Understanding frozen shoulder

1. Disease Overview

Scapulohumeral periarthritis is also known as adhesive capsulitis of the shoulder, commonly known as frozen shoulder or frozen shoulder. It is a chronic specific inflammation of the shoulder capsule and its surrounding ligaments, tendons and bursae, characterized by gradual onset of pain in the shoulder, especially at night, which gradually worsens, and the limited and increasingly aggravated shoulder joint function, which gradually eases after reaching a certain level until it is completely restored.

2. Causes of disease and susceptible population

Chronic inflammation and fibrosis of the shoulder capsule and surrounding ligament tissue are the main pathological changes of frozen shoulder. The reduced elasticity of soft tissues caused by fibrosis and the reduction of the gap between the glenohumeral joint surfaces are the direct causes of limited shoulder joint movement. According to a global epidemiological survey, the incidence of the disease is about 2% to 5%; the age of onset is 45 to 65 years old, with the most common being around 50 years old; the incidence is higher in women, with a male-female ratio of about 1:3; the incidence of the left shoulder is higher than that of the right shoulder. It is more common in manual laborers, or in long-term lack of activity leading to joint stiffness, as well as in those who get cold due to weather changes.

3. Diagnosis

1. Pain

In the early stages of the disease, patients with frozen shoulder often experience chronic dull pain or knife-like pain, chills in the shoulders, and pain that is milder during the day and heavier at night. The pain worsens in the second half of the night, causing sleep disorders, and symptoms are aggravated by weather changes or fatigue.

2. Joint dysfunction

After suffering from periarthritis of the shoulder, the movement of the shoulder joint will be restricted, and the movement in all directions will be restricted, often more obvious in abduction, flexion, internal and external rotation. In severe cases, the function of the elbow joint may also be affected.

3. Tenderness

Most patients can feel obvious tenderness points around the shoulder joint, which are mostly located in the tendon groove of the long head of the biceps brachii, the subacromial bursa, the coracoid process, the attachment point of the supraspinatus muscle, etc.

4. Muscle spasms and atrophy

In the early stage, the deltoid muscle, supraspinatus muscle and other muscles around the shoulder joint may experience spasm, and in the late stage, disuse muscle atrophy may occur, with typical symptoms such as acromion protrusion, difficulty in lifting, and inability to extend backward. At this time, the pain symptoms are actually alleviated.

IV. Treatment

1. Drug treatment: Commonly used oral nonsteroidal anti-inflammatory drugs include etoricoxib, ibuprofen, meloxicam, risperidone, etc. They take effect quickly and can reduce tissue inflammation and swelling, thereby relieving pain and improving shoulder joint function, but they should not be taken for a long time to avoid side effects on the gastrointestinal tract and kidneys.

2. Physical factor treatment: Ultrashort wave, low-frequency electricity, medium-frequency electricity, infrared and other local treatments can be used to play an anti-inflammatory and analgesic role.

3. Joint mobilization: Therapy through which the therapist uses manipulation to perform physiological movements and accessory movements such as sliding, rolling, pushing, rotating, separating and pulling the shoulder joint can relieve pain, promote the flow of synovial fluid, improve the range of joint motion and increase proprioceptive feedback.

4. Functional strength exercises: Perform shoulder and back strength training on patients to improve cystic tension caused by insufficient joint activity, further expand the range of joint motion, improve bad postures such as shrugging shoulders and forward head extension caused by long-term abnormal postures, and at the same time improve the biomechanical structure of scapula movement, so that the scapula and shoulder joint can move normally while ensuring stability and flexibility.

5. Prognosis

Frozen shoulder is a self-limiting disease that can generally heal itself in 6 to 24 months, but most patients cannot return to their normal functional level and may have long-term shoulder pain and dysfunction. When patients experience shoulder pain and stiffness, they should be given full attention. If patients are significantly affected or even unable to perform simple activities such as raising their arms, undressing, and combing their hair, it is recommended to seek medical attention in a timely manner. For patients who have already developed frozen shoulder, in addition to actively treating the affected side, they should also prevent the healthy shoulder from developing. Studies have shown that 40% of patients with frozen shoulder will also develop frozen shoulder on the opposite side after 3-6 years of illness; about 12% of patients will develop bilateral frozen shoulder. Therefore, targeted preventive measures such as keeping warm and actively moving should also be taken on the opposite side. Rehabilitation medicine is an important part of modern medicine, and it plays a significant role in the functional recovery of musculoskeletal diseases. A large amount of data studies have shown that postoperative rehabilitation can effectively accelerate the patient's recovery process, improve their function, and significantly reduce the risk of disability. Among the 135 common human diseases, 106 are related to bones and joints. The high incidence of orthopedic diseases has placed a huge burden on society and families. Strengthening the clinical and rehabilitation treatment of orthopedic diseases is extremely important for restoring patients' body functions and improving their quality of life.

The Department of Physical Therapy at Beijing Xiaotangshan Hospital can treat patients in the field of musculoskeletal rehabilitation from three aspects: manual therapy, physical factor therapy, and exercise therapy. Among them, manual therapy is based on the principle of painlessness, stresslessness, and stimulationlessness, and fully increases the joint angle; physical factor therapy can eliminate edema and inflammation, relieve chronic pain, soften scars, promote wound beauty, prevent the occurrence of thrombosis and muscle atrophy, accelerate wound healing, stimulate callus formation, and reduce the risk of fracture nonunion; exercise therapy can enhance the muscle strength around the wound, improve balance function, correct abnormal gait, improve the quality of daily life, and achieve the standard of returning to society and family as soon as possible.

(Pictures from the Internet)

About the Author

Physical Therapy Department

Rehabilitation therapists are good at using various rehabilitation techniques to provide rehabilitation treatment after traumatic fracture surgery, frozen shoulder, arthroscopic suture of rotator cuff injury, tendon suture after hand trauma, perioperative period of artificial joint replacement, cruciate ligament reconstruction of the knee, meniscus repair and plasty, complex patellar dislocation, ankle ligament repair and Achilles tendon rupture suture.

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