Shoulder pain is actually very common in clinical practice. Some people have mild shoulder pain, just dull pain, while others have very severe shoulder pain, which affects sleep in severe cases. Sometimes shoulder pain is short-lived, just a few days or a few weeks, while some people have shoulder pain that lasts for two or three years.
We have seen some patients in the clinic, young people in their 20s, say that the doctor has pain in the shoulder joint, do I have frozen shoulder? In this case, the answer is often no.
On the one hand, frozen shoulder, also known as fifty shoulders, generally refers to the age of onset of patients in their 50s.
Secondly, according to statistics, only 15% of shoulder pain related diseases are caused by frozen shoulder.
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Soa person in their 20s with shoulder pain is less likely to be diagnosed with frozen shoulder.
Then someone asked, there are many patients with shoulder pain over the age of 60 and 70, so are most of them frozen shoulder?
Here I am, let’s sell a case first, let’s figure out this problem through a case.
Auntie Zhang, 65 years old, when she came to the clinic, she said that her left shoulder joint has been hurting for more than three months. Now it not only hurts, but also affects the activities of the joint, such as combing hair and lifting pants and other daily activities All strenuous.
She said that 3 months ago, when she closed the window with force, her left shoulder hurt a little, and she didn’t pay much attention to it. Later, when she went out for a walk with the dog, the dog suddenly ran forward, Zhang Auntie’s left arm was suddenly pulled again. This time, the pain was worse than the last time. After that, the symptoms of this pain became more and more severe. After applying plaster and physical therapy in the community, the pain was not relieved.
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2 weeks ago, the movement of the shoulder joint was obviously limited, and it was not only difficult to do all kinds of housework, but also difficult to complete my personal daily grooming. Aunt Zhang suspected that she had frozen shoulder, so she went to the hospital to see if there was a good solution.
I analyzed the condition in the outpatient clinic, because the shoulder joint pain has been more than three months. This gradually appeared shoulder joint pain is accompanied by limited mobility, and the medical history is also Beyond three months, the first thing to consider is a chronic shoulder pain and function.
Then, let’s take a targeted look at the specific actions that can cause her current pain and the characteristics of the pain, so that we can get a preliminary clinical impression, and then through further consultation and investigation If some other related diseases are excluded, the initial diagnosis can basically be clarified.
So I took the initiative to ask her medical history again. After detailed inquiries, I further learned that Aunt Zhang often needed to lift heavy objects due to work when she was young, and her daily housework after work was relatively heavy, and she occasionally had shoulder discomfort. At present, shoulder pain often occurs when the upper limbs are overhead or stretched. In addition to pain and functional limitation, there is also obvious “weakness”. There are no symptoms such as numbness, fever, redness, and weight loss of the affected limb.
Physical examination of the shoulder revealed:
There is no deformity in the appearance of the shoulder joint, and there is no obvious abnormality in the skin temperature and skin color, indicating no infectious disease;
The tenderness around the shoulder joint is obvious, especially on the lateral side;
Shoulder abduction, lift, and internal rotation are significantly limited;
Both upper limbs did not feel significantly weakened, suggesting that cervical spondylosis is unlikely;
left upper extremity deltoid atrophy;
The left shoulder horizontal adduction test (-) excludes acromioclavicular joint injury;
Left shoulder abduction resistance test (-) excludes subacromial impingement syndrome;
Hawkins sign (+): arms flat, open, palms open and four fingers close together, thumbs down, lift up with force, and press down the arms with a certain amount of external force. If one of the arms feels weak, unable to exert strength, and one shoulder is high and one shoulder is low during the test, it is a rotator cuff injury.
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According to the above examination, I came to a preliminary diagnosis that the patient is probably not periarthritis of the shoulder, but a rotator cuff injury. Therefore, I suggest that patients, do a shoulder joint nucleusmagnetic, to verify this judgment. Sure enough, after the shoulder MRI results came out, it was indeed a complete rotator cuff tear.
Since there is currently no non-surgical way to heal the tendon, surgery is the best treatment option [1].
Because Aunt Zhang is in good health and has no other problems except shoulder pain, and she has high requirements for quality of life, her shoulder joint activities are limited and the pain is already serious affecting her quality of life, so she underwent arthroscopic rotator cuff repair after consideration.
The postoperative effect was also good. After rehabilitation training, the original joint movement was quickly restored, and the shoulder joint pain also disappeared [2].
Through the case of Aunt Zhang, we also learned that shoulder pain in middle-aged and elderly people is not necessarily frozen shoulder. Most of the shoulder pain in middle-aged and elderly people is shoulder pain. Caused by torn sleeves.
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Because there is a big difference in the diagnosis and treatment of these two diseases, we should not think that if the shoulder joint is painful and the movement is limited, it must be frozen shoulder.
We need to go to the hospital to find a specialist for a detailed consultation, as well as a targeted physical examination. Reasonable and effective treatment.
References:
[1] Oh LS, Wolf BR, Hall MP, et al. Indications for rotator cuff repair: a systematic review. Clin Orthop Relat Res 2007; 455:52.
[2] Galatz LM, Ball CM, Teefey SA, et al. The outcome and repair integrity of completely arthroscopically repaired large and massive rotator cuff tears. J Bone Joint Surg Am 2004; 86- A:219.
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