periarthritis of shoulder
Introduction
Introduction to inflammation around the shoulder joint Periarthritis of the shoulder is also known as frozen shoulder, adhesive shoulder arthritis, fifty shoulders and so on. It is caused by soft tissue lesions around the shoulder joint and causes shoulder pain and activity dysfunction. It occurs in patients over 40 years old, more women than men (about 3:1), and the left shoulder is more than the right shoulder. It is characterized by shoulder pain and shoulder. The joint movement disorder gradually increased. After several months or even longer, the pain gradually subsided, the function gradually recovered, and finally healed. basic knowledge The proportion of illness: 30-50% (the above is the incidence of the elderly over 50 years old) Susceptible people: good for patients over 40 years old Mode of infection: non-infectious Complications: congenital multiple joint contracture
Cause
Causes of inflammation around the shoulder joint
The cause of inflammation around the shoulder joint is still unclear and is generally considered to be related to the following factors:
Limited shoulder movement (30%)
Because of diseases other than the shoulder joints, such as coronary heart disease, pneumonia, cholecystitis and other reflexive shoulder pain, the shoulder joint activity is limited, the shoulder joint is limited for a long time, the joint cavity mucus is concentrated, and it is easy to cause inflammation.
Soft tissue degenerative disease (25%)
Clinical statistical analysis, degeneration of soft tissue around the shoulder joint, such as acromion sac bursitis, supraspinatus tendonitis, biceps tendon tenosynovitis can lead to inflammation around the shoulder joint.
Upper extremity lesions (15%)
Because of upper limb fractures, cervical spondylosis and other upper limbs are fixed to the side for too long.
Pathogenesis
Depalma (1983) divided the pathological process of frozen shoulder into three phases: the early stage is coagulation. The lesion is mainly located in the shoulder joint capsule. The shoulder joint angiography shows that the joint capsule is tight, and the folds under the joint capsule disappear and stick to each other. There is a thin adhesion between the long-headed scorpion and the tendon sheath. Later, as the degree of lesions intensifies, it enters the freezing period. In this period, except for the severe contracture of the joint capsule, the soft tissue around the joint is involved, the degeneration becomes worse, the synovial membrane is congested, and the tissue lacks elasticity. The patellofemoral contracture restricts the external rotation of the humeral head, the supraspinatus muscle, the infraspinatus muscle, the subscapularis muscle contracture, and the long head tenosynovitis of the biceps, which significantly restricts the movement of the shoulder joint. After 7 to 12 months, the inflammation gradually subsides. The pain disappeared and the function of the shoulder joint gradually recovered. It was called the thawing period. Depalma suffered from bilateral frozen shoulders and self-healing in 15 cases. The autopsy of both sides of the biceps femoris was found in the humeral nodules. The groove has obtained new bone attachment points, and the inner part of the tendon joint capsule has disappeared. The author believes that biceps tendon inflammation is the main cause of frozen shoulder. Once the long head scorpion adheres to the internodal groove, a new one is obtained. Attachment point, and the pathological tear in the part of the tendon joint capsule, the shoulder joint function is improved, the frozen shoulder tends to improve, and some people find that the long side of the side of the shoulder, the condyle and the humeral head squeeze the joint capsule to appear swelling or necrosis. Freeze the cause of the shoulder.
Prevention
Prevention of inflammation around the shoulder joint
1. Master the correct sitting position and hand posture. The thigh and the waist, the thigh and the calf should be bent at 90 degrees, and the curvature of the upper arm and the forearm should be kept at 70-135 degrees, and the wrist and the forearm are in a straight line to avoid excessive bending and tension of the wrist during work.
2. Try to avoid operating the computer for a long time. If your work is inseparable from the computer, then you need to rest for 5 to 10 minutes per hour, and move your neck, shoulders and wrists.
3. The height of the keyboard and mouse on the computer desk should be slightly lower than the height of the elbow when you are sitting. This will minimize damage to the back, neck muscles and hand muscle tendon sheaths when operating the computer.
4. The display screen is slightly lower than the line of sight to ensure smooth blood circulation in the neck and reduce fatigue caused by neck and shoulder muscle tension.
5. Don't let your arms hang. If possible, use the arm support to relax the muscles of your shoulders.
6, do more neck and shoulder activities.
Complication
Periarthritis of the shoulder joint Complications congenital multiple joint contracture
Can be complicated by joint contracture dysfunction.
Symptom
Symptoms around the shoulder joint Common symptoms Frozen shoulder-filled joints contracture scapula pain nodules
Acute phase
Also known as frozen shoulder phase, rapid onset, severe pain, muscle spasm, limited joint activity, increased nighttime pain, difficulty sleeping, extensive range of tenderness, condyle, patellar ligament, subacromial, gang Muscle, biceps femoris long head sputum, four-sided hole and other parts can be tender, X-ray examination is generally no abnormal findings, arthroscopic observation can be seen synovial congestion, villus hypertrophy, proliferation, filling in joint space and scapular glial folds The gap, the joint cavity is narrow, the volume is reduced, and the long head of the biceps brachii is covered by vasospasm, and the acute phase can last for 3 to 10 weeks.
2. Chronic phase
Also known as the frozen phase, the pain symptoms are relatively relieved, but the range of tenderness is still extensive, the joint function limitation caused by the acute phase of muscle protective spasm develops to the joint contracture dysfunction, joint stiffness, combing, wearing Clothes, arm lifts, backward belts and other movements are difficult. The soft tissue around the shoulder joints is in a "frozen" state. The supraspinatus, the infraspinatus and the deltoid muscles contract, and the shoulders can be observed on X-ray films. Large nodule bone sparse, cystic changes, arthrography, increased intracavitary pressure, volume reduced to 5 ~ 15ml (normal adult capacity 15 ~ 30ml), subscapularis gliding sac occlusion not developed, shoulder slid film The wrinkle gap disappeared, and the biceps tendon sheath was incompletely filled or blocked.
3. Functional rehabilitation period
The ankle joint cavity, the shoulder sac sac, the biceps brachial sulphate sheath and the subscapular sac sac sac gradually absorbed, the blood supply returned to normal, the synovial membrane gradually recovered synovial secretion, adhesion absorption, and the joint volume gradually Returning to normal, during the gradual recovery of motor function, the blood supply and neurotrophic function of the muscles are improved. In most patients, the shoulder function can be restored to normal or near normal, and the muscle atrophy takes a long time to return to normal.
Examine
Examination of inflammation around the shoulder joint
X-ray films can be seen without obvious abnormalities. Shoulder joint angiography has contraction of the shoulder joint capsule and disappearance of the lower part of the joint capsule.
Arthroscopy: fibrosis of the ankle joint, thickening of the cyst wall, adhesion in the joint cavity, occlusion of the scapula scapula, occlusion of the gap, reduction of joint volume, visible fiber cords and floating debris in the cavity, this period can last for several months or even More than 1 year.
Diagnosis
Diagnosis and diagnosis of inflammation around the shoulder joint
According to the clinical manifestations, combined with the results of auxiliary examination and arthroscopy, comprehensive analysis and judgment.
Clinically common diseases associated with frozen shoulder include: cervical spondylosis, shoulder dislocation, suppurative shoulder arthritis, shoulder tuberculosis, shoulder tumor, rheumatic, rheumatoid arthritis and simple supraspinatus tendon injury. Torsion of the rotator cuff, biceps tendon inflammation and tenosynovitis. These conditions can be manifested as limited shoulder function and shoulder movement. However, because the nature of the disease is different, the lesions are not the same, so there are different complications for identification.
