“My shoulder hurts so much that I can’t even comb my hair, and I can’t even button my hands behind my back, so people say it’s frozen shoulder. When middle-aged and elderly people face shoulder pain, they tend to attribute their shoulder joint problems to frozen shoulder, because the name of the disease has long been deeply rooted in people’s minds. In fact, the incidence of frozen shoulder is very low, accounting for only 10-15% of shoulder pain patients. Today, we will explain the shoulder joint disease and emphasize that 90% of shoulder pain is not frozen shoulder. If you have pain when touching your back pocket with your hand, you may have shoulder impingement. Shoulder impingement is a condition in which the humeral head and the greater tuberosity are repeatedly impinged upon during shoulder abduction, causing local osteophytes and compression of the subacromial bursa, resulting in shoulder pain, shoulder weakness and limited movement. The disease has the highest incidence in the shoulder pain population, accounting for 70%. The common clinical features are pain in the range of 60°-120° of active abduction of the shoulder joint, painful awakening at night when lying down, limited active activity, but passive activity is still possible, and the disease is often misdiagnosed as frozen shoulder. Director Li Qiang shares with you a simple test. If you feel pain in your shoulder but can actively lift your arm, then you can basically tell that you are not suffering from frozen shoulder. Frozen shoulder is an adhesive inflammation where the joint is so stiff that you can’t lift your arm either actively or passively. If you feel the back pocket with your hand and you cannot feel it and the pain increases, then you may have frozen shoulder. In response to the fact that so many people confuse acromioclavicular impingement with frozen shoulder, Director Li Qiang said that X-rays are a simple and effective diagnostic tool to observe all types of forms of acromioclavicular impingement, and MRI examinations can directly and clearly show the lesion. For the treatment of shoulder impingement, physical therapy and manual therapy can be applied in the early stage, with the aim of eliminating edema and congestion and relieving local pain. If the symptoms do not improve with long-term conservative treatment, arthroscopic shoulder decompression should be performed as soon as possible. Shoulder arthroscopy is a highly sophisticated and minimally invasive technique that allows for accurate detection of the lesion and precise treatment by making several small 2-3 mm holes in the shoulder. The goal of this surgical treatment is to remove the impingement factor and create a large space for the shoulder to move the arm freely. Painful, weak arm lifts may be a rotator cuff injury If you feel particular pain and significant weakness when you lift your arm, it’s time to consider whether you have a rotator cuff injury. Director Li Qiang told us that he often encounters such patients in his clinic: when riding a bus, the bus brakes sharply and the hand pulling the pull ring is injured; some people suddenly lift a heavy object and feel their hand strained. These are all common causes of rotator cuff injuries. The rotator cuff refers to the supraspinatus, infraspinatus, teres minor and subscapularis muscles, which play an extremely important role in the function and stability of the shoulder. The clinical manifestations of rotator cuff injury are mainly shoulder joint pain, difficulty in lifting the affected shoulder, and obvious pain at night when lying on the side. Director Li Qiang emphasized that rotator cuff injuries are more common in older people over the age of 60, and the prevalence increases with age. Lifting and pulling heavy objects, falling, etc. are often the causes of rotator cuff injuries in the elderly, and subacromial impingement is a common cause of rotator cuff degeneration and tearing. Some cases that are misdiagnosed as frozen shoulder, many are rotator cuff injuries. Director Li Qiang told us that when the rotator cuff injury is in the superficial layer and does not involve the major part of the tendon, there is no significant impact on the movement and the treatment is mostly conservative. If the rotator cuff tear occurs in the full layer when the upper limb supination activity is affected, minimally invasive shoulder arthroscopic surgery is necessary. Due to the lack of knowledge, many people are used to labeling shoulder pain as “frozen shoulder”, not knowing that there are complex and diverse diseases behind shoulder pain. If shoulder impingement and rotator cuff injury are misdiagnosed as frozen shoulder, blind manipulation and inappropriate exercise will lead to aggravation of the condition.