Overview: (1) Definition: Frozen shoulder, adhesive shoulder arthritis, and “fifty shoulder” are also known as frozen shoulder. It is caused by soft tissue lesions around the shoulder joint, resulting in shoulder joint pain and motor dysfunction. It is commonly referred to as frozen shoulder, and is more common in patients over 40 years of age, with more women than men (about 3:1), more left shoulders than right shoulders, and some patients are bilateral. In the same age group, those with heart disease, lung disease, diabetes, and cervical spine disease are higher than healthy people. It is clinically divided into primary and secondary. (2) Clinical presentation: It is clinically characterized by pain, stiffness, and limitation of motion, which affects normal daily life (e.g., driving, dressing, sleeping) and work. The clinical course is variable, but all patients terminate spontaneously. Some get better in a few months, others take years and are often unpredictable. However, recurrence after cure is rare. (3) Pathological and clinical staging: The pathological process of periarthritis of the shoulder is divided into 3 phases: the coagulation phase, the freezing phase and the thawing phase. The coagulation phase: The main manifestation is the adhesion of the loose parts of the shoulder joint capsule and the adhesion of the biceps tendon and tendon sheath; subsequently, the fibrosis of the adhesions leads to contracture, and the folds of the joint capsule disappear by adhering to each other. The main clinical manifestation is pain. Freezing stage: In this stage, in addition to the severe contracture of the joint capsule, the soft tissues around the joint are involved, and the degenerative changes are intensified, with congestion and thickening of the synovial membrane and lack of elasticity of the tissue. The shoulder joint movement is severely restricted, with persistent pain, which is aggravated at night, and the limitation of the Monohumeral joint movement reaches its peak. Thawing period: After a freezing period of six months to one year, the fibrotic individual tissues remodel, the tendons change their attachment points on the bone, and the contracted tissues regain their original length due to pathological tearing, which manifests as gradual improvement of shoulder joint function and pain relief. (4) Diagnosis: Primary frozen shoulder is a disease whose etiology is not yet clear. Patients with secondary frozen shoulder can recall specific triggers for the development of the disease, usually related to overuse and injury of the shoulder joint. Combining the etiology, the clinical manifestations described above and the clinical staging, the diagnosis is generally not difficult. Most x-rays of frozen shoulder have no abnormalities. Treatment: Surgical treatment: If the long-term comprehensive non-surgical treatment is ineffective, surgical treatment should be considered, and the main surgical methods are as follows: 1. Biceps long head tendon fixation or transposition: For early cases, if the non-surgical treatment is ineffective and the long head of the biceps is involved, biceps long head tendon fixation or transposition can be done. If the long head of the biceps tendon is not significantly degenerated, it can be cut from the attachment of the supraspinatus node, withdrawn from the joint, and fixed to the rostral process. If the tendon has undergone severe degeneration, it will be fixed in the intertrochanteric sulcus of the humeral tuberosity and the acromioplasty will be done at the same time. 2.Rostral humeral ligament cut: It is suitable for late stage cases, which are not effective by comprehensive non-surgical treatment and manual release, etc. 3.Hydraulic dilatation of the joint cavity: The pressure of the fluid injected into the joint is used to loosen the adhesions around the joint. 4.Arthroscopic joint capsule release. Non-surgical treatment: The purpose of non-surgical treatment is to relieve pain and restore the motor function of the shoulder. Currently, most scholars advocate the combined use of several treatment methods for frozen shoulder, believing that they can complement each other’s strengths and improve the efficacy. Different treatments are performed according to the different stages of frozen shoulder, but each stage has its own focus. In the coagulation phase, anti-inflammation and pain relief are the main treatments; such as ultrashort wave, microwave, transcutaneous electrical nerve stimulation, sinusoidal modulated medium frequency electricity and functional exercise. During the freezing period, pain relief and adhesion release are the main treatments, such as manipulation under anesthesia, massage, local painful nerve block, small acupuncture and functional exercises. Restoration of function during the thawing period is the main focus; such as freehand exercises and apparatus exercises. 1.Pharmacological treatment 1.1 Steroid hormones and local anesthetics: This is the current drug of choice for the treatment of shoulder pain. Hormones such as dexamethasone, methylprednisolone and tretinoin are mixed with local anesthetics such as lidocaine and bupivacaine for nerve block therapy. 1.2 Non-steroidal anti-inflammatory drugs and muscle relaxants: Although local nerve block therapy has obvious effect on relieving pain, the action time lasts <12h, so it is used in the acute pain period with oral ibuprofen, anti-inflammatory pain, clozoxazone and other drugs to reduce or relieve pain, relax the tense or spastic muscles, reduce the muscle pull on the local lesion, and promote the repair of the local injury lesion. 2.Physical therapy 2.1 Low-medium frequency pulse electrotherapy: transcutaneous electrical nerve stimulation, sinusoidally modulated medium frequency electricity and other therapies have significant analgesic effects. 2.2 High-frequency electrotherapy: mainly using ultrashort wave and microwave therapy, ultrashort wave and microwave have direct anti-inflammatory effects on nerve roots, and can improve nerve nutrition and functional improvement, so that the excitability of inflammatory lesions is reduced and the vicious cycle of pathological impulses is blocked or reduced. 2.3 Magnetic therapy: There are dynamic magnetic field for acute pain and static magnetic field for chronic pain. The magnetic field can reduce the excitability of nerve endings and accelerate the dissipation of inflammatory exudates, so as to achieve the effect of eliminating pain. 3.Chinese medical treatment 3.1 Massage: The purpose is to improve blood and lymph circulation of the affected limb, eliminate edema, relieve pain, and maintain the function of shoulder joint movement. After the pain is reduced, active movement can be increased. 3.2 Acupuncture: Modern research has also proved that acupuncture can reduce the concentration of pain-causing substances in peripheral blood, such as 5-hydroxytryptamine, potassium ion, histamine, etc. It can also affect the changes of prostaglandin and cyclic monophosphate II, thus improving the pain threshold and acupuncture effect. 3.3 Manipulation under anesthesia: For those who have severe freezing, which has affected their work and life, and who have not been treated with various treatments, the soft tissue around the shoulder joint can be released by manipulation under the anesthesia of interosseous groove brachial plexus nerve block, which has the effect of restoring the function of the shoulder joint immediately. The ideal technique should fully release the lower part of the biceps muscle and fibrocartilage capsule and minimize the damage to other tissues, thus reducing pain and restoring joint movement. 4.Self-care and exercise therapy The various treatments mentioned above can be combined, but the most important and effective treatment for patients with frozen shoulder is self-exercise. Insisting on correct and effective exercise can prevent and release adhesions, relax the tendons and blood, improve local blood circulation, prevent muscle twinning, enhance and improve muscle function, and have obvious efficacy in the treatment of frozen shoulder. Generally, you should exercise at least once a day for about 30 minutes each time, with the shoulder joint moving as much as it takes to cause tolerable pain. The specific methods commonly used are manual exercises and apparatus exercises. Manual exercise: ① Climbing method: The patient stands upright facing the wall, raises both hands upward and slowly climbs upward along the wall. (②Hold the neck with both hands: Abduct the two shoulders, hold the neck with both hands, and then do shoulder abduction and induction activities, repeatedly. ③Shoulder rotation method: Take the shoulder joint as the center, do small rapid inward rotation movement, and then do external rotation, alternately. ④Shoulder hitching method: Cross your arms left and right and then hold them in front of your chest. ⑤ Auxiliary method of the healthy limb: the healthy side of the hand holds the affected side of the finger lift over the shoulder and behind the back side of the cross-up movement. Apparatus exercise: ① Gymnastic stick: standing position, holding the stick with both hands in front, the distance between the hands depends on the degree of shoulder movement disorder, the lighter one is the same as shoulder width, the heavier one is relatively wider. Do the front planks, left and right pendulum movements. Then do the left and right pendulum and upward movement behind the body. In addition, the rod can be placed behind the back, with the affected hand holding the lower end and the healthy hand holding the upper end and shaking outward to do the pushing and pulling action. ②Hanging ring: through the pulley, the healthy limb pulls the affected limb to do abduction and forward flexion. ③Shoulder joint activity device: a comprehensive training device for the shoulder, shoulder and wheel axis flat, adjust the handle until the upper limb is completely straight, and then make circular movements. ④Tensioner: mainly trains the shoulder related muscles.