Although the disease has a tendency to heal on its own, there are obvious functional limitations of the shoulder joint and different degrees of pain during the freezing phase, which seriously affect the patient’s daily life and work ability. Currently, the more common methods of local closure, physical therapy, massage and functional training can only relieve the pain of the patient, but do not significantly improve the mobility of the shoulder joint.
Functional exercises of the joint
1. Diagnostic criteria
(1) Shoulder pain: slow onset, persistent pain, aggravated at night, aggravated by cloudy days and cold, localized warmth and fear of cold;
②Dysfunction: The shoulder is limited in all directions, especially in abduction and rotation;
③Widespread pressure pain: there is pressure pain in the anterior shoulder, posterior shoulder, subacromial and deltoid muscles;
④Muscle atrophy: there are different degrees of shoulder muscle atrophy;
⑤ X-ray examination can exclude shoulder fracture, dislocation, osteomyelitis, bone tuberculosis, bone tumor and severe osteoporosis.
2.Treatment methods.
All cases were treated in a lying position, and a brachial plexus nerve block was performed on the affected side in the anterior and middle oblique intermuscular grooves.
The method is: the operator holds the affected shoulder with one hand and the forearm with the other hand, and then does the forward flexion, back extension, abduction, adduction, internal rotation and external rotation of the affected shoulder in order, and finally does the circular rotation movement, and then repeats the technique from light to heavy, and the range of movement gradually increases. Then the operator feels that the resistance of the shoulder joint to movement in all directions disappears, and the shoulder joint is released until it reaches its normal range of motion.
It is important to note that the order of movement must not be rotated first, otherwise it may cause medical injury. After completing the release, the affected shoulder is routinely disinfected above the posterior surface, and after successful puncture of the joint cavity, 2 ml of sodium hyaluronate is injected, and the shoulder joint is massaged and rotated several times.
3. Postoperative management.
After the operation, the shoulder was fixed with an abduction frame at 90° of shoulder abduction. 24 hours after the operation, functional exercises such as circle drawing, finger climbing and abduction exercises were started, 3-5 times a day for 15 minutes each time. After the operation, the shoulder joint was punctured and injected with 2 ml of sodium hyaluronate 5 times a week.
Depalma divides the pathological process of frozen shoulder into three phases: the coagulation phase, the freezing phase and the thawing phase. In addition to severe contracture of the joint capsule, the periarticular soft tissues are involved in the frozen phase, with increased degeneration, congestion and thickening of the synovial membrane, and lack of elasticity of the soft tissues; this phase is characterized by a progressive decrease in shoulder mobility, including active and passive external rotation, internal rotation and abduction of the shoulder.
The treatment of this stage of frozen shoulder has two main goals: to relieve pain and to restore shoulder mobility. The commonly used methods such as oral NSAIDs, local closure, physiotherapy, massage and functional training are effective for patients with mild pain and limited mobility, but they take a long time and are not effective for patients with significant pain and cannot significantly improve shoulder mobility.
Under brachial plexus anesthesia, we can release the shoulder joint with no pain and relaxed muscles to avoid pain during treatment. The shoulder joint mobility is fully restored.
The manual release operation should be performed in sequence and should not be rotated first to prevent possible shoulder dislocation, fracture, nerve injury, rotator cuff injury, etc. due to violence and impulse; the operation should be performed by experienced physicians to properly control the magnitude and intensity.
Hyaluronic acid (HA), an acidic mucopolysaccharide, is widely found in the intercellular matrix of various tissues of vertebrates, and HA is the main component of joint cartilage and synovial fluid.
Intra-articular injection of sodium hyaluronate restores the lubricating function of synovial fluid by filling the synovial fluid with exogenous HA, which has the following effects: increasing the content of HA in synovial fluid, promoting the synthesis of endogenous HA and its accumulation on the surface of cartilage and synovial membrane, repairing the damaged barrier and preventing further destruction and loss of bone; improving the physiological function of synovial fluid under pathological conditions, playing a lubricating role, reducing friction caused by joint movement and tissue sliding, and increasing the range of motion of the joint. Caborn et al. Caborn et al. found that intra-articular injections of HA had a more significant effect on pain and functional improvement than injections of similar doses of prednisolone.