Periarthritis of the shoulder joint

　　The etiology of periarthritis of the shoulder joint is not yet clear, and it is generally believed to be related to the following factors:
　　1, Due to diseases outside the shoulder joint, such as coronary heart disease, pneumonia, cholecystitis, etc., which reflexively cause shoulder pain, limiting the movement of the shoulder joint.
　　2, Due to the prolonged immobilization of the upper limb due to fractures of the upper limb, cervical spondylosis, etc.
　　3, Degeneration of shoulder periphery soft tissues, such as subacromial bursitis, supraspinatus tendinitis, biceps brachii long head tenosynovitis, etc.

　　If periarthritis of the shoulder joint develops for a long time, it may compress the blood vessels, causing poor blood flow in the hand and shoulder, leading to muscle atrophy in severe cases, which seriously threatens the physical and mental health of patients with periarthritis of the shoulder joint. During an attack, both daily life and work are affected, and long-term compression of the nerves may cause nerve damage and numbness in the hands, affecting the health of patients with periarthritis of the shoulder joint.

　　Periarthritis of the shoulder joint mostly occurs in middle-aged and elderly people over 40 years old, with degenerative changes in soft tissues, and reduced ability to withstand various external forces. The specific clinical manifestations are as follows:
　　1, Shoulder pain
　　Initially, the shoulder may present with intermittent pain, mostly chronic onset, and the pain may gradually intensify or become dull, or sharp like a knife cut, and be persistent. Changes in weather or fatigue often worsen the pain. Pain may spread to the neck and upper limb (especially the elbow), and when the shoulder is accidentally bumped or pulled, it often causes tearing pain. Shoulder pain being worse at night than during the day is a major characteristic of this disease. If pain is caused by cold, the patient is particularly sensitive to changes in weather.
　　2, Limited shoulder joint movement
　　The range of motion of the shoulder joint in all directions may be limited, especially in abduction, elevation, internal rotation, and external rotation. With the progression of the disease, due to long-term disuse, adhesions may occur between the joint capsule and the soft tissues around the shoulder, leading to a gradual decrease in muscle strength. Factors such as the coracohumeral ligament fixed in a shortened internal rotation position also contribute to the limitation of active and passive movements of the shoulder joint in all directions, especially difficult to complete actions such as combing hair, dressing, washing face, and crossing the waist. In severe cases, the function of the elbow joint may also be affected, with the hand unable to touch the same side of the shoulder when bending the elbow, especially when the arm is extended backward.
　　3, Tenderness
　　Most patients can feel obvious tender points around the shoulder joint, and the tender points are usually located at the long head of the biceps brachii tendinous groove, subacromial bursa, coracoid process, and supraspinatus insertion point, etc.
　　4, muscle spasms and atrophy
　　Early symptoms of shoulder periphery muscles such as deltoid and supraspinatus muscles may include spasms. In the late stage, disuse muscle atrophy may occur, with typical symptoms such as prominent acromion, difficulty in lifting the arm, and inability to extend backward, with the pain symptoms even alleviating at this time.

　　Periarthritis of the shoulder joint is a completely preventable disease, and attention should be paid to the following aspects in daily life:
　　1. Strengthening physical exercise is an effective method for preventing and treating periarthritis of the shoulder joint, but persistence is key. If exercise is not maintained, and rehabilitation treatment is not consistently carried out, it will be difficult to restore the function of the shoulder joint.
　　1. Strengthening physical exercise is an effective method for preventing and treating periarthritis of the shoulder joint, but persistence is key. If exercise is not maintained, and rehabilitation treatment is not consistently carried out, it will be difficult to restore the function of the shoulder joint.
　　2. Cold exposure is often a triggering factor for periarthritis of the shoulder joint. Therefore, middle-aged and elderly people should pay attention to keeping warm and preventing cold, and not allowing the shoulder to be exposed to cold. If exposed to cold, treatment should be sought promptly, and it is crucial not to delay treatment.
　　3. Strengthening the exercise of shoulder joint muscles can prevent and delay the occurrence and development of periarthritis of the shoulder joint. According to investigations, the incidence of shoulder joint periarthritis is much lower in people with well-developed shoulder joint muscles and strong strength. Therefore, the strengthening of shoulder joint ligaments and muscles is of great significance for the treatment and recovery of periarthritis of the shoulder joint.

　　The diagnosis of periarthritis of the shoulder joint relies not only on clinical manifestations but also on necessary auxiliary examinations. Common examinations include:
　　1. X-ray This examination may show no abnormalities, but shoulder joint arthrography may show changes such as contraction of the shoulder joint capsule and disappearance of the lower fold of the capsule.
　　2. Arthroscopy Fibrosis of the glenohumeral joint, thickening of the capsule wall, and adhesions within the joint cavity. The space between the glenohumeral synovial plica is closed, the joint volume is reduced, and fibrous strands and floating debris can be seen inside.

　　Patients with periarthritis of the shoulder joint should pay attention to their diet to achieve the purpose of辅助 treatment and promote the recovery of the disease. The main dietary precautions are as follows:

　　1. Avoid eating greasy and fatty foods According to traditional Chinese medicine, periarthritis of the shoulder joint belongs to the category of 'Majing'. High-fat foods can affect the transformation of the spleen and stomach, and exacerbate the blockage of Qi and blood. If patients with periarthritis of the shoulder joint often eat a large amount of high-fat foods, such as fatty meat, milk, and fried foods, it can worsen symptoms such as dysfunction, joint stiffness, and pain.

　　2. Avoid eating meals cooked in iron pots Iron in the human body can combine with protein to form a substance, which can then combine with iron molecules (which can be found in meals cooked in iron pots) to form ferritin and accumulate in the synovial fluid within the joints. When ferritin molecules bind with iron, they can reach a saturated state, and saturated ferritin has toxicity, which can trigger and worsen joint symptoms. Therefore, patients with periarthritis of the shoulder joint should avoid eating meals cooked in iron pots.

　　3. Avoid eating seafood Sea products such as sea cucumbers, kelp, seaweed, and seafood contain a certain amount of uric acid. After being absorbed by the human body, these uric acids can form urate crystals in the joints, exacerbating the condition of arthritis. Therefore, patients with periarthritis of the shoulder joint should not eat seafood.

　　4. Eat light and easily digestible foods Eating fresh vegetables and fruits rich in vitamins, such as tomatoes, apples, and honeydew melons, is recommended. Moreover, patients with periarthritis of the shoulder joint should consume more nutritious foods, such as lean meat and soy products, to meet the body's nutritional needs and promote the recovery of the disease.

　　The treatment of periarthritis of the shoulder joint includes non-surgical treatment and surgical treatment. The specific methods of treatment are as follows:

　　First, Non-surgical Treatment
　　Periarthritis of the shoulder joint is a chronic disease, most patients can gradually improve and recover, and patients should understand the process and outcome of the disease and build confidence in overcoming the disease. In the early stage of the lesion, the upper limb should be suspended and immobilized, and the shoulder joint should be gently moved several times a day. Oral salicylate preparations or other anti-inflammatory and analgesic drugs can be taken. For localized tenderness, 1% procaine 5-10ml plus hydrocortisone acetate 25mg can be used for local infiltration, once a week, for 2 or 3 times. Physiotherapy or hot compress can help relax muscles, reduce inflammation, and relieve pain. Appropriate massage not only reduces pain but also helps to increase the range of motion. In the range where pain can be tolerated, active and planned exercises of the shoulder joint function should be carried out. As the range of motion increases, pain also gradually decreases. Avoid holding the shoulder when lying on the side.

　　Second, Surgical Treatment
　　For patients with frozen shoulder who have failed to respond to long-term non-surgical treatment, surgical treatment should be considered, and the main methods of surgery are as follows.
　　1. Long Head of Biceps Tendon Fixation or Transfer Surgery: For frozen shoulder patients whose symptoms have not improved after long-term and planned conservative treatment, and whose clinical examination shows that the lesion is mainly located in the long head of the biceps tendon, biceps tenotomy or transfer surgery can be performed. If the long head of the biceps tendon shows no significant degeneration, it can be cut from the附着处 of the supraglenoid tubercle, pulled out from the joint, and fixed to the coracoid process. If the tendon has undergone severe degeneration, it can be fixed in the intertubercular groove of the humerus, and anterior shoulder acromioplasty can be performed at the same time.
　　2. Olecranon Tenotomy: The normal abduction of the upper arm is necessarily accompanied by the external rotation of the humeral head to make the greater tuberosity of the humerus and the acromioclavicular arch move in unison. Severe frozen shoulder patients, due to the long-term internal rotation of the upper arm, cause the olecranon ligament to contract and restrict the external rotation of the humeral head, affecting its abduction function. If conservative treatment is ineffective after a long period, olecranon tenotomy can be performed, which is expected to improve the external rotation and abduction function of the upper arm.