Shoulder pain is a relatively common disease that can seriously affect a person’s mood and cause great inconvenience to normal work and life, and many people are treated as frozen shoulder in hospitals, which makes it difficult to cure and risks aggravating the condition. So how do you identify whether it is frozen shoulder or another disease?
Shoulder periarthritis is caused by chronic aseptic inflammation of the muscles, tendons, ligaments, bursa, joint capsule and other soft tissues around the shoulder, resulting in adhesions inside and outside the joint, which hinders the movement of the shoulder joint, also known as adhesive shoulder arthritis, fifty shoulders, frozen shoulder, or frozen shoulder. The disease can be triggered by trauma, chronic strain, prolonged inactivity or immobilization, or local wind and cold attack. The clinical manifestations are mainly shoulder pain, shoulder joint movement disorder or stiffness, and muscle atrophy around the shoulder. Some patients develop from biceps tenosynovitis, supraspinatus, subacromial bursitis, etc. The disease is more common in middle-aged and elderly people over 40 years old, with more women than men (about 3:1) and more right shoulders than left shoulders, and most of them have a chronic onset. The prognosis of this disease is good, and most of them can heal on their own (after several months to about two years). If you are active in exercise and other treatment, the disease will be short and recovery will be fast. It can also recur after healing.
Symptoms.
1. Slow onset, most have no history of trauma, a few have only minor trauma. There may be a history of exposure to wind and cold.
2. The duration of the disease is long, often with a history of pain for several months. Initially, the shoulder pain is mild, with loss of movement, and gradually worsens. The pain is usually located in the front and outside of the shoulder, and may radiate to the neck, ear, forearm and hand, but there is no sensory impairment. In severe cases, the pain is unbearable when touched, or you may not be able to sleep at night, or wake up in the middle of the night with pain, and you may not dare to lie on the affected side.
3. The affected shoulder muscle is atrophied, and there is spasm in the latissimus dorsi and the large and small circular muscles. The pressure pain in the shoulder is widespread, and the pressure pain in the long head tendon of the biceps is the most obvious. Shoulder movement is severely restricted, especially abduction, external rotation and posterior extension.
4. In advanced stage, the shoulder joint may be stiff.
Diagnostic basis.
1. Slow onset and long duration of disease.
2. Shoulder pain, impaired shoulder movement or stiffness, and widespread pressure pain, especially in the long head tendon of the biceps tendon. Atrophy of the periapical muscles.
3.The shoulder joint abduction, external rotation and posterior extension are obviously obstructed, even in a stiff state.
4.X-ray of shoulder joint: generally no special changes. Sometimes local osteoporosis, calcification of supraspinatus muscle and increased density of large nodules are seen. Shoulder arthrography shows that the joint cavity is shrunken and square.
Rotator cuff injury can be caused by acute trauma or due to repeated strain.
In middle-aged and elderly people, rotator cuff injuries are often caused by degenerative changes and brittle texture of the rotator cuff, and therefore usually occur in the habitual shoulder. In addition, rotator cuff injuries have specific symptoms: recurrent or persistent shoulder pain; increased pain at night, especially when sleeping on the affected side; decreased muscle strength, especially when trying to lift the upper arm; and possible limitation of joint mobility. The common site is anterior shoulder pain, located in the front and lateral deltoid muscle. In the acute phase, the pain is severe and persistent; in the chronic phase, the pain is spontaneous and dull, and the symptoms are aggravated after shoulder activity or increased load. Passive external rotation of the shoulder joint also makes the pain worse, and the aggravation of symptoms at night is one of the common clinical manifestations. Functional impairment: In large rotator cuff ruptures, active shoulder supination and abduction are limited, and the range of abduction and forward elevation is less than 45°, but the passive range of motion is not significantly limited. Muscle atrophy: If the history of the disease is more than 3 weeks, there are different degrees of atrophy of the muscles around the shoulder, with the deltoid, supraspinatus and infraspinatus muscles being more common. Secondary contracture of the joint: If the disease duration is more than 3 months, there are different degrees of limitation in the range of motion of the shoulder joint, and the limitation of abduction, external rotation and supination is more obvious.
Special signs
1.Shoulder drop test: If the affected arm is passively raised to the range of 90°-120° of supination and the support is removed, the affected arm cannot support itself and arm drop and pain occurs, then the test is positive.
2.Impact test: Press the shoulder peak downward, while passively lifting the affected arm, if there is pain in the subacromial space or accompanied by inability to lift the arm, it is positive.
3.Pain arc sign: If the pain occurs in the anterior shoulder or subacromial region within the range of 60° to 120° of raising the affected arm, it is positive, which is diagnostic for rotator cuff contusion and partial tears.
4.Friction sounds in the glenohumeral joint: that is, friction sounds or gravel sounds appear in the glenohumeral joint during active or passive activities, often caused by scar tissue at the end of the rotator cuff disruption. It is not easy to make a correct diagnosis of rotator cuff rupture. Patients with a history of shoulder trauma, pain in the front of the shoulder with pressure pain in the proximal side of the greater tuberosity or in the subacromial region should consider the possibility of rotator cuff tear if any one of the above 4 special positive signs are present at the same time. In cases of suspected rotator cuff rupture, X-rays, arthrography, CT, MRI, ultrasonography and arthroscopy should be performed to help establish the diagnosis.
What is the difference between the two in terms of treatment?
Frozen shoulder: The aim of treatment is to relieve pain and dysfunction of the shoulder joint. Non-surgical treatment is generally used. Functional exercise is extremely important. It should be actively carried out at the beginning of the disease and should be used throughout the treatment process. It should be carried out actively and systematically, and the following methods can be used.
1. the prone forward and backward internal and external oscillation method.
2.Bending over and drawing circles method.
3.Wall climbing method.
4.Sliding car with arm up method. Several times a day, bear the light pain active exercise, after the pain is reduced, gradually increase the amount and scope of movement, but avoid passive activities. Painful point closure: for obvious local pressure pain, use 1% procaine 4-10ml plus hydrocortisone acetate or prednisolone 25mg for local closure once a week, 2-3 times. Medication: internal and external use of Chinese and Western medicine to relax the tendons and activate the blood circulation, activate blood stasis, anti-inflammatory and pain relief. Acupuncture and physiotherapy or hot compress locally. Massage and tui-na: massage at the rostral prominence point and subacromial bursa immediately after closure. Sometimes it is done under general anesthesia, and the upper arm is abducted and lifted up with gentle techniques to loosen the joint adhesions. If long-term conservative treatment is ineffective and the symptoms are severe, surgery is feasible.
Surgical methods.
1.Biceps long head tendon fixation or transposition: after cutting at the attachment, the biceps long head tendon is fixed in the rostral process or in the groove between the humeral tuberosities, and anterior acromioplasty is done at the same time.
2, rostro-humeral ligament severance. The disease can mostly heal on its own, but it takes longer (ranging from several months to 2 years), is painful, has incomplete functional recovery, and can recur after healing. Many patients have sought medical help for many times, but are distressed by the lack of effective drugs. In fact, as long as the disease is actively treated with comprehensive non-surgical treatment, the results are quite satisfactory. The disease has a long course, so you should build up confidence in overcoming the disease, actively carry out active functional exercises, have a long-term plan, gradually increase the amount and magnitude of shoulder joint activities, and gradually restore its function. After the symptoms have basically disappeared, you should also insist on functional exercises to avoid the shoulder getting cold and wind to facilitate the healing of the disease and avoid recurrence.
The treatment of rotator cuff injury is the opposite of the treatment of frozen shoulder, which requires activities to strengthen the shoulder joint to accelerate the blood supply to improve the inflammatory symptoms. It requires the patient to keep the shoulder absolutely rested and inactive, to take care of it and to restore the degree of muscle damage. In the acute stage, selective non-steroidal anti-inflammatory drugs can be given. Those who have been suffering from the disease for more than six months without significant relief of symptoms by conservative treatment often need to undergo shoulder arthroscopy, which can achieve satisfactory results.