“Doctor, I’ve had frozen shoulder for months and it’s not good, I wake up every night with pain, I can’t do anything with my shoulder! Is there an end to this problem? Can it be cured?” This is what a woman in her 50s said to Dr. Xie during a recent outpatient visit, and I believe it also represents the feelings of most patients suffering from frozen shoulder.
What is frozen shoulder?
In fact, the diagnosis of frozen shoulder is a rather misused term, but really, we call frozen shoulder, or periacetabular bursitis.
What does that mean? Our shoulder joint is protected by a very dense capsule, which is not tightly wrapped around the shoulder joint, but has a certain degree of laxity, and with this protection, our joint can move freely within a certain range and at the same time has a certain degree of stability. The muscles, bones and cartilage structures of the shoulder joint, for example, are responsible for this.
The patient’s range of motion of the shoulder joint will be significantly limited, and it will be difficult for the patient to go to the toilet or lift up her pants.
Although we don’t know exactly what causes this change in the shoulder joint, there are some high-risk factors that we do know about, and that is that people with high blood pressure, coronary heart disease, diabetes, and thyroid disease are very susceptible to this condition, and also people who are around 50 years old are also susceptible to this condition, which is why it’s also called 50 shoulder, especially women who are in the menopause around 50 years old, and what we’re going to focus on here is the diabetic population, and nearly 30% of patients who develop periacetabular bursitis have a history of diabetes.
So if you’re a diabetic and you’re close to 50, especially if you’re a woman, it’s important to keep an eye on your shoulder joint and not overuse it.
There are generally three stages of frozen shoulder and it heals itself!
Usually there are three stages of periarticular bursitis of the shoulder joint, as already mentioned, in the early stages of the disease there will be significant inflammation of the synovial membrane in the joint cavity, which will cause a lot of exudation, causing the patient acute pain, when, if we perform a shoulder arthroscopy, we will find that the entire surface of the synovial membrane and joint capsule of the patient’s shoulder joint cavity is blood red, which is caused by the presence of many new proliferating blood vessels on the surface of the synovial membrane and joint capsule.
Slowly the patient’s pain will decrease somewhat, and the inflammation in the joint cavity will also slowly diminish, but the exuding and proliferating synovial membranes in these joint cavities, as well as other tissues in the joint cavity, will slowly form scarring and adhesions, and the patient’s shoulder joint movement will be significantly limited, whether it’s forward flexion, abduction, or internal or external rotation, and this condition is as if the shoulder joint is frozen, which is why frozen shoulder and periacetabular bursitis are also known as frozen shoulder.
As the disease slowly progresses, these adhesions may be absorbed by themselves and the patient’s range of joint motion may be gradually restored, which we call the thawing period.
So what is the approximate time span of going through the entire process?
Some patients have milder symptoms and may go into remission within 3-6 months, while others may last 1-2 years or even longer.
Some people may say, “Why treat the frozen shoulder when it can heal on its own? Let’s talk about this next.
In fact, those of you who have never had frozen shoulder can feel free to ask this question, but only those who have it are anxious to ask their doctor if there is anything they can do to get better faster.
The reason is that patients with frozen shoulder are in real pain, especially the part of the patient with particularly pronounced symptoms, where the shoulder joint can’t move properly, and the slightest range of motion of the shoulder can induce tearing pain, especially during nighttime sleep, which makes it hard to sleep all night long, and wakes up in the middle of the night with pain, and most of the daily activities that require moving the shoulder can’t be performed properly, even getting dressed. Others help, such a day, you can say that every day is a struggle to get through, patients in such a state are prone to anxiety and depression, do we want to give patients the peace of mind to wait for the disease to heal itself? If you are suffering from this condition, would you still consider waiting for the disease to heal itself?
Frozen shoulder, it can be treated!
For the treatment of frozen shoulder, timely pharmacological intervention in the early stages of the disease can help to reduce symptoms, for example, in the early stages of pain, consider oral or topical NSAIDs to help control the inflammatory response in the joint cavity to reduce exudation and reduce pain.
For particularly severe symptoms, consider giving medication into the shoulder joint cavity, where a small amount of hormone injections can be very helpful in controlling the inflammation and reducing leakage into the joint, which will not only reduce the patient’s pain, but also reduce the potential for adhesions in the future.
In some patients, there is no systematic intervention in the early stage and they gradually enter the freezing phase, so there is also intervention to help patients control the pain by oral or topical medication, and at the same time, scientific and systematic rehabilitation exercises should be carried out to help patients gradually open the adhesions.
On the day of the exercise, the range of motion of the joint will be increased, but on the second day, the adhesions may return to their original state, so the spring will lose its elasticity and the range of motion of the joint will return to normal, and the pain will gradually disappear as the range of motion of the joint increases and the patient’s joint function recovers.
The following are some of the common methods of shoulder joint rehabilitation exercises. Dr. Xie also advises that if you are able to do so, it is best to consult a local professional rehab therapist or rehabilitator to perform systematic rehabilitation exercises, and it is best to do so under the guidance of a professional for a month to master the techniques of rehabilitation exercises.
There is a rehabilitation action that we must emphasize to you, that is, many of us who have frozen shoulder have heard from our friends, or some people that we can shake our shoulders by standing up, shaking our shoulders is right, but try not to stand up to shake them, we suggest that we must bend down, like the picture below to shake our shoulders, when we bend down to shake our shoulders, our lumbar spine must not be bent, we must try to flatten our waist, and the affected limb can do its best. It is very important to maximize the back and forth or circle motion, as this can be a great way to promote the opening of the shoulder joint adhesions and will not cause impingement or induce rotator cuff injury.
sum up
Remember, not all shoulder pain is frozen shoulder!
When there is significant pain in the shoulder joint and there is reduced range of motion in the shoulder joint, it is important to consult with a medical professional to clarify whether you have periacetabular bursitis or not, and whether there are other possibilities than, for example, shoulder impingement syndrome, such as calcific supraspinatus tendinitis, such as an injury to the rotator cuff.
When a diagnosis of periacetabular bursitis is made, early intervention can help bring the symptoms under control, and even if we enter the freezing phase, a scientific system of rehabilitation exercises and some supportive measures can help accelerate the thaw.
Even though periacetabular bursitis is self-healing, that is, has the tendency to heal itself, the scientific and rational intervention to reduce the disease process of the patient, it does not smell good?
I’m Xie Xinhui, who insists on using simple language to explain the knowledge of complex diseases, it’s not easy to write, if you agree with my opinion, please help me to follow or praise, if you or your family and friends also suffer from shoulder pain, please forward this article to them in need, thank you!
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