frozen shoulder
Introduction
Introduction to frozen shoulder Periarthritis of shoulder is a pain gradually produced by the shoulders. At night, it gradually worsens. The function of the shoulder joints is limited and is getting worse. It will gradually relieve after a certain degree, until it finally recovers into the main performance of the shoulder capsule. Chronic specific inflammation of the surrounding ligaments, tendons and bursa. basic knowledge The proportion of sickness: 0.8% Susceptible people: good for middle-aged people over 40 years old Mode of infection: non-infectious Complications: wear, acromion bursitis
Cause
Cause of periarthritis of shoulder
Age factor (20%):
Most of the disease occurs in middle-aged and elderly people over 40 years old, soft tissue degeneration, and the ability to withstand various external forces is the basic factor.
Environmental factors (15%):
Chronic injury caused by long-term excessive activity and poor posture is the main cause of stimulation.
Physical factors (20%):
After the upper limb trauma, the shoulder was fixed for too long, and the shoulder tissue was atrophied and adhered.
Other factors (15%):
Acute contusion of the shoulder, improper treatment due to improper treatment.
Disease factors (20%):
Cervical spondylosis, the shoulders involved in heart, lung and biliary tract diseases involve pain. The long-term unhealed primary disease causes the shoulder muscles to become persistent and paralyzed, forming an inflammatory lesion and transforming into true shoulder inflammation.
Periarthritis of the shoulder is divided into primary and secondary according to the cause of formation. The shoulder joint is the joint with the largest range of motion in the joints of the human body. The joint capsule is relaxed, and the stability of the joint is mostly maintained by the strength of the muscles, muscles and ligaments around the joint. Because the blood supply of the tendon itself is poor, and the degenerative changes occur with the increase of age, and the shoulder joints are more active in life, the surrounding soft tissue is often subjected to friction and extrusion from various aspects, so it is prone to chronic strain and gradually The formation of primary shoulder inflammation.
Prevention
Periarthritis prevention
1. Strengthen physical exercise is an effective method to prevent and treat frozen shoulder, but you insist on it. If you do not adhere to exercise and do not insist on rehabilitation, the function of the shoulder joint is difficult to return to normal.
2, malnutrition can lead to physical weakness, and physical weakness often leads to frozen shoulder. If the nutritional supplement is more adequate, plus proper exercise, shoulder inflammation can often be cured without medication.
3, cold is often the predisposing factor of frozen shoulder, therefore, in order to prevent frozen shoulder, middle-aged and elderly should pay attention to keep warm and cold, do not let the shoulders get cold. Once you are cold, you should treat it promptly and avoid delaying treatment.
4, strengthen the shoulder joint muscle exercise can prevent and delay the occurrence and development of frozen shoulder. According to the survey, in the muscles with strong shoulders and strong strength, the incidence of periarthritis of the shoulders has dropped a lot. Therefore, the ligaments around the shoulder joints and the muscles are strong, which is of great significance for the treatment and recovery of frozen shoulder.
Complication
Periarthritis of shoulder Complications, wear, acromion, bursitis
The shoulder joint is prone to a wide range of aseptic inflammation, and there is no definitive conclusion on its etiology. According to most basic research and clinical observations, it is related to the following factors.
(1) related to the characteristics of bone and joint structure
The shoulder joint is a multi-joint complex. These bone joints mainly rely on the soft tissues such as ligaments, tendons and muscles around them to maintain their stability, overcome the gravity of the upper limbs, and because of the unstable structure of the bones and joints, when subjected to super-strong external force, the surrounding Soft tissue is extremely vulnerable to strain. For example, the area of the humeral head of the ankle joint is larger than the area of the iliac crest. The humeral head needs to move and slide in multiple directions in the joint. The stability of the humeral head is mainly maintained by the loose joint capsule. When lifting, pulling or moving, lifting heavy objects, The joint capsule is the most stressed, and it is easy to be strained or deformed by fatigue for a long time, eventually leading to chronic aseptic inflammation.
(2) related to the distribution characteristics of the bursae
There are many sacs around the shoulder joint, such as the shoulder sac, the deltoid sac, the sacral sac and the subscapularis, the pectoralis major, the latissimus dorsi, the great round muscle, etc. The bursa on both sides, these sacs are easily squeezed and collided by the external force when the shoulder joint is active, and when the shoulder joint is frequently active, its own tendon also stimulates the sac, and the wear and tear of the accumulated time Stimulation can affect its lubrication mechanism and eventually develop into chronic aseptic inflammation.
(3) related to muscle distribution characteristics
The shoulders are covered with rich muscles, and there are more and concentrated muscle stress points around the shoulder joints, forming a cap-like shape. For example, the condyle is the attachment point of the biceps short head, the diaphragm, the chest muscle, and the tibia. The great nodule is the stop point of the subscapularis muscle, the supraspinatus muscle, the infraspinatus muscle and the small round muscle. These parts are susceptible to excessive external force, tearing or cumulative fatigue damage and degeneration, eventually leading to aseptic inflammation. .
(4) related to the nature of joint function activities
The shoulder joints are flexible and the range of activities is large and frequent. In daily life and work, there is no coordination movement. For example, brushing, washing, combing, writing, lifting and lifting heavy objects, the shoulder soft tissue bears the main weight. When writing, on the surface, the shoulder arm activity is not obvious, but the actual shoulder muscles still bear different coordinated movements such as extension and flexion. These endless frequent movements will inevitably lead to strain or strain, degeneration, etc. of the soft tissue of the shoulder, which will eventually lead to aseptic inflammation.
In addition, in daily life and work, the shoulder joints are most affected by wind and cold. For example, when the rain is raining, the shoulders are first drenched; when sleeping at night, the shoulders are often exposed to the outside of the quilt and stimulated by the cold. The stimulation of wind and cold will cause vasoconstriction in local soft tissue, blood circulation disorder, and slow metabolism. Such long-term stimulation will form cumulative damage, accelerate the degeneration of soft tissue, and eventually cause aseptic inflammation.
Symptom
Symptoms of scapulohumeral symptoms Common symptoms Shoulder pain Scapula pain sore shoulder Shoulder joint activity limitation Neck and shoulder fatigue and soft tissue pain Shoulder movement limitation Shoulder pain Painful maternal neck back pain Collision sign Joint stiffness
Patients with frozen shoulder have the following characteristics:
(1) Shoulder pain:
At first, the shoulders showed paroxysmal pain, most of which were chronic attacks. Later, the pain gradually increased or pain, or the knife cut pain, and it was persistent. After climate change or fatigue, the pain was often aggravated, and the pain could be applied to the neck and The upper limbs (especially the elbows) spread. When the shoulders are accidentally bumped or pulled, they often cause tearing pain. The shoulder pain is light and the night is a major feature of the disease. Most patients often complain that they wake up in the middle of the night. Can not be awkward, especially not to the side of the affected side, this situation is more obvious due to blood deficiency; if it is caused by cold, it is particularly sensitive to climate change.
(2) Limited shoulder movement:
The shoulder joints can be restricted in all directions, and the abduction, lifting, internal and external rotations are more obvious. As the disease progresses, the muscles of the joint capsule and the soft tissues of the shoulders are gradually weakened due to long-term disuse, and the muscle strength is gradually decreased. The patellar ligament is fixed in the shortened internal rotation position and other factors, so that the active and passive activities of the shoulder joint are restricted in all directions. When the shoulder joint is abducted, a typical "shoulder" phenomenon occurs, especially combing, dressing, washing, The movements such as the akimbo are difficult to complete. In severe cases, the function of the elbow joint can also be affected. When the elbow is flexed, the hand cannot touch the shoulder of the same side, especially when the arm is extended.
(3) afraid of cold:
Suffering from shoulders and cold, many patients wrap their shoulders with cotton pads all the year round. Even in the summer, the shoulders don't dare to blow.
(4) tenderness:
Most patients have obvious tender points around the shoulder joints, and the tender points are mostly in the long head sulcus of the biceps. The shoulder peak sag, the condyle, the attachment point of the supraspinatus muscle.
(5) Muscle spasm and atrophy:
The muscles around the shoulders such as the deltoid muscle and the supraspinatus may appear in the early stage of the muscles. In the late stage, disuse muscle atrophy may occur, and shoulder peaks may appear, such as inconvenient lifting and unfavorable posterior bending, and the pain symptoms may be alleviated.
(6) X-ray and laboratory inspection:
Conventional radiography, mostly normal, some patients with osteoporosis, but no bone destruction, can see calcification shadow under the shoulder. Laboratory tests are more normal.
Examine
Periarthritis of the shoulder
In the auxiliary examination, the disease can mainly use X-ray examination and shoulder joint angiography:
First, X-ray inspection
One of the purposes of diagnosing X-ray films in the treatment of frozen shoulder is as a differential diagnosis method for diseases such as shoulder fracture, dislocation, tumor, tuberculosis and osteoarthritis, rheumatism and rheumatoid arthritis. However, it is clinically found that about one-third of patients show different characteristic changes on X-ray films of different stages of scapulohumeral periarthritis.
1. The early characteristic changes mainly showed the blur deformation and even disappearance of the fat line under the shoulder. The so-called subacromial fat line refers to the linear projection of a thin layer of adipose tissue on the lower fascia of the deltoid muscle on the X-ray film. When the shoulder joint is excessively rotated, the fat tissue is just in the tangential position and shows a linear shape. In the early stage of scapulohumeral periarthritis, when the soft tissue of the shoulder is congested and edema, the contrast of soft tissue on the X-ray film decreases, and the fat line under the shoulder is blurred and even disappears.
2, in the advanced stage, soft tissue calcification of the shoulder, X-ray film can be seen in the joint capsule, synovial sac, supraspinatus tendon, biceps brachial sputum, etc. There are light and uneven calcifications. In the late stage of the disease, X-ray films showed calcification and sharpness. In some cases, large nodular bone hyperplasia and osteophyte formation were observed. In addition, osteoporosis, joint hyperplasia or osteophyte formation or narrowing of joint space can be seen in the acromioclavicular joint.
Second, shoulder arthrography
Shoulder arthrography is an auxiliary examination method for injecting contrast media into the shoulder joint cavity and taking X-ray films to locate the diagnosis of shoulder disease. Generally, it is diluted with 10 ml of 60% diatrizoate 10 ml, plus 2% lidocaine 10 ml, and then added with 0.5 ml of adrenaline hydrochloride of 1:1000. After injecting into the joint cavity, the center line is tilted 20 degrees to the head end. The shoulder joint has an inner rotation and an outer rotation piece, and the center line is inclined to the fixed end by 10 degrees, and each of the outer rotation and the outer protrusion piece. An angiogram can show:
(1) The joint capsule shrinks as follows:
1 joint capacity is reduced.
2 The crypt is reduced or occluded.
3 The shoulder sac sac or the biceps long head tendon sheath is not developed.
(2) The joint capsule is ruptured, the contrast agent overflows from the rupture, and an irregular sheet or bag shadow appears in the axillary space outside the joint.
(3) The scapula sac ruptures, and the overflowing contrast agent is mainly accumulated in the lower scapula and does not exceed the joint rim.
(4) The shape and volume of the sac sac, the surface morphology of the superior scapular muscle of the scapular wall, and the rotator cuff injury. It can reliably reflect the rupture of the rotator cuff and the retraction of the broken end. The angiographic examination of frozen shoulder is mainly to understand the location of the lesion and the extent of the lesion before surgery.
Diagnosis
Diagnosis of shoulder scapulohumeral
diagnosis
The diagnosis of frozen shoulder can be diagnosed in combination with clinical manifestations and examinations.
Limited shoulder movement: due to the adhesion of the joint capsule and the soft tissue around the shoulder, the movement of the shoulder joint is restricted in all directions. The abduction, lifting, internal and external rotation are particularly obvious. Some patients have difficulty in combing, dressing and washing their face. Take care of yourself.
Joint stiffness: Limited shoulder mobility is one of the early symptoms of frozen shoulder, usually occurring 3-4 weeks after the pain symptoms are obvious. At first, because of pain, muscle spasm, etc., it was the soft tissue adhesion and contracture of the joint capsule and ligament, which caused the shoulder joint to be obviously stiff.
Pain: The shoulders are mostly chronic, paroxysmal pain, after which the pain will gradually increase and persist. When the climate changes or is tired, the patient's pain is aggravated and radiates to the neck and upper limbs. When the shoulder is accidentally bumped or pulled, it can cause tearing pain. And most patients have obvious tender points around the shoulder joints.
1. Can not work normally when the disease occurs, life is affected, and the nerves will be damaged by long-term compression of nerves, and the hands are numb.
2. Long-term compression of blood vessels, causing poor blood flow in the shoulders of the hands, and severe muscle atrophy.
3. Due to the extensive adhesion around the joints, the movement of the joints in various directions is obviously restricted, and even the joints are stiff, forming a "frozen shoulder".
Periarthritis of the shoulder is a chronic inflammation caused by soft tissue damage and degeneration around the shoulder joint. The main symptoms are cold, tenderness, spread of shoulder pain, muscle atrophy and shoulders. Due to the limited function of the shoulder joint, the daily work and life of the patient are seriously affected.
Differential diagnosis
Periarthritis of the shoulder is a degenerative change of the shoulder joint capsule and its surrounding muscles, tendons, ligaments, and bursa, and chronic aseptic inflammation characterized by pain and activity limitation in the shoulder joint and its surroundings, and even stiffness and rigidity. . Due to the anatomical and functional characteristics of the shoulder joint, some other different types of shoulder pain often occur inside and outside the joint, which need to be differentiated from the periarthritis of the shoulder to avoid disrepair and mistreatment, leading to adverse consequences. Clinically common diseases associated with shoulder pain 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 shoulder pain and shoulder function limitation. However, because the nature of the disease is different, the lesions are not the same, so there are different complications for identification. Combined with the different characteristics of the pain and the different characteristics of functional activities, as well as reference auxiliary examination, differential diagnosis is not difficult.
First, the differentiation of shoulder and shoulder tuberculosis:
Shoulder joint tuberculosis is divided into synovial type and bone type tuberculosis, and simple synovial type tuberculosis is very rare. Tuberculosis of the right shoulder joint is more common than the left side. Bone-type joint tuberculosis can be divided into two types: bacterial type and dry type. The symptoms vary according to the type of disease. The course of the disease progressed slowly, and symptoms gradually appeared. Often pain, dysfunction is the first symptom. Pain often occurs below the deltoid muscle, which is painful when abducting and external rotation. The swelling of the deltoid muscle is most obvious. The sinus is formed in the late stage, often pierced in the weakest part of the joint capsule, that is, it is easy to pierce near the front of the axilla or deltoid. Bone atrophy is an initial X-ray of shoulder tuberculosis, especially bone atrophy of synovial tuberculosis can last for a long time. Shoulder joint tuberculosis is most common with total joint tuberculosis. Simple bone tuberculosis rarely causes bone joint dyskinesia or is only slightly restricted. Periarthritis of the shoulder is also known as inflammation around the shoulder joint. It occurs mostly after the age of 50. The main clinical features are shoulder-arm pain and limited activity. It is a chronic aseptic inflammation of soft tissues such as muscles, tendons, ligaments and bursae around the shoulder joints. X-ray findings are mainly: osteoporosis of the shoulder joint, cystic changes and hyperplasia of the large nodules or the opposite part of the acromion, and early stage of soft tissue calcification, shoulder tuberculosis and frozen shoulder, whether from clinical manifestations or X-ray findings There is no characteristic on the top and it is easy to be confused.
Second, the identification of periarthritis of shoulder and tumor around the shoulder:
Tumor growth around the shoulder can cause shoulder pain or activity dysfunction with the shoulder arm. The difference between it and the periarthritis of the shoulder is that the shoulder pain of the affected part is gradually worsened, and the painful part is gradually enlarged due to the growth of the tumor. The shape of benign tumors is multi-rule, soft and active; malignant tumors are irregular in shape and hard and fixed. Due to the compression of the tumor, functional limitations may occur, and some patients suffer from numbness in the shoulder arms and fingers. The appearance of X-ray films is not the same due to the nature of the tumor, the location of the growth and the length of the disease. Generally, soft tissue tumors are not developed or only outlined in X-ray films. If the tumor erodes the bone tissue, X-ray films can be seen with varying degrees of bone destruction or even pathological fractures.
