[Definition]
Shoulder periarthritis is a degenerative, aseptic inflammatory disease of the tissues surrounding the shoulder joint, mostly occurring in middle-aged and elderly people. Its clinical manifestation is diffuse pain in the shoulder, which is mild at day and heavy at night, and the movement of the shoulder joint is obviously restricted. This disease is referred to as “frozen shoulder”, which belongs to the Chinese medical term “shoulder paralysis”, “frozen shoulder”, “frozen shoulder”, “frozen shoulder”, “frozen shoulder” and “frozen shoulder”. It belongs to the categories of “shoulder paralysis”, “frozen shoulder” and “50 shoulders” in Chinese medicine.
According to Chinese medicine, this disease is caused by old age and weakness, liver and kidney deficiency, deficiency of qi and blood, loss of moistening of tendons and muscles, as well as strain and injury, wind, cold and dampness, resulting in blood not glorying tendons and phlegm stasis blocking the meridians and joints.
[Clinical manifestations]
1. Initial stage (pain phase): spontaneous pain in the shoulder, which is often persistent and varies in performance. Most patients have chronic pain. Some patients only feel discomfort in the shoulder or a feeling of constriction, while individual patients have acute attacks. The pain is mostly confined to the anterolateral aspect of the shoulder joint and may extend to the point of resistance of the deltoid muscle. It often involves the scapular region, upper arm or forearm. The pain is aggravated by activities such as shrugging or internal rotation of the shoulder while wearing a shirt, and the patient cannot comb his hair or wash his face. The shoulder pain increases rapidly afterwards, especially at night, and you dare not lie on the affected side.
2.Late stage (adhesive phase): Shoulder pain gradually decreases or disappears, but the shoulder joint contracture and stiffness gradually increases to a “frozen state”. The shoulder joint activity in all directions is reduced by 1/4 to 1/2 compared to normal; in severe cases, the shoulder-humeral joint activity disappears completely, and only the scapulothoracic wall joint activity is available. Difficulty is felt in combing the hair, dressing, raising the arm, and knotting the belt backward. This period lasts for a long time, usually 2 to 3 months.
[Signs and examination]
1. Initial stage (painful stage): The range of motion of the shoulder joint is reduced, especially the limitation of abduction and external rotation is most significant. The appearance of the shoulder is normal. Local pressure points are mostly located in the inter-nodal groove, rostral process, subacromial bursa or deltoid muscle attachment, supraspinatus muscle attachment, internal superior scapular angle, etc.
2.Late stage (adhesion phase): Shoulder joint activity in all directions is reduced by 1/4 to 1/2 compared to normal, and in severe cases, the shoulder-humeral joint activity disappears completely. The pressure pain is slight or no pressure pain.
3.X-ray examination: The anterior-posterior plain film of the patient’s upper limb in the down position of the shoulder joint is compared with the maximum supination position photograph, and the angle between the internal axis of the scapula and the axis of the humeral stem is delineated as less than 140°, which is used as an objective indicator for the X-ray examination of frozen shoulder.
[Identification and typing]
1. Wind-cold-damp type: Pain in the shoulder is increased by wind-cold and slowed down by warmth, fear of wind and cold, or a feeling of heaviness in the shoulder. The tongue is pale, the coating is thin and white or greasy, and the pulse is smooth or tight.
2.Stagnation type: Swelling of the shoulder, pain and refusal to press, more so at night. The tongue is dark or with petechiae, the coating is white or thin yellow, and the pulse is stringent or thin and astringent.
3.Qi and blood deficiency type: soreness and pain in the shoulder, aggravated by exertion, accompanied by dizziness, shortness of breath, laziness, palpitation and insomnia, and weakness of the limbs. The tongue is pale, with little or white fur, and a weak or sunken pulse.
[Diagnostic basis]
1, Preferred age is around 50 years old, mostly seen in manual laborers, mostly with chronic onset.
2. Chronic strain, traumatic injury to the muscles and bones, lack of qi and blood and feeling wind, cold and dampness.
3. Pain around the shoulder, especially at night, often triggered by weather changes and exertion, and shoulder joint dysfunction.
4. Shoulder muscle atrophy, pressure pain at the front, back and outside of the shoulder, limited abduction function, typical “shoulder carrying” phenomenon.
5.X-ray examination: the anterior-posterior plain film of the shoulder joint with the patient’s upper limb in the down position is compared with the maximum supination position, and the angle between the scapular internal axis and the humeral stem axis is less than 140°, which is used as an objective indicator for the X-ray examination of frozen shoulder. Osteoporosis can be seen in those with long duration of disease.
[Differential diagnosis]
1, shoulder joint trauma: pain caused by acute injury to the shoulder bones and joints or soft tissues, often accompanied by significant local swelling and ecchymosis, can be identified by asking the history of the injury.
2.Biceps longus tendinitis: The pressure point is mostly at the inter-nodal groove in front of the shoulder joint, which causes severe pain in the above mentioned area when flexing the elbow and resistance test, and in some cases, there is frictional sensation at the inter-nodal groove, but no pain when passively moving the shoulder joint.
3.Supraspinatus tendonitis: pain in the lateral shoulder, with obvious pressure pain below the peak of the shoulder (at the large nodule of the supraspinatus tendon against the stop). The passive activities of the shoulder joint are not limited, but the pain is severe when the shoulder is abducted in the range of 60° to 120°, with occasional popping sound, or even affecting the activities.
4.Shoulder bone diseases: such as osteoarticular tuberculosis, septic arthritis, bone tumor of the upper humerus, etc. can be identified by asking medical history, X-ray radiographs and laboratory tests.
5.Shoulder dislocation and humeral tuberosity avulsion fracture: positive shoulder hitch test, which can be identified by medical history, X-ray and other methods.
[Treatment]
I. Tuina treatment (taking the right shoulder joint as an example)
(I) Initial stage (painful period)
1. The patient is placed in a supine position. The doctor presses the anterior part of the patient’s shoulder (equivalent to the upper edge of the pectoralis major, the anterior edge of the deltoid, the long head of the biceps tendon, and the rostro-humeral ligament area) with the root of the palm of the right hand. Repeat the application for 2 to 3 minutes.
2. The surgeon uses both hands to do the holding and kneading method on the patient’s upper limbs, focusing on the deltoid, biceps and triceps. Repeat the procedure for 2 to 3 minutes.
3.The physician uses both thumbs to do continuous pressure along the rostral process of the inferior clavicle from the inside out, focusing on the rostro-humeral ligament and the long head of the biceps tendon. Repeat the procedure for 2 minutes.
4. The patient is placed in the healthy side position. The doctor stands behind him and uses both palms to do alternate rubbing along the front and back of the upper arm for about 3 minutes (warmth is appropriate). Then, press the shoulder k with one hand and rub the Quchi point with the other hand, while doing abduction, induction and rotation, to the extent that the patient can bear, for about 2 minutes.
5. The doctor uses both hands to knead the infraspinatus, subscapularis, teres minor, and posterior border of the deltoid muscle with multiple fingers to relax the muscles. Repeat the procedure for about 2 minutes.
6.The patient is placed in a prone position. The doctor uses the palm root of both hands (large and small fissure) on both sides of the patient’s spine (chest 1 to chest 7), focusing on the supraspinatus, infraspinatus, sacrospinous, rhomboid, and trapezius muscles. Repeat the procedure for 3 minutes. Subsequently, take the points of shoulder middle Yu, shoulder Zhen, Tianzong and Ankylosis and press them with soreness and swelling, about 1 minute for each point.
7. The patient takes a sitting position. Do take and knead along both sides of the neck and the shoulder to the deltoid area for about 1 minute.
8.The doctor uses the tiger’s mouth of both hands in a symmetrical manner to do circular tapping along the radial-ulnar nerve travel area repeatedly for about 1 minute.
(II) Middle and late stage (adhesion period)
The functional activities of the shoulder joint are limited due to adhesions of some soft tissues, and the specific methods are as follows (take the right side as an example)
1.Limited forward flexion and supination
(1) The surgeon uses the left thumb to rub the biceps longus tendon and rostro-humeral ligament along the front of the shoulder joint from top to bottom. At the same time, the right hand holds the patient’s hand for flexion and extension for 2 to 3 minutes.
(2) Press the shoulder lift point (1.5 inches from the front edge of the shoulder peak), the shakuhachi and the fissure point.
2.Limited abduction and supination
(1)The doctor uses both thumbs to alternate between the shoulder well point and the deltoid bursa to do the paddling method for 2 to 3 minutes.
(2) Press the shoulder k, Quchi and Hegu points.
3.Limited internal rotation and touching of the spine
(1) Ask the patient to hold his hand on his head, and the doctor uses both thumbs to do the paddle kneading method along the lower gonad and the outer edge of the scapula (equivalent to the area of the large round muscle, the small round muscle and the posterior edge of the deltoid muscle), repeatedly for 2 to 3 minutes. Afterwards, the doctor uses the left thumb to point and press the shoulderzhen point, while the right hand holds the patient’s elbow and does a backward circular rotation movement of the shoulder joint 8 to 10 times.
(2) Point and press the Tianzong, Xiaohai and shoulder s points.
II. Fumigation
Take Stretching Herb, Turbinaria, Haitongpi, Wujiapi and Chuanjiao, fumigate the shoulder with water for 30 minutes each time, twice a day, for 10 days as a course of treatment.
C. Acupoint injection
Take acupuncture points such as shoulder k, Tianzong and arm, and inject 1~2ml of Danshen injection into each point, 2~3 times a week, 10 times a course of treatment.
Acupuncture
Choose shoulder K, shoulder front and Quchi as the main acupoints, and arm, giant bone and Tianzong as the supporting acupoints, and use the strong stimulation technique of lifting and twisting.
V. Closure
If the pain is severe, inject 0.5~1ml of prednisolone acetate plus 1-2ml of 2% procaine locally under the acromion of the shoulder, once every 1~2 weeks, 2~3 times in total.
VI. Physiotherapy
Chinese medicine ion introduction or magic lamp.
Seven, drug therapy
(A) Topical medication
Topical rubs and adhesive pain relief creams, such as Futalin emulsion, Qizheng pain relief paste, etc.; or raw aconite with appropriate amount of rubbing vinegar, suitable for cold limb pain; or comfrey oil applied externally, suitable for topical drug allergy after discontinuation.
(B) Internal medicine
The treatment should be to nourish the qi and blood, benefit the liver and kidney, warm the meridians, dispel wind and dampness, can take three paralysis soup or unique live parasitic soup, etc.. For those who are weak and have heavy blood deficiency, we can add or subtract Angelica Sinensis Chicken Blood Vine Soup.
In case of severe pain, drugs such as fenbid and speed pain can be taken.
VIII. Functional exercise
1.Shoulder external rotation: Bend the elbow 90° and tuck the fist against the body, with the fist heart upward and the elbow tip as a fulcrum to facilitate internal and external swinging, i.e., external shoulder rotation.
2.Shoulder supination: Lie on your back or lean back chair exercises, both hands embedded or not, using the weight of the limb plus gravity, so that the healthy limb with the affected shoulder easier to achieve results.
3.Shoulder abduction: Straighten both arms and chop in the direction of side planks, once palms up, once palms down, practice dozens of times.
[Prevention and care]
1.Strengthen the exercise, enhance confidence and eliminate the patient’s concern.
2.Pay attention to rest and keep the shoulder warm to prevent the symptoms from being aggravated by wind and cold again.
3.Progress step by step every day and overcome impatience.
[Indications for admission]
1. Pain around the shoulder is obvious, especially at night, no lying down, limited shoulder movement.
2.Diagnosis is clear, conventional treatment is not obvious, adapt to local seal or other treatment.
[Efficacy criteria]
Cured: The shoulder pain disappears and the functional activities of the shoulder joint are basically restored.
Improved: Shoulder pain mostly disappears and functional activities of the shoulder joint are improved.
Not cured: No improvement of symptoms.
[Discharge criteria]
1.The clinical symptoms and signs disappeared or reduced significantly, and those without complications can be discharged.
2. Clinical symptoms and signs are reduced and shoulder joint activity is partially restored.
[Clinical evaluation index]
Cure rate>71% Improvement rate>24% Failure rate<5% Death rate0