In outpatient clinics, we often see patients complaining of shoulder pain, waking up at night with pain, not being able to carry their pants, pulling out their back pockets, not being able to wear a bra or apron, not being able to turn their arms to hold something, and the doctor will tell you that you have “frozen shoulder”, so what exactly is frozen shoulder?
Frozen shoulder is also known as “frozen shoulder” and usually has five characteristics.
1. Slow onset of disease.
2. Pain around the deltoid stops of the shoulder joint, with pain at night.
3. Restriction of active and passive movement of the shoulder joint in all directions.
4, Negative X-ray examination.
5.Except for other causes of shoulder pain.
Of these, number 3 is the most important. If the patient’s symptoms do not match this one, the diagnosis of frozen shoulder needs to be questioned. The overall incidence of frozen shoulder in the general population is about 2-5%, nearly 70% of patients are female, and about 20%-30% of patients also develop it contralaterally. However, the incidence of frozen shoulder is much higher in the following groups of diseases, such as diabetes, cervical disc disease, hyperthyroidism, myocardial ischemia or myocardial infarction, autoimmune diseases, and trauma.
Based on clinical experience, frozen shoulder can be divided into several types.
1.Primary frozen shoulder: The age of 40-60 years old is the high incidence age, but rarely occurs in people under 40 years old, so it is also called “fifty shoulder”. It rarely recurs after the onset of the ipsilateral shoulder joint.
2. Diabetic frozen shoulder: Some scholars reported that the incidence of frozen shoulder in diabetic population is about 20%.
3, post-traumatic frozen shoulder.
4.Stiffness of the shoulder joint after surgery.
Frozen shoulder can be divided into 3 phases: the beginning phase, the freezing phase and the thawing phase.
In the beginning phase, pain is the main symptom and usually lasts for several months. Typical symptoms are pain arcs at rest and severe pain occurring with activity, especially sudden activity, and difficulty sleeping due to pain.
During the freezing phase, the pain symptoms begin to improve, but activities are severely restricted and the patient’s movements such as undressing, turning off lights, and washing hair become an ordeal.
After the thawing phase, the patient’s pain gradually decreases and mobility gradually improves, but full recovery takes months to years. Therefore, frozen shoulder is usually considered a self-healing condition that lasts 12-18 months, or 36 months, and the vast majority of patients heal without long-term sequelae. However, this does not mean that no medical help or treatment is needed. Normal people cannot gauge the pain of the patient, and for patients with shoulder pain that prevents them from sleeping, time passes by the second. Very few patients will wait that long and instead ask for aggressive treatment to be taken before December. It is wrong to easily ignore it and let it go when “the rooster crows and the sky is clear,” and this is usually the point most easily overlooked by doctors and patients.
The treatments for frozen shoulder include physical therapy, functional rehabilitation exercises, NSAIDs, oral corticosteroids, intra-articular closure therapy, closed manipulative release, incisional surgery and arthroscopic release.
With the advancement of minimally invasive arthroscopic techniques, incisional surgery has been largely abandoned. For patients with frozen shoulder whose symptoms are stubborn and ineffective with conservative treatment or who require rapid recovery, arthroscopic release is a fast and effective treatment, but usually less than 5% of patients require surgical treatment.
In conclusion, the first step in the treatment of frozen shoulder is diagnosis and the second step is treatment. There are many diseases that can cause shoulder pain and limited movement, such as calcific tendonitis, rotator cuff injury, acromioclavicular arthritis, tuberculosis, tumor, etc. If we do not differentiate them correctly, we will easily go to the wrong path of treating them in a generalized manner and cover them all with bias.