Orthopedic surgeon: Periarthritis of shoulder can heal itself, but it has to go through these four stages.

Periarthritis of shoulder is a common name of common people, and some people call it fifty shoulders, condensed shoulders and air leakage shoulders. But its real medical name is "adhesive scapulohumeral periarthritis", and the primary adhesive scapulohumeral periarthritis with unknown causes is also called "frozen shoulder" in our medicine. It is a common clinical disease, accompanied by shoulder pain and progressive activity disorder. The pain is obvious at night, and the affected shoulder often has nowhere to put it at night, which affects sleep.

Long-term chronic pain can also lead to mental trance, irritability and high blood pressure, which is extremely harmful to patients. In addition, there are many "kind-hearted" neighbors around, who will always tell you that scapulohumeral periarthritis is fine and activities will be fine, so the clinical treatment and cure rate are low, and there are different degrees of dysfunction after self-healing, which needs to attract social attention. It is recommended that patients be treated in time.

At present, the etiology is unknown, and there are mainly four theories: inflammatory reaction mechanism, fibrous contracture mechanism, neurogenic mechanism and endocrine mechanism. However, no theory can be completely accepted and explain all clinical phenomena, so the etiology and pathogenesis of scapulohumeral periarthritis are still unclear. But through these theories and explanations, we find that women who are around 50 years old, with left shoulder, diabetes and ADHD are more likely to suffer from scapulohumeral periarthritis.

The first stage of inflammation is about 3 months before onset. This stage is mainly characterized by inflammatory reaction in the shoulder joint capsule, and there is no contracture and thickening of the joint capsule. Therefore, the clinical manifestations are mainly pain, and the pain mainly appears at the end of various activities. At this time, there is already night pain, which affects sleep.

The second stage of gradual freezing lasts for 3-6 months. At this stage, the inflammatory reaction is further aggravated, the joint capsule is adhered and thickened, and the range of motion of the joint in all directions is gradually reduced, especially the abduction rotation (that is, the posture of playing badminton). At this stage, patients are the most painful, not only the pain at night obviously affects their sleep, but also their shoulder function is more and more limited, and their daily life, gfd and dressing are all limited to varying degrees.

The third stage is the freezing period, which generally lasts for 9- 15 months. At this stage, the patient's inflammatory reaction is not obvious, but the joint capsule fibrosis and contracture are obvious, the patient's shoulder joint activity is obviously limited, and the activity in all directions is obviously reduced, which seriously affects daily life.

The fourth stage is the thawing period, which lasts 15-24 months. As the name implies, the patient's scapulohumeral periarthritis gradually improved, the pain disappeared, the shoulder joint activity gradually improved, and the condition improved.

Therefore, the natural course of disease is about 2 years, which is self-limited. However, it does not mean that all patients will get better after two years, and there are always some patients who will leave shoulder joint dysfunction to varying degrees. Some patients with serious illness and severe pain will take the initiative to see a doctor at the beginning of the first or second phase.

The diagnosis of the disease mainly depends on clinical manifestations, and it is easy for experienced specialists to diagnose it. Auxiliary examinations, such as shoulder X-ray and MRI, mainly exclude other shoulder diseases, such as rotator cuff tear, subacromial impact, acromioclavicular dislocation and calcified tendinitis.

At present, the treatment is mainly divided into conservative treatment and surgical treatment.

Conservative treatment is suitable for patients with stage I and early stage II. The main pathological manifestation at this stage is inflammatory reaction, and there is almost no adhesion and thickening of the joint capsule. Oral non-steroidal anti-inflammatory drugs and local joint cavity closure can inhibit inflammation, relieve pain, shorten the course of disease, and even prevent the disease from progressing. Combined with functional exercise and physiotherapy needle, the clinical effect may be better.

Surgical treatment is suitable for patients whose conservative treatment is ineffective and whose pain and dysfunction obviously seriously affect their life and work. At present, almost all of them are minimally invasive treatment under arthroscope, and the contracture of shoulder capsule is completely released 360 degrees during the operation to treat this disease, and the postoperative effect is good. Almost all patients can sleep well on the night after operation, feel their shoulders relaxed a lot, their activity ability is obviously improved, and their satisfaction is extremely high, which is the first choice for the treatment of scapulohumeral periarthritis at present.

The joint capsule is completely released at 360 degrees (the arc red line is the cutting part of the joint capsule).

Periarthritis of shoulder is a common clinical disease. Although it is self-limited, it has a long course of disease and obvious pain, and may leave different degrees of dysfunction after self-healing. Therefore, patients who highly suspect that they have scapulohumeral periarthritis must go to the specialist clinic in time to rule out other shoulder diseases, and at the same time, treat them as soon as possible to shorten the course of disease and alleviate the pain. If conservative treatment fails, arthroscopic shoulder capsule release has the advantages of minimally invasive, rapid, safe and effective, and short hospitalization time, and is the best choice for the treatment of scapulohumeral periarthritis.

refer to

Li Lin, Wang Fang, Li Li and Li Ming. Research progress on pathological mechanism and treatment of primary frozen shoulder [J]. Chinese Journal of Shoulder and Elbow Surgery, 2019,7 (2):178-181.