Epidemiologic characteristics (1) Age of onset: 40 to 70 years old; (2) Incidence: 2% to 5%; 10% to 35% in diabetes mellitus; (3) Female (70%) > male; (4) Chance of one side developing and the other side developing is 20% to 30%, and recurrence is rare. Classification 1. Primary/idiopathic 2. Secondary/acquired External fixation Shoulder surgery Shoulder trauma 3. Definitions – American Society of Shoulder and Elbow Surgeons (1) Adhesive capsulitis leading to glenohumeral contracture; (2) Shoulder pain; (3) Decrease in mobility in all directions, with decrease in mobility in external rotation being the most pronounced; (4) No abnormal findings on imaging. No abnormal findings on diagnosis. IV. Natural course–primary frozen shoulder (self-limiting) 1. Painful stage: lasting 2~9 months, the main symptom is pain. 2.Freezing period: lasts for 3~12 months, the main symptom is activity limitation, and the pain can be reduced compared with the previous period. 3.Dissolution phase: lasts for several months to several years, and the mobility of the shoulder joint is gradually restored. V. Treatment strategy 1. Non-steroidal anti-inflammatory drugs Reduce pain and inflammatory response. Need to be combined with systematic functional exercise. Physical therapy is suitable for patients within 3-6 months of the onset of the disease. Advocates multiple training sessions, each lasting 5 to 10 minutes. Each session should slightly exceed the pain point in terms of mobility. Use hot compresses before training and cold compresses after training. 3.Injection therapy (1) Intra-articular hormone injection: Reduce pain and inhibit inflammatory reaction around the joint. Under the supervision of imaging. Side effect: degeneration of tendon and articular cartilage. (2) Subacromial space injection: not very effective: most of the changes occur within the joint (3) Capsule dilatation (capusular distention): inject 60-100 ml of fluid into the joint cavity, and increase the pressure to 800-1500 mmHg. Literature varies widely, and the effect is better in patients with moderate limitation of activity. (4) Pain point closure Inhibition of extensive periarticular inflammatory response to reduce pain (5) Suprascapular nerve closure The sensory nerves of the joint capsule, which may be the main source of frozen shoulder pain. (4) Manipulative release under anesthesia (1) For patients who have been ineffective after 3 months of systematic functional exercise. (2) Performed under brachial plexus nerve block or general anesthesia. Indicators of a good prognosis: significant recovery of mobility after the tearing sound. Hormones can be injected into the joint cavity after release: to reduce pain, inhibit the inflammatory response and delay the healing of the joint capsule. 5. Surgical release (1) Excision of the inflamed synovium at the rotator cuff space (2) Release of the rostro-humeral ligament for external rotation mobility Upper glenohumeral ligament Middle glenohumeral ligament Anterior fascicle of lower glenohumeral ligament (3) Release of the axillary pouch of the lower glenohumeral ligament for abduction and supination mobility (4) Release of the posterior fascicle of the lower glenohumeral ligament for internal rotation mobility. 6. Summarization 1. Early diagnosis and treatment can change the natural course of the disease; 2. The rotator cuff space may be the primary focus of the disease; 3. Local closure of the rostro-humeral ligament in early and mid-term. Ligament local closure can effectively relieve pain; 4. Arthroscopic release is an effective way to treat frozen shoulder in the rigid phase.