symptoms of frozen shoulder will occur over time.
It is generally considered to be a degenerative change in the soft tissues surrounding the shoulder joint. Specifically, due to the lack of activity in the shoulder joint, the metabolism and circulation of the shoulder joint becomes impaired, and the blood and lymphatic circulation and reflux are reduced, resulting in degenerative lesions around the joint such as the joint capsule, rotator cuff, biceps tendon and rostro-humeral ligament.
There is inflammatory exudation and cellular infiltration (similar to various types of chronic inflammation), followed by fibrosis and adhesions of the tissues, and finally the joint is unable to move properly.
Frozen shoulder is more common in middle-aged and elderly people, especially in women than in men. The onset of the disease may be triggered by minor trauma or cold, but it may also start without any obvious reason, and gradually worsen to the point where you are afraid to move your arm.
The main symptom of frozen shoulder is localized pain in the shoulder joint, which is usually worse at night when you sleep. In severe cases, you cannot sleep on the affected side because of the pain, and you can only lie flat or on the side that does not hurt, which is very painful.
Because of the pain, the arm does not dare to do abduction and internal and external rotation at the beginning, and if the pain is severe or persistent, the movement of the shoulder joint is reduced in all directions and is obviously restricted. At the same time, the muscles of the shoulder (especially the deltoid) may become atrophied.
This causes a lot of inconvenience in life, such as not being able to lift the arm, so you can’t wash your face or comb your hair; not being able to extend your hand behind your back because you can’t rotate it internally, so you can’t wash your back in the shower, and you can’t even lift your pants when you go to the bathroom. Without treatment and systematic rehabilitation exercises, the symptoms will worsen and the shoulder joint movement will become more and more restricted, making the function and quality of life even worse.
The entire course of frozen shoulder can be divided into three parts. These are the acute phase, the adhesive phase and the remission phase. These three phases have different clinical manifestations and pathological changes, so the treatment and rehabilitation of functional exercises are also different.
In the acute phase, which is when the pain first starts. The symptoms are mainly pain around the shoulder joint at irregular points. Sometimes the pain is in a large area or even in the whole shoulder. In some cases, it may also involve radiation to the large arm and small forearm.
Due to this and other pains, the first thing that happens is that you are afraid to move around to protect yourself, and the painful stimulation also causes muscle spasms and tightening of the soft tissues around the shoulder joint. This causes varying degrees of shoulder joint movement restriction, that is, the fear to move and the aggravation of pain when moving.
Therefore, the focus of treatment at this stage is to eliminate the inflammation and relieve the pain through various methods so that the symptoms can be relieved at the root. At the same time, it is necessary to use appropriate rehabilitative exercises to maintain the mobility of the shoulder joint in all directions to avoid the pain and the risk of adhesions in the shoulder joint.
Of course, the amount of activity should be strictly controlled, as clenching your teeth at this time will only increase irritation, inflammation and aggravate the pain.
After the acute pain has developed for a period of time, it enters the adhesion phase. At this stage, the pain will be relieved, but don’t think that the frozen shoulder is getting better, rather it is entering a more troublesome stage.
This is because although the symptoms of pain may be significantly relieved, hyperplasia and adhesions within the shoulder joint are the main pathological processes at this point. The joint movement in all directions of the shoulder joint will start to become more and more obviously restricted, especially the abduction and external rotation of the shoulder joint is usually the most obvious restriction.
Therefore, continued anti-inflammatory analgesia is necessary during this phase. However, it is more important to maintain and improve the mobility of the shoulder joint. Not only do you need to practice more on your own, but if necessary, you need to undergo a special “joint release” technique in the hospital by a rehabilitation therapist to avoid joint adhesions, stiffness and immobility.
At this time, if you are too “heartbroken” and can not suffer a little pain, you will miss the opportunity to practice mobility, joint adhesions will further aggravate, and later want to practice will have to pay a greater price.
Finally, there is the remission period. During this period, there is a significant improvement in both the pain and the limited movement of the shoulder joint. With active treatment and exercises, the function of the shoulder joint may be basically restored, or there may still be some functional impairment left, but most of them can be improved gradually through various exercises and daily life.
It is important to note that sometimes it is said that frozen shoulder can “heal itself”. This means that even without any treatment or exercises, the above three stages will develop and go through one by one, from the acute phase when the pain is too much to move, to the beginning of pain relief, to the beginning of adhesions and immobility, to the end when the pain is basically gone.
On the surface, it seems to be really untreated, but the final functional difference is very big! Without practice and treatment, the pain will gradually subside over time, but the angle of the shoulder joint will not be restored. In short, although it doesn’t hurt anymore, you can’t lift it up, you can’t get behind it, and if the angle is severely restricted, you can’t even lift your pants or put your hand in your pocket! There is really no function to speak of!
In general, the function of frozen shoulder can be restored through conservative rehabilitation and functional exercises. However, in some cases, if the joint adhesions are very serious, we can only consider surgery to release the adhesions in the joint, and then continue the rehabilitation exercises after the surgery in order to completely restore the function. Therefore, you must pay attention to the joint mobility exercises, not just rest and pain relief, which will delay the practice and make the treatment more troublesome.
Don’t think it is frozen shoulder when your shoulder hurts, you must go to a regular hospital for examination to confirm the diagnosis. Because shoulder pain and limited movement can be caused by many reasons, it is not necessarily frozen shoulder.
At the very least, it is important to rule out rotator cuff injury, supraspinatus tendonitis, biceps tendonitis and glenoid labrum injury or even a minor fracture. Sometimes the pain in the shoulder joint may also be radiating pain from coronary artery disease, so don’t diagnose yourself with frozen shoulder and then blindly treat it afterwards, you must have a professional diagnosis and guidance before you start the appropriate treatment and exercises.