Li Zhihan, the attending physician of the Department of Rehabilitation, Taoyuan Hospital, Fuwei Department, said that the patients above 50 shoulders are mostly aged 50-60, and the incidence rate of women is slightly higher than that of men. Fifty shoulders, also known as frozen shoulders, is medically called "shoulder-sticking bursitis", which is inflammation and fibrosis of synovium of joint capsule, resulting in adhesion, thickening and tightening of the whole joint capsule, causing pain and limited range of motion.
The occurrence of fifty shoulders can be divided into primary and secondary. Primary, that is, unexplained, can only be said to be a physical problem. Most patients are secondary, such as diabetes, thyroid diseases and immune diseases. Patients who can't move their hands after stroke; Patients with rotator cuff injury who dare not move because of pain; And patients with long-term shoulder inactivity, such as fractures that need fixation.
Early treatment can shorten the course of disease and reduce sequelae.
Li Zhihan said that the course of the fifty-shoulder disease is about 2-3 years, and then it may heal itself, the pain will be relieved or disappeared, and the adhered tissue will "debond" and restore the angle of motion. However, about 40% of patients can't insist on it completely, which will leave sequelae, the shoulder movement angle can't be completely normal, and the hand movement is limited, which will affect some daily life. But if it can be treated early, the recovery of shoulder joint motion angle will be improved a lot.
If a patient wants to be lucky enough to be 60% patients without residual sequelae without treatment, it may take 2 ~ 3 years to go through a long and unbearable course of disease. Therefore, Li Zhihan suggested that proper treatment can not only shorten the course of disease, but also leave no sequelae.
The age of patients has a downward trend.
At present, 3C products are very popular, and the number of computer users and mobile phone users has greatly increased. Li Zhihan said that many young people who frequently use computers and mobile phones in outpatient clinics for a long time come to see a doctor because of shoulder pain. Some patients had 50 shoulders after examination, and the patients were quite surprised. They feel young. How can they stand 50 shoulders?
Discomfort caused by using 3C products is not uncommon in clinic. The reason is that long-term use of incorrect posture makes the muscles of shoulders and hands stiff and tight, and the circulation is not smooth, resulting in muscle damage and muscles can not be repaired well. Under the vicious circle, some people develop into fifty shoulders.
Li Zhihan reminded that shoulder pain is not caused by people of this age group, although shoulder pain is common in people around 50 years old, because shoulder tissues are complex, including bones, muscles, tendons, nerves and joint capsules. Moreover, every part may cause shoulder pain, and cervical problems may also transfer to cause shoulder pain, so you should seek medical diagnosis and find out the reasons.
Five treatment methods
◎ Oral drugs:
Most of them use anti-inflammatory painkillers and muscle relaxants. The use method and time vary according to the patient's condition and the doctor's judgment.
At the time of injection:
Steroids or hyaluronic acid can be injected into the shoulder joint to reduce synovitis, treat severe pain and improve shoulder mobility. It is suggested that the earlier the injection, the better, and the inflammation should be controlled as soon as possible, so that the subsequent tissue fibrosis and adhesion will not be too serious. How long the drug effect can last after injection varies from person to person. It is suggested to discuss the frequency and interval of injection with the doctor to avoid the deterioration of the condition or the pain affecting the mood and quality of life of patients.
Rehabilitation treatment:
Patients with fifty shoulders must cooperate with rehabilitation treatment. At first, in order to relieve the pain of patients and increase the angle of limb movement, patients were treated with hot compress and electrotherapy to soften tissues and increase circulation, and physiotherapists assisted patients with shoulder joint activities. After the patient's pain is relieved, he will join more active angle exercises. Finally, muscle strength training will be increased after the patient's pain and range of motion are improved.
Joint capsule expansion:
When the rehabilitation effect is not ideal, the joint capsule can be expanded. This therapy is to put the needle into the joint capsule and inject liquid under the guidance of ultrasound. Some doctors will add vitamins, anesthetics, glucose water or physiological saline. Every doctor has a different formula and uses physical methods to open the sticky joint capsule. The frequency of flapping depends on the condition, ranging from 1 to 5 times. After opening the adhesive joint capsule, the motion angle will be improved a lot. It is suggested to cooperate with rehabilitation treatment to achieve the best effect.
Surgery:
Zhang Pengyuan, the attending physician of the Department of Neurology, Taoyuan Hospital, Fu Wei Department, reminded that because the shoulder joint is sticky or inflamed, it is similar to the symptoms of compression of the fifty shoulders and cervical vertebrae. Therefore, the most important role of neurosurgery is to identify whether this pain is caused by cervical vertebrae. If the cervical nerve is compressed (including cervical disc herniation and long bone spur), the problem can be solved by surgery and the symptoms can be improved.
Many patients with 50 shoulders can't bear the pain, or can't bear the long-term treatment in rehabilitation department. Therefore, they seek neurosurgery for "high-frequency thermocoagulation nerve block" to relieve pain. After most of the pain is relieved, they can have a good mood for long-term rehabilitation.
Content source: Changchun Monthly No.429