frozen shoulder
Introduction
Introduction Frozen shoulders are a common type of frozen shoulder. The so-called frozen shoulders are often referred to as frozen shoulders. They are common symptoms of shoulder joint pain and inconvenience. It is a chronic aseptic inflammation of soft tissues such as muscles, tendons, bursae and joint capsules around the shoulder joints. Inflammation leads to adhesions inside and outside the joint, which affects the movement of the shoulder joint. Its lesions are characterized by a wide range of pains, extensive functional limitations, and extensive tenderness. Because of the high age of about 50 years old, it is also called "fifty shoulders", which is more common in middle-aged and elderly people.
Cause
Cause
(1) Causes of the disease
The cause of inflammation around the shoulder joint is still unclear and is generally considered to be related to the following factors:
1 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.
2 Because of upper limb fractures, cervical spondylosis, etc., the upper limbs are fixed at the side for too long.
3 Degeneration of soft tissue around the shoulder joint, such as acromion sac bursitis, supraspinatus tendonitis, biceps brachii tenosynovitis.
(two) pathogenesis
Depalma (1983) divided the frozen shoulder pathology into three phases: early coagulation, which is mainly located in the shoulder joint capsule. Shoulder angiography showed that the joint capsule was tight, and the folds under the joint capsule disappeared and disappeared. There was a thin adhesion between the long head scorpion and the tendon sheath. Later, as the degree of lesions intensifies, it enters the freezing period. In this period, except for severe contracture of the joint capsule, the soft tissue around the joint was involved, the degeneration was intensified, the synovial membrane was congested, and the tissue lacked elasticity. The patellar ligament contracture limits the external rotation of the humeral head, the supraspinatus muscle, the infraspinatus muscle, the subscapularis muscle contracture, and the biceps tendon tenosynovitis, which significantly limits the shoulder joint activity.
After 7 to 12 months, the inflammation gradually subsided, the pain disappeared, and the function of the shoulder joint gradually recovered, which was called the thawing period. Depalma had a self-healing patient with a bilateral frozen shoulder 15 years ago. In the autopsy, both sides of the biceps brachii were found to have new bone attachment points in the tibial nodular sulcus, while the intramuscular part of the tendon joint was obtained. Both have disappeared. The authors believe that biceps tenosynovitis is the main cause of frozen shoulders. Once the long head scorpion adheres to the internodal sulcus to obtain a new bone attachment point, and the intramuscular part of the tendon joint is pathologically torn, the shoulder joint function Improvement, frozen shoulders tend to improve. It has also been found that prolonged lateral shoulders, swelling of the joint capsules of the condyle and humeral head, swelling or necrosis are the causes of frozen shoulders.
Examine
an examination
Related inspection
Bone and joint MRI examination of mammography X-ray examination of shoulder joint abduction test
In the auxiliary examination, the disease can mainly use X-ray examination and shoulder joint angiography:
X-ray examination
One of the purposes of diagnosing frozen X-rays is to use it as a differential diagnosis method for shoulder fractures, dislocations, tumors, 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.
Shoulder angiography
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, the performance is 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, and 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 rupture, the overflow of the contrast agent is mainly accumulated in the lower scapula, no more than the joint rim.
4. The shape and volume of the sac sac, the surface morphology of the superior sacral 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 frozen shoulder examination is mainly for understanding the location of the lesion and the extent of the lesion before surgery. Sometimes some special conservative treatments are used, and shoulder joint angiography is also needed to accurately understand the condition and position.
Diagnosis
Differential diagnosis
Should be differentiated from various shoulder symptoms:
1. Heavy sense of shoulder and back: heavy shoulder and back, weakness of upper limbs, numbness of fingers, decreased skin feel of the limbs, etc. are all clinical manifestations of cervical spondylosis.
2. Persistent severe shoulder pain: persistent severe shoulder pain, often caused by dislocation of the shoulder joint. There is a clear history of trauma.
3. Scapular radioactive pain: Radiation pain: the pain is radioactive, and the conductive pain will be released from the proximal end of the limb (near the heart side) to the telecentric end, just like a string of inductance. This means that the lesion does not occur in the limb itself, but in the spinal cord of the neck, chest, or waist, or at a large nerve center or nerve trunk. Radiation pain in the upper extremities indicates a lesion in the neck or shoulder of the nerve plexus.
4. Neck and shoulder pain: neck and shoulder pain is the main pain point around the shoulder joint, so it is called the shoulder joint inflammation, referred to as shoulder inflammation, commonly known as condensate shoulder, leaking shoulder wind or frozen shoulder. The onset of the disease is mostly caused by freezing, trauma, and infection of tissues around the shoulder joints, such as tendons and bursae. Many patients are caused by rheumatism. The main symptoms are continuous pain in the neck and shoulders. The upper limbs of the affected side are elevated, rotated, and the swinging is limited. The feeling of cold in the wind is heavy and painful. If not treated in time, prolonged prolongation can cause joint adhesion, the upper limbs of the affected side become thin, weak and even form a disuse atrophy. The disease is more common in middle-aged people around the age of 50, and young people and the elderly also occur. The pain is characterized by pain in the movement of the arm, no pain or slight pain, and it is difficult to comb, dress, lift, and lift. When the attack is severe, it can be painful and it will not sleep all night.
