Shoulder pain is actually very common clinically. Some people have shoulder joint pain is relatively mild, but it is faintly painful, and some shoulder joint pain is very intense, which affects sleep when it is serious. Sometimes shoulder pain is short, just a few days or weeks, but some people have shoulder pain that lasts for two or three years.
We have seen some patients clinically, young in their 20s or so, saying that the doctor has shoulder pain, am I suffering from 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 around 50 years old.
Secondly, according to statistics, only 15% of the diseases associated with shoulder pain are caused by frozen shoulder.
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Therefore, people in their 20s have shoulder joint pain, and the possibility of diagnosing frozen shoulder is extremely low.
Then some people asked, that there are many patients with shoulder pain at the age of 60 and over 70 years old, so most of them are not frozen shoulder?
Here, I will sell a pass, and we will figure out this problem through a case.
Aunt Zhang, 65 years old, said when she came to the clinic that her left shoulder joint had been in pain for more than three months, and now not only does it hurt, but the activity of the joints is also affected, and daily activities such as combing her hair and lifting pants are laborious.
She said that 3 months ago there was a window closed hard when the left shoulder was a little painful, did not care too much, and then went out to walk the dog, the puppy suddenly ran forward, Aunt Zhang's left arm was suddenly dragged again, this pain is worse than the last time, after this, the pain symptoms are getting worse and worse, after the community plaster and physiotherapy, the pain has not been relieved.
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Before 2 weeks, the shoulder joint movement was obviously limited, not only was it difficult to do various housework, but it was even difficult to complete his personal daily grooming. Aunt Zhang suspected that she had frozen shoulder, so she went to the hospital to see if there was a good way.
I analyzed the condition in the outpatient clinic, because the shoulder pain has been more than three months, this gradual appearance of shoulder pain, accompanied by limited mobility, the medical history is also more than three months, first of all to consider a chronic shoulder pain and function.
Then, we can understand the specific actions and characteristics of pain that can cause her current pain, we can get a preliminary clinical impression, and then through further consultation and physical examination, exclude some other related diseases, basically you can clarify the preliminary diagnosis.
So I asked her medical history again. After detailed inquiry, it was further understood that Aunt Zhang often needed to lift heavy objects due to work when she was young, and her daily chores after work were relatively heavy, and occasionally there was shoulder discomfort. At present, shoulder pain often occurs when the upper limb is done over the head or pulling action, in addition to pain and limited function, there is a significant "feeling of weakness", there is no numbness, fever, redness, weight loss and other symptoms of the affected limb.
Physical examination of the shoulder joint reveals:
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 that there is no infectious disease;
Tenderness around the shoulder joint is pronounced, especially on the outside;
Shoulder joint abduction upward lifting, as well as obvious limitation of internal rotation;
There is no significant loss of sensation in both upper extremities, suggesting that cervical spondylosis is unlikely;
Atrophy of the deltoid muscles of the left upper extremity;
Left shoulder horizontal adduction test (-) excludes acromioclavicular joint injury;
Left shoulder abduction resistance test (-) excludes subacromial impingement syndrome;
Hawkins sign (+): Arms are raised flat, open, palms open four fingers together, thumbs down, forceful upwards, external force gives a certain amount of force to press down on the arms. If one of the arms feels weak, unable to exert strength, and one shoulder high and one shoulder low during the test, it is a rotator cuff injury.
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Based on the above examination, I came to a preliminary diagnosis, and it is likely that the patient is not frozen shoulder, but a rotator cuff injury. Therefore, I recommend that patients do an MRI of the shoulder joint to verify this judgment. Sure enough, after the results of the SHOULDER MRI, it was indeed a complete rotator cuff tear.
Since there is currently no way to heal tendons in a non-surgical way, surgery is the best treatment [1].
Because Aunt Zhang is in good physical condition, there is no other problem except for shoulder pain, and she has higher requirements for quality of life, limited movement of the shoulder joint and pain has seriously affected her quality of life, so she underwent arthroscopic rotator cuff injury repair after consideration.
The postoperative effect was also good, and after rehabilitation training, the original joint movement was quickly restored, and the shoulder pain disappeared [2].
Through this case of Aunt Zhang, we also learned that the pain in the shoulder joint of middle-aged and elderly people is not necessarily frozen shoulder, and most of the shoulder pain in middle-aged and elderly people is caused by rotator cuff tears.
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Because there is a big difference in the diagnosis and treatment of these two diseases, we should not think that the shoulder joint is painful, and there is limited movement, that is, frozen shoulder.
We need to go to the hospital to find a specialist for a detailed consultation, as well as a targeted physical examination, and if necessary, we must also do auxiliary examinations such as MRI to confirm the doctor's diagnosis in order to get reasonable and effective treatment.
bibliography:
[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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