Overview
Periarthritis, also known as frozen shoulder, frozen shoulder, frozen shoulder, or frozen shoulder, is a common condition with shoulder joint pain and limited mobility as the main symptoms. The disease is more common in women than in men and is more common in manual laborers. If not treated effectively, it may seriously affect the functional activities of the shoulder joint and hinder daily life. In the early stage of the disease, the shoulder joint pain is paroxysmal, often triggered by weather changes and exertion, and then gradually develops into persistent pain, which gradually worsens, with light day and heavy night, unable to sleep at night, unable to lie on the affected side, and limited active and passive activities of the shoulder joint in all directions. When the shoulder is stretched, it can cause severe pain. There may be widespread pressure pain in the shoulder joint that radiates to the neck and elbow, and there may be different degrees of atrophy of the deltoid muscle.
Disease Description
It is called frozen shoulder. It is a chronic inflammation of the periapical muscles, tendons, bursa and joint capsule. It is characterized by pain and functional limitation during activities due to hyperplasia, roughness and intra- and extra-articular adhesions.
Symptoms and signs
1. The disease is more common in women than men, mostly in middle-aged and elderly people, with more left-sided than right-sided disease, or both sides successively. A few patients may have bilateral onset of the disease at the same time. The age of onset of frozen shoulder is consistent with the age of severe degeneration of the shoulder joint, and there is a history of injury to the shoulder or a history of local external fixation, cold, or hemiplegia.
2. Pain is the most obvious symptom, gradually appearing at a certain place in the shoulder, and there is a clear relationship with the movement and posture. With the prolongation of the disease, the pain expands and involves the middle part of the upper arm, along with the limitation of shoulder joint movement. The degree and nature of the pain varies widely, from dull pain to cutting pain, or severe sharp pain if you want to increase the range of motion. In severe cases, the affected limb cannot comb the hair, wash the face or buckle the belt. At night, the affected limb cannot brush its hair, wash its face, or buckle its belt, and it wakes up with pain due to turning and moving the shoulder. The pain and muscle spasm can be limited to the shoulder joint, but can also radiate upward to the back of the head, downward to the wrist and fingers, or backward to the scapula and forward to the chest; some radiate to the triceps or radiate to the deltoid or biceps straight to the radial side of the forearm. The location of the pressure point and the degree of pressure pain are not consistent depending on the stage of the disease. Patients can still point out the pain point at the beginning, but later the range expands and the pain is felt to come from the humerus.
3. On physical examination, there is mild atrophy of the deltoid muscle and spasm of the trapezius muscle. The supraspinatus tendon, long and short head biceps tendon and the anterior and posterior edges of deltoid muscle can have obvious pressure pain. The shoulder joint is most obviously limited in abduction, external rotation and posterior extension, and in a few people, internal retraction and internal rotation are also limited, but less limited in forward flexion.
4. In older patients or those with a longer course of the disease, osteoporosis of the shoulder, or calcification of the supraspinatus tendon and subacromial bursa may be seen on X-ray plain film.
Disease development
According to the occurrence and development of frozen shoulder, it can be roughly divided into 3 stages, namely, acute stage, chronic stage, and recovery stage. There are no obvious boundaries between the stages, and the length of each stage varies greatly from person to person.
1. Acute stage: This is the early stage of frozen shoulder. The pain in the shoulder is spontaneous, and its pain is often persistent and varies in performance. Some have acute attacks, but
Most of the pain is chronic, while some people only feel discomfort and constriction in the shoulder. The pain is mostly limited to the anterolateral aspect of the shoulder joint and may extend to the point of resistance of the deltoid muscle, often involving the scapular area, upper arm or forearm. The pain increases during activities, such as shrugging or internal rotation of the shoulder while wearing a shirt, and it is not possible to comb the hair or wash the face. Later, the shoulder pain increases rapidly, especially at night, and the patient does not dare to lie on the affected side. Due to the muscle spasm and pain, the range of motion of the shoulder joint is gradually reduced, especially the limitation of abduction and external rotation is most significant. The appearance of the shoulder is normal. The local pressure points are mostly located in the inter-nodal groove and rostral process. The subacromial bursa or deltoid muscle attachment, supraspinatus muscle attachment, and the internal superior scapular angle.
2. Chronic phase: Shoulder pain gradually decreases or disappears, but the contracture and stiffness of the shoulder joint gradually increases in a frozen state. The shoulder joint activity in all directions is 50%-20% less than normal. In severe cases, the shoulder-humeral joint activity disappears completely, and only the scapular-thoracic wall joint activity is present. It is difficult to comb the hair, put on clothes, lift the arm, and knot the belt backwards. Mild muscle atrophy may occur in long-standing cases, mostly in the deltoid and scapular band muscles. The pressure pain is mild or no pressure pain, which lasts for a long time, usually 2-3 months.
3.Recovery period: Shoulder pain basically disappears, individual patients may have slight pain. The shoulder joint slowly relaxes and the movement of the joint gradually increases, with the external rotation activity being restored first, followed by abduction and internal rotation. The length of the recovery period is related to the duration of the acute and chronic phases. The longer the freezing period, the slower the recovery period; the shorter the disease period, the faster the recovery. The entire course of the disease is as short as one to two months, but the onset can be several years.
Disease etiology
(1) Braking
Frozen shoulder pathology
Reduced movement of the shoulder joint, especially with the upper extremity resting on the side of the body for a long period of time, is considered to be the most important trigger of frozen shoulder. Braking usually occurs after a traumatic injury or surgery. Not only can a fracture of the shoulder or upper arm, inappropriate braking for too long after trauma [2] can cause frozen shoulder, but sometimes even reduced movement of the shoulder joint due to the application of a neck and wrist sling after a fracture of the forearm or wrist, or immobilization in a chest cast can also cause frozen shoulder. In addition, heart surgery, thoracic surgery, female mastectomy, and sometimes even hepatobiliary surgery can also cause frozen shoulder on the same side of the shoulder. Frozen shoulder caused after such surgery may be related to postoperative pain and reduced shoulder activity.
(2) Intrinsic lesions of the shoulder joint
Degenerative diseases of the shoulder joint itself, especially local soft tissue degenerative changes, can cause frozen shoulder due to painful restriction of shoulder motion. The most common degenerative soft tissue disorders leading to frozen shoulder are tendonitis and tenosynovitis, followed by impingement syndrome and subacromial damage. These diseases can lead to frozen shoulder due to further opening into damage, adhesions, contractures and other pathological changes in the musculoskeletal, rotator cuff, bursa and joint capsule. In addition, injuries to the shoulder, sometimes even minor ones, are highly likely to be the cause of frozen shoulder.
(3) Neighboring site diseases
A common neighboring site disorder is cervical spine disorders. There are many studies that show that patients with cervical spine disorders have a greatly increased likelihood of developing frozen shoulder, and that patients with frozen shoulder are often associated with a significant decrease in ipsilateral cervical lateral flexion and rotation. Therefore, caution should be exercised when making the differential diagnosis or determining whether a cervical spine disorder is responsible for frozen shoulder. Other adjacent disorders include heart disease, pulmonary tuberculosis, and subphrenic disease.
(4) Neurological disorders
There are many clinical observations that show a higher incidence of frozen shoulder in patients with neurological disorders such as hemiplegia and nerve palsy. This may be related to the decrease in muscle strength and movement, for example, the incidence of frozen shoulder in patients with Parkinson’s disease is as high as 12.7%, and the reason for the high incidence is obviously related to the decrease in movement.
(5) Endocrine system diseases
Endocrine system diseases such as diabetes mellitus, hyperthyroidism or hypothyroidism are also closely related to frozen shoulder, especially in patients with diabetes mellitus, where the incidence of combined frozen shoulder can be 10%-20%. Therefore, endocrine dysfunction may also be one of the triggering factors for frozen shoulder.
(6) Changes in immune function
Although the immune mechanism for the development of frozen shoulder is not well understood, it seems that it may be related to the autoimmune reaction induced by degenerative changes in tendon tissues such as the supraspinatus tendon. Phenomena such as the predisposition of older adults to develop frozen shoulder and the treatment of frozen shoulder with adrenal glucocorticoid injections during the treatment of frozen shoulder support the argument for an immune link. In general, after the age of 50 years, the supraspinatus musculature and other areas become significantly thinner and worn, and focal necrosis occurs in the vascular supply-poor zone at the tendon stop, which is often repeatedly impinged with the subacromial crest during abduction. As a result, it is very susceptible to damage and inflammation. Local evidence of nonbacterial inflammation can produce a foreign body-type cellular immune response that gradually extends to other parts of the rotator cuff and joint capsule, causing diffuse capsulitis. In addition, some patients with frozen shoulder have relatively high immune indicators such as HLA-B27 positivity for human leukocyte-associated antigen, 1gA, C-reactive protein and immune complex levels, all of which may be related to autoimmune reactions caused by fibrous degeneration after soft tissue injury around the shoulder joint.
(7) Postural disorders
A significant number of patients with frozen shoulder occur in occupations with good posture, such as manual work and sedentary posture, and patients with excessive posterior thoracic protrusion (hunchback) are significantly more likely to develop frozen shoulder. This may be due to long-term poor posture or postural disorders that cause tilting of the scapula, and changes in the position of the scapula and humerus due to abnormal stress, gradually forming rotator cuff injury and potentially leading to frozen shoulder.
(8) Psychological factors
Psychological factors such as depression, apathy and emotional urban depression are also related to the occurrence of frozen shoulder. A significant number of patients with frozen shoulder can have a history of emotional instability and trauma. Or they may have a depressed mood due to long-term illness and socioeconomic pressure trap. They are more sensitive to pain, i.e. people with a lower pain threshold tend to be prone to frozen shoulder. The likely reason for this is that once shoulder pain and inflammation has occurred, these individuals tend to have a harder time regaining motor function because they are overly sensitive to pain. Although the triggers of frozen shoulder are diverse, these numerous triggers work together to cause mild, nonspecific inflammatory changes in the soft tissues of the shoulder joint, thus suggesting that the etiology of frozen shoulder may be multifactorial.
Therefore, the treatment and prevention of frozen shoulder should be differentiated according to its predisposing factors.
Pathophysiology
The lesions around the shoulder joint occur mainly around the glenohumeral joint, which includes.
① Muscles and tendons. It can be divided into two layers. The outer layer is the deltoid muscle, and the inner layer is the four short muscles of the supraspinatus, infraspinatus, subscapularis and teres minor and their joint tendons. The joint tendons are closely connected to the joint capsule and are attached to the upper end of the humerus like a cuff, called the rotator cuff or rotator cuff. The rotator cuff is one of the most stressed structures in the shoulder joint and is easily damaged. The long tendon of the biceps muscle starts above the articular labrum and passes through the bone fiber tunnel in the intertrochanteric groove of the humeral tuberosity, which is the site of inflammation. The short head of the biceps muscle begins at the rostral process and travels anteriorly through the glenohumeral joint to the upper arm, where the muscle spasms after inflammation, affecting shoulder abduction and posterior extension.
②Bursa. There are subdeltoid bursa, subacromial bursa and sub rostral bursa. The inflammation can interact with the adjacent deltoid, supraspinatus tendon, and short biceps tendon.
(iii) Articular capsule. The glenohumeral joint capsule is large and loose, and the shoulder has a large range of motion and is therefore vulnerable to injury.
Chronic injury to these structures is characterized by hyperplasia, roughness, and intra- and extra-articular adhesions, resulting in pain and functional limitation. In the later stages, the adhesions become very tight and even adhere to the periosteum, at which point the pain disappears but the functional impairment is difficult to restore.
Diagnostic tests
1.Cervical spondylosis
Neurogenic cervical spondylosis can have shoulder pain due to irritation of the cervical 5 nerve roots, while prolonged pain and muscle spasm can lead to chronic injury inflammation. Therefore, cervical spondylosis can have shoulder symptoms and can also be secondary to frozen shoulder. The main differentiation between the two is that in cervical spondylosis, there is little damage to the single nerve, often there is radicular pain in the forearm and hand, and there are signs of nerve localization. In addition, there are more head and neck signs than periarthritis.
2.Shoulder tumor
Although shoulder tumors are less common than other diseases, they have serious consequences. In clinical practice, sometimes the shoulder pain of middle-aged and elderly people is treated as frozen shoulder or cervical spondylosis for a long time, thus delaying the diagnosis. Therefore, if the pain is progressively aggravated, the pain cannot be relieved by fixing the affected limb, and axial percussion pain is present, radiographic examination should be performed to exclude bone disease.
Clinical typing of frozen shoulder
Frozen shoulder is a chronic aseptic inflammation of the shoulder-humeral joint and its surrounding soft tissues, which is characterized by painful stiffness and limited movement of the shoulder. Broadly speaking, frozen shoulder refers to a multi-joint, multi-site condition occurring in the shoulder complex. There are many methods of classification and confusing diagnostic names, which are divided as follows.
(1) There are four major categories according to the similarity in lesion location and diagnostic significance.
(1) Shoulder joint cavity lesions: frozen shoulder, painful shoulder contracture, adhesive capsulitis, painful shoulder and peri-articular adhesions of the shoulder, etc.
②Bursal lesions: adhesive subacromial bursitis, adhesive bursitis, calcific bursitis, occlusive bursitis, subdeltoid bursitis, tendon synovitis, etc.
Tendonitis and tenosynovitis: biceps longus tendonitis, adhesive tenosynovitis, supraspinatus tendonitis, painful arc syndrome, calcific tendonitis, degenerative tendonitis, rotator cuff inflammation, etc.
(4) Other periapical lesions: shoulder fibrous tissue inflammation, rostral synostosis, degenerative shoulder arthritis, osteoarthritis, rheumatoid arthritis, etc.
(2) Anda Nagao divides periarthritis into three categories according to the site of lesion.
(1) Damage to the sliding mechanism of the shoulder joint: tendonitis of the rotator cuff, rupture of the rotator cuff, calcium deposits in the rotator cuff, etc.
(ii) Damage to the biceps mechanism: tenosynovitis of the long head of the biceps, etc.
(3) Frozen shoulder.
(3) Shinwon’s classifies frozen shoulder into nine categories according to the location, nature and clinical features of the lesion.
①Biceps long head tendinitis and tenosynovitis.
(ii) rostral synovitis.
③ Supraspinatus tendonitis, including both degenerative and injurious.
(iv) Calcific supraspinatus tendonitis.
⑤Subacromial bursitis.
⑥Frozen shoulder, also known as painful joint contracture.
⑦Secondary shoulder contracture, mostly secondary to shoulder trauma, surgery or prolonged immobilization.
(8) Fibrous tissue inflammation of the shoulder.
(9) Shoulder instability or shoulder laxity, including joint instability and subluxation caused by ligament and capsule laxity due to trauma or lesion, glenoid labral lesion, etc.
(4) Based on the reference of foreign classification methods and according to the actual situation of domestic cases, our experts and scholars classify it according to lesion location, disease nature and clinical manifestations as follows.
①Frozen shoulder.
②Rostral synostosis.
③ Rotator cuff lesions: including supraspinatus tendinopathy (supraspinatus tendinitis, calcific supraspinatus tendinitis, supraspinatus tendon rupture), infraspinatus tendinitis, and small round tendinitis.
④Biceps long head tendinitis and tenosynovitis.
⑤ Subacromial bursitis (also known as subacromial bursitis of the deltoid muscle).
(6) Acromioclavicular joint lesion.
(7) Sternoclavicular arthritis.
(8) Shoulder joint instability (including developmental or injury-induced bone structure defects, glenoid labral lesions, excessive laxity of the joint capsule or ligaments, and paralysis of the muscles surrounding the shoulder.
⑨ Fibrous tissue inflammation of the shoulder.
⑩Other periacetabular lesions (including shoulder contusion, subacromial impingement syndrome, suprascapular nerve entrapment syndrome, deltoid tendonitis, etc.).
Treatment of frozen shoulder
The principle is to take appropriate treatment measures for different periods of frozen shoulder, or for the severity of its symptoms. The treatment of frozen shoulder should be mainly conservative. Generally speaking, if the diagnosis is timely and the treatment is appropriate, the course of the disease can be shortened and the motor function can be restored early.
1.In the early stage of frozen shoulder
i.e. the painful period, the patient’s pain symptoms are heavy. Therefore, the main purpose of treatment is to relieve pain and prevent joint dysfunction. To relieve pain, use sling braking to give the shoulder joint adequate rest; or rest with closed therapy, inject prednisolone at the most obvious local pressure pain; or use intermittent electrical therapy, warm compresses, cold compresses and other physical therapy methods to relieve pain. If necessary, you can take anti-inflammatory and analgesic drugs internally and apply topical drugs such as antispasmodic and analgesic tincture externally. In the acute stage, it is generally not advisable to use massage and massage methods too early to prevent the pain symptoms from worsening and prolonging the course of the disease. Generally, you can take some active exercises to maintain the mobility of the shoulder joint, and only after the acute period, you can use massage to improve blood circulation and promote local inflammation.
2.During the freezing period of frozen shoulder
Joint dysfunction is the main problem, and pain is often caused by joint movement disorders. The treatment focuses on restoring the joint movement function. The treatment used can be physical therapy, Western-style manipulation, massage, medical sports and other measures to release adhesions, expand the range of motion of the shoulder joint, and restore normal joint movement function. For symptoms of dysfunction, patients with severe frozen shoulder can be treated with a large thrust under anesthesia to tear the adhesions if necessary. During this phase, functional exercises of the shoulder joint should be adhered to. In addition to passive exercises, the patient should actively cooperate and carry out functional training of active exercises, which is an extremely important part of the whole treatment process.
3. During the recovery period of frozen shoulder, the elimination of residual symptoms should be the main focus, and the main principle is to continue to strengthen functional exercises to enhance muscle strength, restore the scapular band muscles that have undergone waste atrophy in the earlier stage, and restore the normal elasticity and contraction function of deltoid muscles and other muscles to achieve comprehensive recovery and relapse prevention.
4. In addition to taking different treatment measures for different disease processes, treatment measures should also be considered for the severity of the frozen shoulder condition. In this regard, the foreign opinion is that the severity of the condition can be determined by the limitation of movement and end sensation due to pain during the passive motion test, which can guide the treatment. If the patient’s pain occurs before the end sensation during the passive motion test, then the frozen shoulder is often acute and active motion therapy is not appropriate.
The shoulder joint is the joint with the largest range of motion among all joints in the human body. Its joint capsule is loose and the stability of the joint is mostly maintained by the strength of the muscles, muscles and ligaments around the joint. Because of the poor blood supply to the tendons and the degenerative changes that occur with age, and because the shoulder joint is more active in life, the surrounding soft tissues are often subjected to friction and compression from various sources, making it susceptible to chronic strain injury.
Treatment options
1. Frozen shoulder has its own natural course, and generally heals itself in about 1 year. However, if you do not cooperate with the treatment and functional exercise, even if you heal yourself, you will still have different degrees of dysfunction.
2. Early physiotherapy, acupuncture, and moderate massage can improve the symptoms.
3.When the pain is limited, local injection of prednisolone acetate can significantly relieve the pain. But it is not recommended to use this method, closed therapy can have immediate effect, but can only temporarily suppress the pain for a few years, it is easy to relapse, and then the disease will be heavier.
4.If the pain persists and it is difficult to sleep at night, you can take non-steroidal anti-inflammatory drugs for a short period of time and appropriate amount of oral muscle relaxants.
5. No matter how long or short the disease is, and whether the symptoms are mild or severe, active activities of the shoulder joint should be carried out daily, and the activities should be limited to those that do not cause severe pain. In addition, you can use topical Chinese medicine for treatment, such as Lizheng pain relief patch, which is a topical dressing, and the drug penetrates the diseased bone from the skin.
Health care tips
1. Pay attention to the local warmth of the shoulder joint, add or remove clothes at any time with the climate change, avoid cold and wind, and live in a humid place for a long time.
2.Avoid overexertion, avoid lifting heavy objects and pay attention to local warmth.
3.Strengthen the activities of the joints and outdoor exercise, pay attention to safety and prevent accidental injury.
4.The elderly should strengthen nutrition and supplement calcium, such as eating milk, eggs, soy products, bone broth, black fungus, etc., or take oral calcium supplements.
5.In the acute stage, it is not advisable to do active activities of the shoulder joint. Heat compress, cupping, light massage and massage can be used as a comprehensive treatment.
Acupuncture therapy
Shoulder periarthritis is a degenerative and inflammatory disease of the shoulder capsule and soft tissues surrounding the joint. Its clinical manifestations are: mostly seen in middle-aged and elderly people over 45 years old, the early stage is mainly pain, light day and heavy night; the late stage is dominated by dysfunction, with abduction, external rotation and posterior extension movements being the most obvious.
In Chinese medicine, this disease is called “Leaky shoulder wind”, “shoulder condensation”, etc. It belongs to the category of paralysis. It is mostly caused by old age and physical weakness, wind, cold and dampness that take advantage of the deficiency and cause paralysis of the meridians; or fall and injury, stasis of blood and blood stasis inside the body, qi and blood do not work, and the function of the meridians is abnormal.
The treatment of shoulder pain by acupuncture and moxibustion is documented in the “Acupuncture and Moxibustion A.B. Jing”, “Prepared Urgent Thousand Complete Recipes”, “Acupuncture and Moxibustion Zisheng Jing” and “Acupuncture and Moxibustion Dacheng”. Modern acupuncture treatment for periarthritis of the shoulder joint was first mentioned in 1954. It was reported quite a lot in the 1960s, but mainly by the traditional acupuncture method. In the last two decades, almost all kinds of acupoint stimulation therapies have been used in the treatment of this disease, such as blood pricking, acupuncture, moxibustion, cupping, acupoint laser irradiation, thermal acupuncture, acupoint microwave method, electroacupuncture, and acupoint injection, etc. In order to improve the efficacy, two or three methods are often used in combination. At present, the efficacy of acupuncture and various acupoint stimulation methods is generally similar, with an efficiency rate of more than 95%.
Treatment】
Body acupuncture
(I) Acupuncture points
Main acupuncture points: Shoulder k through Jiquan, Tianzong through Bingfeng, Shoulderzhen, and Jokou through Chengshan.
Supporting points: Quchi, Shouze, Shoulder Lings, Shoulder Wells, Hegu, Yanglingquan.
Location of shoulder ling point: 8-9 minutes below yinlingquan.
(II) Treatment
Use the main acupuncture point as the main point and add supporting points as appropriate. Ask the patient to bend the elbow. It is appropriate to use a 28-gauge needle, 3 to 4 inches long, to perform a deep penetrating stab, so that there is a strong local sensation of soreness and numbness. To improve the efficacy of the treatment, these points can be needled first, and then the patient is asked to move the shoulder, rotate it internally and externally, stretch it forward and flex it backward, etc.; then the local points are needled again. Daily or every other day 1 time, 10 times for a course of treatment. The treatment interval is 5 days.
(C) Evaluation of efficacy
The above method treated a total of 448 cases, resulting in 226 cases cured, 100 cases with significant effect, 111 cases effective, and 11 cases ineffective, with an overall efficiency of 97.5% [1-5].
Electroacupuncture plus acupoint injection
(I) Acupuncture points
Main acupoints: shoulder k, Tianzong, Quchi, and shoulder well.
Supporting points: bar kou through Chengshan, arm (bone required), and A-Yi points.
(II) Treatment
Main acupuncture point is the main point. For the supporting points, add strip mouth through Chengshan if the disease lasts <30 days; for >30 days, select the remaining points. First, take shoulder k, stab 1 inch quickly, and after obtaining qi, then stab 3 to 4 inches in the direction of Jiquan, and perform acupuncture for 2 to 3 minutes; the remaining main points are stabbed with conventional acupuncture, and then the electroacupuncture instrument is connected, and the acupuncture is retained for 30 minutes with dense or sparse waves. The intensity of the current should be tolerated by the patient. If the duration of the disease <30 days, first take the affected side of the strip mouth through Chengshan, needle depth 2.5 inches, after getting gas through the electroacupuncture instrument of the positive pole; hand holding the negative electrode, electroacupuncture method as above. For >30 days, needle the rest of the matching points, the same method as above. Select 2 points for acupuncture injection, the drug with Dingongteng injection or 5% angelica injection, 1 ml per point. Electroacupuncture was performed daily or every other day, and acupuncture injection was performed twice a week. Electroacupuncture and acupoint injection were performed on different days.
(C) Evaluation of efficacy
A total of 226 cases were treated, resulting in 135 cases cured or basically cured, 45 cases with significant effect, 41 cases with effective effect, and 5 cases with ineffective effect, with an overall efficiency of 97.6% [6, 7].
Laser irradiation of acupuncture points
(I) Acupuncture points.
Main acupoints: shoulder nei ling, quchi, and a yi points.
Supporting points: shoulder ching, shoulder k, tianzong, and arm (bone required).
Location of the shoulder nei ling point: hanging shoulder, midpoint of the line connecting the end of the anterior axillary stripe and shoulder k.
(II) Treatment
All main points are taken, with 1 to 2 additional points as appropriate. Irradiation with a low-power helium-neon laser with an output power of 7 mW, a wavelength of 6328 Å, a spot diameter of 4 mm, a treatment area of 12.26 mm2, and an irradiation distance of about 50 cm. Each point is irradiated for 5 minutes, and the painful point can be irradiated for 8 to 10 minutes, once a day, 10 times as a course of treatment, with an interval of 3 to 5 days between courses.
(III) Evaluation of therapeutic effect
The above method treated a total of 257 cases, as a result, 95 cases were cured, 50 cases were significantly effective, 100 cases were effective, and 12 cases were ineffective, with an overall efficiency of 95.3% [8-10].
Cupping
(I) Acupuncture points
Main acupuncture point: A-Yi point.
Location of the A-Yi point: the pressure pain point of the shoulder (same below).
(II) Treatment
First, press on the affected shoulder, find the pressure point, and at the most obvious place, quickly pierce with a trigeminal needle or beryllium needle, about 1 to 2 minutes deep, that is, out of the needle. The range should be slightly larger than the caliber of the jar, and the blood should come out like a pearl at the point of puncture. If the pain points are scattered, prick 2 to 3 pain points each time. Use the flash fire method or vacuum cupping device cupping 10-15 minutes, cupping out 1 to 3 ml of blood for the degree. After cupping, press the pinhole with sterilized cotton ball and parallel passive activity for 5-10 minutes, once every 2-4 days, 3 times in a row for a course of treatment.
Patients usually strengthen functional exercise.
(III) Evaluation of efficacy
A total of 228 cases were treated by the above method, and the results were 120 cases cured, 54 cases with significant effect, 39 cases with effective effect, and 15 cases with ineffective effect, with an overall efficiency of 93.5% [11-13].
Blood stabbing
(I) Acupuncture points
Main acupoints: Shouze, Quchi, Quze.
Supporting points: shoulder ching, shoulder s, shoulder nei ling, and a yi points.
(II) Treatment
Only one main point is taken at a time, and the supporting points are taken at the discretion of the patient, all on the affected side. First, carefully search for veins with stasis of blood in and around the acupuncture point, then puncture the vessel with a sterilized trigeminal needle, bleed 10-20 ml, and cupping for 5 minutes after the blood stops. The treatment is carried out once every 10-20 days, and 3 times is a course of treatment.
(C) Evaluation of efficacy
A total of 30 cases were treated, and after 1 to 3 treatments, 28 cases were cured and 2 cases were apparently effective, with an overall healing rate of 100% [14].
Auricular acupuncture
(I) Acupuncture points
Main acupoints: shoulder, clavicle, Shen Men, shoulder joint.
Supporting points: liver, spleen, and subcortex.
Shoulder joint point location: between the shoulder point and the clavicle point.
(II) Treatment
Take two to three main acupuncture points and add matching points as appropriate. After detecting the sensitive points or positive reactions, use a 5-point common milli-needle to pierce quickly and, after obtaining Qi, perform a twisting technique with medium-intensity stimulation for about half to one minute. In the process of applying the technique, the patient is asked to move the affected shoulder in an appropriate amount. If the pain is severe, the shoulder or shoulder joint point is punctured with a trigeminal needle to bleed a few drops. Milli-needle pricking is done once a day, and blood pricking is done once every 2 to 3 days.
(C) Evaluation of efficacy
A total of 78 cases were treated by the above method, resulting in 37 cases of clinical recovery, 28 cases of significant effect, 6 cases of effective, and 4 cases of ineffective, whose total effective rate was 94.4% [15, 16].
Cut treatment
(I) Acupuncture points
Main acupuncture point: aye-point.
(II) Treatment
With the index finger and middle finger of the left hand, tense the A-Yi point, and with the right hand hold a sharp hooked needle to swiftly stab into the subcutaneous tissue, stop the needle when the patient feels soreness, numbness, and swelling, then lift the needle handle up and down, hook and cut several times, and remove the needle. Add fire cupping, 10-15 minutes. Twice a week, 4 times a course of treatment, the course of treatment interval of 1 week.
(C) efficacy evaluation
A total of 60 cases of the above rule of law, 56 cases were cured, 4 cases of significant effect, with an efficiency of 100% [17].
Massage therapy
Some patients with periarthritis of the shoulder have a tendency to heal spontaneously, leaving only a mild functional impairment. The majority of patients need effective treatment to heal. Manual massage with functional shoulder exercises is effective in treating periarthritis of the shoulder. Hand massage can improve the blood circulation of the affected area, accelerate the absorption of exudates, and play a role in relieving pain; functional exercise can loosen adhesions and smooth the joint to promote the recovery of shoulder joint function, which are complementary to each other.
Massage points
Meridian points: Jing Qu, Shaofu, Neiguan, Hegu, Houxi, Zhongqing, etc.
Reflex zones: shoulder joint, neck and shoulder area, trapezius muscle, kidney, ureter, bladder, lung, cervical collar, cervical vertebrae, thoracic vertebrae, liver, spleen, etc.
Response points: shoulder points, spasm stimulation points, posterior head points, cervical points, etc.
Holotropic points: cervical and shoulder points, upper limb points.
Massage method
Push and press the above reflex zones, each point 1OO-200 times; point and press each reaction point 2O0-3O0 times; pinch and press each holographic point 30O times. The above meridian points are divided into two groups, Hegu, Jingqu, Shaofu as one group, Nei Guan, Houxi, Zhongzhu as another group, each massage group, the two groups are used in rotation. Each point is pressed 30-50 times. Massage once a day, 30 times for a course of treatment. Can continue for 3-4 courses of treatment, until healed.
With appropriate functional exercises, such as wall climbing activities, that is, feet together, facing the wall, with both hands or one hand along the wall slowly climb up, so that the upper arm as high as possible, and then slowly back down to the original place, repeated several times; body after pulling hands, that is, hands backward, with the healthy side of the hand pulling the affected wrist, gradually pulling upward, repeatedly; and other shaking hands and other shoulder joint activities in all directions. This is done once a day in the morning and once in the evening for 10-2O minutes each time. Be persistent and progressive, and the amplitude should be small and large.
During the treatment period, avoid lifting heavy objects and pay attention to local warmth. Local hot compresses can be applied once a day for 10 minutes each time. The water temperature should not be too high to avoid scalding.