When people have shoulder pain and limited movement, they think they have “frozen shoulder”, and even some orthopedic surgeons often use the term “frozen shoulder” to diagnose shoulder pain in a general way. Therefore, the diagnosis of “frozen shoulder” is like a big family. In addition to the scientific definition of “true frozen shoulder”, it also includes rotator cuff injury, subacromial impingement, shoulder instability, subacromial bursitis, intra-articular free body, osteoarthritis, and many others. Other shoulder joint diseases.
Studies have confirmed that the incidence of frozen shoulder is relatively low, and rotator cuff injury is the most prevalent shoulder disorder, followed by subacromial impingement and shoulder instability. The total incidence of these three disorders accounts for almost 70% of shoulder disorders and less than 30% of true frozen shoulder disorders.
Due to the misconceptions and limitations of these diseases, there are many patients who are misdiagnosed as “frozen shoulder” and suffer from increased pain and treatment errors. We hope that after reading this article, readers will have a scientific understanding of shoulder disorders and treat them correctly, so that we can become more “shoulder” strong.
The real frozen shoulder
Li, 52 years old, retired from home, usually less physical exercise. Recently, he had difficulty in lifting his right arm to comb his hair. He thought it was because he was getting older, so he bought a cream for external use, but it didn’t get better. Her family thought it was because she had less exercise, so they told her to lift more and exercise more, but the more she practiced, the more painful it became. On the recommendation of a friend, she went to our hospital and was confirmed to have frozen shoulder by physical examination and imaging. When conservative treatment with medication and rehabilitation exercises did not work, we performed a minimally invasive arthroscopic surgery on her to completely release the joint capsule that had become adherent. After a period of rehabilitation exercises, she gradually regained joint mobility.
Professional analysis: also known as “frozen shoulder”
Frozen shoulder, also known as “frozen shoulder”, is a primary stiffness of the shoulder joint, which is more common in middle-aged and elderly people around 50 years old, commonly known as “fifty shoulder”.
Frozen shoulder is an inflammation of the soft tissues of the shoulder joint, including the muscles, tendons, ligaments and joint capsule, that causes congestion and edema, which can lead to adhesions in severe cases, resulting in shoulder pain and limited movement, thus reducing the patient’s quality of life.
In addition to the generally accepted degeneration of periarticular tissues, the cause of frozen shoulder may also be related to diabetes, cervical spondylosis, and certain cardiovascular and neurological diseases. Those with a history of shoulder joint trauma are prone to develop frozen shoulder.
Typical presentation: shoulder pain with limited active and passive movement
The name “frozen shoulder” graphically describes the impaired active and passive movement of the shoulder joint in all directions in these patients. Patients often feel stiffness in the joint and limited mobility in rotating the arm backward and outward, making daily life affected, such as difficulty in combing hair and putting on and taking off clothes.
Wise treatment: staging
Patients with frozen shoulder in the acute stage are generally not suitable for massage and surgery treatment. If the pain is intolerable, you can take oral anti-inflammatory and analgesic drugs and apply cold compresses to the affected shoulder. If necessary, local pressure and pain points can be closed. While giving the shoulder joint adequate rest, it should also be supplemented with moderate active exercise to maintain the mobility of the shoulder joint.
Some patients with frozen shoulder may improve after a period of conservative treatment, and joint mobility will gradually return. A small number of patients with frozen shoulder can heal on their own. The chronic phase is based on functional exercises such as wall climbing exercises, stick exercises and physical therapy. If the patient’s condition does not improve significantly after 3 to 4 months of the above conventional treatment, surgery should be considered. Minimally invasive arthroscopic surgery is a safe and effective joint adhesion release procedure that has good long-term results in the treatment of frozen shoulder.
Rotator cuff injury
Aunt Li, a 51-year-old housewife, often felt pain in her left arm and could not lift it for a year. Later, the pain became more and more severe, and she often woke up at night with pain and could not lie on her side. She went to many hospitals for checkups and was treated as “frozen shoulder”. She had done manual massage, physiotherapy, and closure, but it did not heal for a long time. She came to our department, and after careful examination, we found that she was not suffering from frozen shoulder, but from a left rotator cuff injury.
Professional analysis: Rotator cuff – the tissue that is easily injured
Rotator cuff tissue can strengthen the stability of the shoulder joint and protect the shoulder joint, but at the same time, the rotator cuff itself is also a tissue that can be easily damaged and torn.
Rotator cuff injury is a very common degenerative disease of the shoulder joint, and its occurrence is positively correlated with age. It is very common in older people over 60 years old who have “shoulder pain”, with a prevalence rate of 70%, much higher than the so-called “frozen shoulder”. In addition, athletes, people with a history of shoulder trauma and those who often lift heavy objects are also prone to rotator cuff injuries.
Typical symptoms: waking up in the middle of the night with pain and weakness in lifting
Rotator cuff injuries are divided into two types: acute lacerations and chronic strain injuries, with the latter being the most common. Patients with rotator cuff injuries have pain in the neck and shoulder area, with significant pain at night and even waking up in pain; pain when lifting the affected arm, and weakness when abducting or posteriorly extending.
Wise treatment: surgical repair
If a patient with a rotator cuff injury continues to perform exercises such as “pulling the hoop” or forcibly loosening the shoulder joint, it may cause the rotator cuff tissue fracture to continue to expand, aggravating the condition and even causing disability in severe cases. Patients with a diagnosed rotator cuff injury can undergo an arthroscopic rotator cuff repair, where several suture anchors are inserted to close the torn rotator cuff tissue.
Subacromial impingement
Mr. Liu is 38 years old and is a keen fitness enthusiast, playing basketball and badminton, especially strength training. In recent months, he felt significant pain in his shoulder during supination training, and the symptoms did not improve and affected his shoulder movement after pausing training. He went to a small clinic several times for physiotherapy and closed treatment, but the results were not good. He went to our hospital and was diagnosed with subacromial impingement after physical examination and imaging.
Professional analysis: related to long-term overuse of the shoulder joint
Subacromial impingement is a painful condition in the shoulder caused by the impingement of the acromion and subacromial bursa at a certain angle during shoulder abduction and supination. If left untreated, repeated impingement may also affect the rotator cuff attachment point, resulting in a rupture of the rotator cuff tissue, worsening the pain and seriously affecting the patient’s quality of life.
Typical presentation: dull shoulder pain and supination dysfunction
Chronic dull pain in the shoulder, aggravated by lifting or abduction activities. Subacromial impingement is common in older people, people who frequently work with their upper extremities elevated, and sports enthusiasts. Exercises such as badminton, gymnastics, and swimming can lead to subacromial impingement if done improperly.
Wise treatment: Reduce shoulder activity, surgical treatment if necessary
Patients need to reduce shoulder extension exercises and combine them with medication for anti-inflammatory and analgesic treatment. Some patients also need minimally invasive arthroscopic surgical treatment to eliminate the causative factors of subacromial impingement.
Patients with subacromial impingement who are misdiagnosed with frozen shoulder and undergo certain inappropriate treatments are likely to aggravate the condition, delay treatment, and even cause rotator cuff impingement tear injuries.
Shoulder joint instability
Xiao Chen is a college student who loves sports. Once on a bus, when braking sharply, Xiao Wang’s shoulder was accidentally hit, and the pain was obvious at that time. He went to a nearby hospital and had a general plain film taken, which did not reveal any obvious fracture, so he stopped paying attention to it later. After some time, Xiao Chen played basketball, with a beautiful basketball into the bar, Xiao Chen suddenly felt “arm off”, and pain, immediately went to the hospital, reset. Later, this situation was found many times, so much so that Xiao Chen is now afraid to participate in sports. After the trauma, Xiao Chen’s shoulder joint instability was typical.
Professional analysis: traumatic joint instability is common
The shoulder joint is the most mobile and flexible joint in the human body, but its stability is relatively poor because of its large humeral head and shallow scapular fossa, and the weak restriction of the surrounding joint capsule.
Traumatic shoulder instability is most common in the young, athletic population. When the shoulder is traumatized or the joint structure degenerates, there can be a symptomatic displacement of the humeral head relative to the shoulder pelvis, i.e., shoulder dislocation or subluxation occurs. If you do not pay attention to protection in later life and sports and often perform large arm movements, such as gymnastics, swimming, throwing, etc., you may develop recurrent shoulder instability, also known as habitual shoulder dislocation.
Typical symptoms: shoulder pain, fear of shoulder movement
Patients describe vague symptoms, such as shoulder pain in an unclear location, and feeling certain abnormalities and discomfort when the arm is moved to certain positions. Patients with recurrent dislocations harbor a fear of daily life and sports and are afraid to fully exercise the shoulder joint. If left untreated, bone defects may develop secondary to the dislocation, leading to bone defective shoulder instability with serious consequences.
Wise treatment: Arthroscopic minimally invasive surgery is preferred for recurrence
In general, patients with shoulder instability can undergo non-surgical treatment, but the recovery process is long, usually taking about 6 months. If the results are still poor, surgical treatment is required. For patients with recurrent shoulder instability, minimally invasive arthroscopic surgery is the treatment of choice, with a success rate of more than 95 percent. Patients with shoulder instability who are misdiagnosed with frozen shoulder and undergo wrong rehabilitation may be more prone to dislocation and aggravate their condition.
Rotator cuff injury, subacromial impingement, shoulder instability, and frozen shoulder are the four main causes of shoulder pain. Arthroscopic minimally invasive surgery is done through several small 5mm holes and is currently the best treatment for shoulder pain.