Shoulder pain is actually very common in clinical practice. Some people's shoulder pain is relatively mild, only faintly painful, and some shoulder pain is very severe, which affects sleep when it is serious. Sometimes shoulder pain lasts for a short period of time, just a few days or weeks, but some people have shoulder pain that lasts for two or three years.
We have seen some patients in the clinic, young in their 20s, saying that the doctor has my shoulder pain, 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 around 50 years old.
Secondly, according to statistics, only 15% of shoulder pain-related diseases are caused by frozen shoulder.
Therefore, people in their 20s have shoulder pain and the possibility of diagnosing frozen shoulder is extremely low.
So some people ask, there are many patients with shoulder pain over 60 years old and over 70 years old, so are most of them frozen shoulder?
Here, let's sell a pass, let's figure out this problem through a case.
Aunt Zhang, 65 years old, came to the clinic and said that the left shoulder joint had been hurting for more than three months, and now not only does it hurt, but the movement of the joints is also affected, and daily activities such as combing hair and lifting pants are difficult.
She said that 3 months ago, when she closed the window hard, her left shoulder hurt a little at that time, and she didn't 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 time the pain was worse than the last time, after that, the symptoms of this pain became more and more severe, and after the community plaster and physiotherapy, the pain was not relieved.
Two weeks ago, the shoulder joint movement was significantly restricted, and not only did it struggle to do various household chores, but it was also difficult to complete my own daily grooming. Aunt Zhang suspected that she had frozen shoulder, so she came 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 shoulder pain, accompanied by limited mobility, the history is also more than three months, the first thing to consider is a chronic shoulder pain and function.
Then, we can get a preliminary clinical impression by understanding the specific actions and characteristics of pain that can cause her current pain, and then rule out some other related diseases through further consultation and physical examination, which can basically clarify the preliminary diagnosis.
So I took the initiative to ask about her medical history again. After detailed inquiry, 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 suffered from shoulder discomfort. At present, shoulder pain often appears when doing upper limbs over the head or pulling movements, in addition to pain and functional limitations, there is also a significant "feeling of weakness", there is no numbness, fever, redness, swelling, weight loss and other symptoms of the affected limb.
Physical examination of the shoulder joint reveals that:
There is no deformity in the appearance of the shoulder joint, and there is no obvious abnormality in the color of the skin temperature, indicating no infectious disease;
Tenderness around the shoulder is pronounced, especially laterally;
Bilateral upper extremity sensation was not significantly weakened, indicating that cervical spondylosis was unlikely;
Atrophy of the deltoid muscle of the left upper extremity;
Horizontal adduction test of the left shoulder (-) excludes acromioclavicular joint injury;
Left shoulder abduction resistance test (-) excludes subacromial impingement syndrome;
Hawkins sign (+): Raise your arms flat, open, open your palms with four fingers together, thumbs down, lift up forcefully, and press down on your arms with external force. If one of the arms feels weak and weak, and one shoulder is high and one shoulder low during the test, it is an rotator cuff injury.
Based on the above examinations, I came to the preliminary diagnosis, and it is likely that the patient is not frozen shoulder, but rotator cuff injury. Therefore, I recommend that the patient do a shoulder MRI to verify this judgment. Sure enough, after the results of the shoulder MRI examination, it was indeed a complete rotator cuff tear.
Since there is currently no non-surgical way to heal tendons, surgery is the best treatment [1].
Because Aunt Zhang is in good health, there are no other problems except shoulder pain, and she still has high requirements for quality of life, and the limited movement of the shoulder joint and pain have 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, the original joint freedom of movement was quickly restored, and the shoulder pain disappeared [2].
Through Aunt Zhang's case, we also learned that the pain in the shoulder joint in 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.
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 has limited mobility, that is, it must be frozen shoulder.
We need to go to the hospital to find a specialist for detailed consultation, as well as targeted physical examination, and if necessary, do auxiliary examinations such as MRI to confirm the doctor's diagnosis so as to get reasonable and effective treatment.
Special author: Sun Qi
Deputy Chief Physician of Department of Orthopedics, Dongzhimen Hospital, Beijing Hospital of Traditional Chinese Medicine University
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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