Talk about scapulohumeral periarthritis

A female colleague of my daughter-in-law "dodged" her shoulder because she played badminton last month. When I went back, I felt a little pain in my shoulder, uncomfortable and unable to move, so I went to the massage shop in the community. The manager said that I have "scapulohumeral periarthritis" and I need to massage my shoulders "loose", and then I will go back and exercise my shoulders. So, the girl listened to the manager's words, endured the pain and "loosened her bones" three times in the massage shop, and went home to do various swing arm movements according to the manager's instructions. However, instead of getting better, the shoulder pain became more and more serious, and finally the arm could hardly move.

She knew I was an orthopedic surgeon, so she asked me what I was doing. She said that she looked it up on the Internet, and that's how scapulohumeral periarthritis is treated. Why is she getting worse? I told my daughter-in-law that, not surprisingly, your colleague is not scapulohumeral periarthritis at all, but another "opposite" disease called "rotator cuff injury". Tell her to come to the hospital for me quickly. This estimate is that surgery is needed.

Sure enough, on the third day, the girl came to the hospital for an MRI. The results showed that there was a big hole in the supraspinatus tendon of her right shoulder, and she had to be operated as soon as possible.

The girl cried directly. She said that she didn't understand why all the symptoms were like scapulohumeral periarthritis on the Internet, and how it turned out to be the opposite disease.

Yes, in fact, she not only experienced misdiagnosis and mistreatment, but many of them were regarded as "scapulohumeral periarthritis" at first, and the more serious they were treated, the more serious they were, and finally they were found to be "rotator cuff injuries". Never think that shoulder pain is "scapulohumeral periarthritis" as long as it is inconvenient, and it may be "opposite" rotator cuff injury. If you rush to exercise and shake your arms to treat scapulohumeral periarthritis, it is likely to bring serious consequences. # Here comes the truth # # Rumor #

Let's talk about "rotator cuff injury" and "scapulohumeral periarthritis" today.

In fact, the name "scapulohumeral periarthritis", which is well known to women and children, is not very accurate. More is the common name of ordinary people. Its more accurate professional name is actually shoulder adhesive bursitis, which is also called "frozen shoulder" in the industry. The most common age is 40-60 years old, and there are more female patients than male patients. And it is mainly unilateral.

This kind of scapulohumeral periarthritis is mainly due to shoulder joint degeneration, chronic injury, fixed shoulder, improper treatment of acute injury, or long-term fatigue caused by other shoulder diseases. Because it is more common in middle-aged people around 50 years old, it is also called fifty shoulders.

The main symptoms are pain around the shoulder joint and limited movement in all directions. Moreover, the inconvenience of this activity has an obvious feature, that is, "I can't lift my arm by myself and others can't help me", which is very important and one of the important points that distinguish it from rotator cuff injury.

Periarthritis of shoulder, also known as scapulohumeral periarthritis, is mainly treated conservatively, that is, desperately moving and stretching the shoulder to make the adhered tissue "loose" as soon as possible.

But in fact, most shoulder pain is immobile, not caused by scapulohumeral periarthritis, but the rotator cuff injury we are going to talk about below.

Before talking about "rotator cuff injury", we have to talk about what rotator cuff is.

In fact, the so-called "rotator cuff" is a general term for doctors to combine four muscle ligaments in the shoulder joint like sleeves.

As shown in the above picture, four special muscles (supraspinatus, infraspinatus, subscapular and teres minor) actually surround our shoulders like sleeves, which can make our shoulders move in all directions, especially upward and forward, and make our shoulder joints more stable.

The so-called rotator cuff injury is actually that these four muscles (including their tendons) are injured for various reasons (trauma, aging, etc.). ), leading to pain and shoulder joint movement disorder.

Of course, the severity of symptoms depends on the severity of rotator cuff injury, that is, the more serious the injury, the more serious the pain and immobility of the shoulder. And this kind of immobility, compared with before, is "my shoulders can't be lifted, and others help to lift them."

More importantly, rotator cuff injuries are constantly developing. Simply put, the injured wound may get bigger and bigger. Therefore, whether you do surgery or not, you must first stop the movement of the shoulder joint. The tear caused by rotator cuff injury will become bigger and bigger, and the symptoms will become more and more serious. This is why rotator cuff injury and scapulohumeral periarthritis are almost "opposite" diseases, and it is also the reason why my wife and colleagues have problems at the beginning of the article.

Generally speaking, there are three main differences.

(1) Etiology and age

Rotator cuff injury usually has an obvious history of external injury. For example, on a snowy day, I fell on my hand, such as lifting heavy objects or swinging badminton and spraining my shoulder. However, scapulohumeral periarthritis generally has no obvious history of trauma.

Rotator cuff injuries can occur in both young and old people. Moreover, scapulohumeral periarthritis generally only occurs in the elderly. In other words, if young people suddenly have a shoulder pain and can't move, they should consider rotator cuff injury.

Middle-aged and elderly people have shoulder pain and limited activities. rotator cuff injury and scapulohumeral periarthritis need to be checked. Young people's first concern is rotator cuff injury.

(2) the characteristics of the shoulder can't move.

As mentioned above, patients with rotator cuff injury cannot lift their shoulders by themselves (active activities are limited), but others can lift their shoulders and arms (passive activities are not limited). Patients with scapulohumeral periarthritis can't raise their arms, that is, their active and passive activities are restricted.

However, it is worth noting that many patients with rotator cuff injury will have local adhesion because of the long injury time. At this time, rotator cuff injury combined with scapulohumeral periarthritis can not be judged only by this judgment, and further examination is needed to make it clear.

(3) treatment

The most important thing is here.

Scapulohumeral periarthritis, that is, scapulohumeral periarthritis, needs to exercise the shoulders to prevent stiffness. Whether climbing a wall or swinging your arm, try to move your shoulder as much as possible, and move when it hurts.

However, rotator cuff injury is just the opposite! It is necessary to fix the shoulder joint first, and then consider whether to treat it conservatively or surgically according to the severity of the injury. The reason why you can't move at first is because the rotator cuff structure has already been damaged. At this time, if you still exercise vigorously, the tear will become bigger and bigger, making the condition more and more serious.

In fact, it is also very simple, and you need to go to a regular hospital as soon as possible. Doctors will do various tests, especially magnetic resonance imaging, to evaluate the severity of rotator cuff injury.

According to the severity of the injury, combined with the patient's own requirements for future shoulder function, conservative treatment or surgical treatment should be chosen as appropriate.

For patients with minor injuries or patients with low requirements for shoulder function, conservative treatment can be chosen. Including rest, joint abduction brace fixation, early ice compress and later physical therapy, oral non-steroidal anti-inflammatory drugs symptomatic treatment.

For serious injuries, such as acute rotator cuff injuries, the tear exceeds 1cm. For example, young people with torn rotator cuff all the way, patients have higher requirements for shoulder function. Most of the operations are minimally invasive arthroscopic surgery, with little injury and quick recovery.

In short, I will find that my shoulder hurts and I can't move. Don't think it's scapulohumeral periarthritis as soon as you come up, and then yank, massage and pull everywhere, which will be counterproductive. What we have to do is to go to a regular hospital as soon as possible, first determine what disease it is, and then talk about the later treatment.