The pain feels like a tiger bite. Do you understand this kind of shoulder joint pain?

This is the 4261st article of Da Yi Xiao Hu

Aunt Wang recently encountered a troublesome matter. One day more than a month ago, Aunt Wang suddenly felt severe pain in her right shoulder joint. She could not take care of herself due to the pain, could not move, and could not sleep. It felt like the shoulder joint was bitten and tearing, and the pain would "jump". She went to the hospital for treatment and found that a "calcification focus" had grown near the armpit of the shoulder joint. The doctor told Aunt Wang that this is called calcific tendinitis of the rotator cuff, and the location of the lesion is on the outer side of the proximal humerus. First, use medication including non-steroidal anti-inflammatory analgesics, and then use shock wave physical therapy. If it doesn't work, you can find the lesion under ultrasound guidance and puncture to see if the calcification in the lesion can be extracted.

So why does calcific tendinitis occur?

The cause of most calcific tendinitis is not particularly clear, and may be related to trauma, chronic inflammation, etc. A large amount of hydroxyapatite will be deposited at the lesion site, inducing inflammation, producing strong stimulation, and very severe pain, just as the ancient literature described the "White Tiger Calendar" as "painful like a tiger bite", which has a very serious impact on the patient's quality of life.

In addition to the patient's symptoms, the high-density lesions that can be seen on X-rays can be used as a basis for diagnosis. CT and MRI can accurately locate the lesions, and ultrasound detection with a higher level can also help diagnose and locate calcification foci.

In terms of treatment, the preferred drug treatment is non-steroidal anti-inflammatory drugs. At the same time, ice compresses can also have an analgesic effect. If the effect is not obvious, local corticosteroid therapy, extracorporeal shock wave therapy, ultrasound-guided calcification puncture and aspiration therapy, etc. can be gradually adopted. If all types of conservative treatments are not ideal, shoulder arthroscopy can be used, which has the advantages of less trauma, good effect and quick recovery.

Aunt Wang tried various treatment options during this month, including but not limited to oral nonsteroidal anti-inflammatory drugs, extracorporeal shock wave therapy, and local blockade therapy. The local blockade therapy worked for a few days, but then she felt uncomfortable again and couldn't sleep all night. She also punctured the lesion under ultrasound guidance, but none of them achieved good results. Finally, she was hospitalized in the joint department for further CT and MR positioning, and underwent arthroscopic cleaning and repair of the damaged rotator cuff. She was discharged from the hospital three days after the operation. After more than a month of pain, Aunt Wang finally felt the long-lost comfort.

Author: Yueyang Hospital of Integrated Traditional Chinese and Western Medicine affiliated to Shanghai University of Traditional Chinese Medicine

Department of Orthopedic Surgery, Orthopedic Center, Feng Shengyi, Li Xuejia, Li Bo

Quyang Road Community Health Service Center, Hongkou District, Shanghai

Acupuncture and Traumatology Lu Wenting