Shoulder Periarthritis Adhesive capsulitis of shoulder, also known as "frozen shoulder," is a widely accepted and relatively accurate term in the medical field. It encompasses adhesive capsulitis of the shoulder joint and frozen shoulder, with the latter being more commonly used. In China, the term "肩周炎" mainly includes unexplained shoulder pain and movement disorders. According to the American Shoulder and Elbow Surgeons (ASES) definition, this condition is a type of adhesive capsulitis that causes stiffness in the glenohumeral joint, characterized by pain around the shoulder joint that worsens at night, decreased active and passive range of motion in various directions, and progressive worsening, leading to restricted shoulder joint movement.

Shoulder periarthritis, also known as "frozen shoulder," "adhesive capsulitis," and "painful stiff shoulder," is widely accepted and accurately named in the medical field. It encompasses adhesive capsulitis of the shoulder joint and frozen shoulder, with the latter being more commonly used. In China, the term "shoulder periarthritis" mainly includes unexplained shoulder pain and movement disorders. According to the definition by the American Shoulder and Elbow Surgeons (ASES), this condition is a type of adhesive capsulitis that causes stiffness in the glenohumeral joint, characterized by pain around the shoulder joint that worsens at night, decreased active and passive range of motion in various directions, and progressive worsening, leading to restricted shoulder joint movement.

Based on whether frozen shoulder has an etiology, it can be divided into primary (idiopathic) and secondary types, with the former referred to as primary frozen shoulder and the latter as secondary shoulder joint stiffness.

Primary Frozen Shoulder

It has no obvious triggering factors and occurs naturally, with its pathogenesis not yet clearly understood.

Secondary Shoulder Joint Stiffness

Generally occurs after upper limb trauma or surgery.

Based on the nature of the primary disease, it can be further divided into traumatic and non-traumatic subtypes.

Traumatic

The former includes proximal humeral fractures, shoulder dislocations, shoulder stiffness after rotator cuff repair, and shoulder stiffness after joint replacement surgery.

Non-traumatic

Such as chronic rotator cuff injury, long head of biceps tendonitis, calcific tendinitis, etc., treatment requires comprehensive management targeting the primary disease.

Pain Phase

The pain phase generally lasts 2 to 9 months.

The main symptoms for patients are shoulder pain, which worsens at night. Additionally, there is a gradual onset of shoulder stiffness, although it may not be very apparent.

As the condition progresses, the significant nighttime shoulder pain can gradually evolve into persistent pain throughout the day.

Stiffness Phase

The stiffness phase generally lasts 4 to 12 months.

During this phase, the shoulder joint pain will gradually improve, but the symptoms of shoulder joint stiffness persist or worsen, and the range of motion of the shoulder joint will decrease.

Remission Phase

The remission phase generally lasts 5 to 26 months, and some patients may fully recover within 12 to 18 months.

During this phase, the shoulder stiffness gradually improves, and the range of motion of the shoulder joint will slowly recover.

However, some patients may not fully recover, and shoulder pain and stiffness may persist for several years, or residual restricted movement may remain.

Cold Sensitivity

Patients have a sensitivity to cold in the shoulder, and many use cotton pads to cover their shoulders year-round, even in hot weather.

Tenderness

Most patients may experience tenderness around the shoulder joint, with tender points typically found in the bicipital groove of the long head of the biceps tendon, the subacromial bursa, the coracoid process, and the attachment points of the supraspinatus muscle, among others.

Muscle Spasms and Atrophy

In some patients, muscles around the shoulder, such as the deltoid and supraspinatus muscles, may experience early spasms, followed by disuse muscle atrophy in advanced stages, leading to symptoms such as shoulder prominence, inability to raise the arm, or difficulty combing hair. Surprisingly, pain symptoms may diminish at this stage.

The acute phase of the condition is mainly treated with various pain relief methods.

Rest and reducing muscle burden on the shoulder are crucial.

Cold packs can be used during acute flare-ups.

For persistent pain, short-term use of non-steroidal anti-inflammatory drugs (NSAIDs) may be recommended. Local tender point injections can be used for localized pain.

In cases of severe and persistent symptoms, joint cavity blockades or nerve block therapies may be considered.

Some patients may require manipulation under anesthesia or arthroscopic release of adhesions, followed by the injection of corticosteroids or hyaluronic acid for treatment.

Throughout history, traditional Chinese medicine has offered rich treatment methods for shoulder bi syndromes, including dispelling wind and eliminating pathogenic factors, promoting blood circulation, resolving phlegm and relieving stagnation, nourishing the liver and kidneys, and invigorating qi and supporting the body. Treatment methods should be selected based on individual conditions.

It is recommended that patients seek treatment in regular medical institutions and undergo treatment under the guidance of traditional Chinese medicine practitioners.

Internal Administration of Chinese Medicine

This condition falls within the category of traditional Chinese bi syndromes, caused by the deficiency of the liver and kidneys, external pathogenic factors, and obstruction of tendons and vessels. Commonly used treatments include Sanbi Tang, Jianbi Tang, Shenti Zhu Yu Tang, Huangqi Guizhi Wuwu Tang, and Qianghuo Shengshi Tang, which have shown certain efficacy.

External Application of Chinese Medicine

Common treatments include medicinal wine and ointment for external application. Using qi-supplementing and blood-nourishing, blood-activating and collaterals-opening, cold-dispelling and pain-relieving Chinese medicine to make medicinal wine and ointments for massage therapy can achieve good results. Additionally, Chinese medicine fumigation combined with functional exercises can alleviate shoulder pain.

Acupuncture Therapy

Acupuncture offers the advantages of good efficacy, economic safety, and minimal side effects. Acupuncture therapy includes regular needling, electroacupuncture, fire needling, warm needling, abdominal needling, auricular acupuncture, and floating needling, which can be used alone or in combination with other treatment methods, depending on the circumstances.

Tuina Therapy

Tuina promotes local blood circulation improvement and tissue repair, and is widely used in the treatment of this condition. Common tuina techniques include one-finger zen pushing, rolling, plucking and stretching, shaking, kneading, and joint mobilization.

Small Needle Knife Therapy

The small needle knife is a combination of traditional Chinese acupuncture and Western surgery, and it can effectively release adhesions in the soft tissues around the shoulder, reduce patient suffering in a short time, and restore joint function. When using this method, it is important to seek treatment in a regular medical institution to ensure standardized surgical operations and reduce related complications.

Keeping the shoulders warm

Muscles also experience "expansion with heat and contraction with cold." During winter mornings and evenings, attention should be paid to keeping the shoulder and neck warm. Even when using air conditioning in summer, avoid direct cold air blowing on the shoulder and neck.

Correcting Poor Posture

Maintaining proper sitting and standing posture can reduce the burden on the shoulder and neck. In daily life, it is advisable to keep the chest and back straight, maintaining a healthy and comfortable body posture.

Avoid sleeping on the affected side.

Additionally, it is important not to maintain the same posture for too long to avoid placing excessive strain on the muscles. It is recommended to change positions or move the body at least every 1 to 2 hours.

Healthy Lifestyle

Maintain regular sleep patterns, avoid staying up late, quit smoking and limit alcohol consumption, and engage in moderate and regular physical exercise.