Treatment of scapulohumeral periarthritis (May 29, 2002)
Chief physician Huang Gongyi, a professor of orthopedics in Beijing Hospital and a member of China Orthopedic Society, has been engaged in clinical teaching and scientific research in orthopedics for nearly 40 years, and is good at the diagnosis and treatment of shoulder joint diseases. It is the first in China to establish a research center for shoulder joint surgery to classify and diagnose scapulohumeral periarthritis. (Left)
Dr. Sun Changtai, deputy chief physician and director of the Department of Orthopaedics, Beijing Hospital, went to Japan and Denmark to study the diagnosis and treatment of shoulder joint diseases, and published 1 1 domestic scientific papers on the treatment of scapulohumeral periarthritis. (right)
Hello, audience friends! This is CCTV's live program "The Road to Health". Today we are going to talk about scapulohumeral periarthritis.
Moderator: What kind of disease is scapulohumeral periarthritis?
Huang Gongyi: Periarthritis of shoulder is a common disease, a kind of shoulder pain and shoulder dysfunction. There was a misunderstanding in the previous diagnosis that all shoulder pain belonged to scapulohumeral periarthritis. In fact, scapulohumeral periarthritis is a disease that includes more than ten causes.
Moderator: Is it true that shoulder pain or dysfunction must be periarthritis of shoulder?
Sun Changtai: Periarthritis of shoulder is actually a broad concept, including all diseases with shoulder pain or dysfunction except fracture, inflammation and tumor.
Moderator: Which situation is more common?
Huang Gongyi: There are three common situations in China: 1, supraspinatus tendon injury or tear. 2, long head tendinitis of biceps brachii tendon. 3. Periarthritis of shoulder or fifty shoulders, which is the most common situation, is mainly caused by adhesion of joint capsule.
Moderator: Why is it called scapulohumeral periarthritis or fifty shoulders?
Sun Changtai: Because from the state of onset, the shoulder looks frozen after onset, so it is formally called scapulohumeral periarthritis. In addition, according to the age statistics of the patients, it is found that most patients are in the age stage of about 50 years old, so they are usually called fifty shoulders.
Moderator: What is the cause of scapulohumeral periarthritis?
Sun Changtai: The causes of scapulohumeral periarthritis are as follows: 1, mild traumatic sprain of joint. 2. Decreased shoulder joint activity. 3. Endocrine disorder. 4. Immune dysfunction caused by infection. 5. Feel the cold.
Moderator: Can periarthritis of shoulder be cured?
Huang Gongyi: The course of scapulohumeral periarthritis is divided into three stages: the early stage is mainly pain, which may be very intense and I can't sleep at night. The pain is relieved in the middle stage, but the dysfunction is obvious, which is called freezing period, and the freezing period may be very long. Finally, it enters the rehabilitation stage, but the recovery situation varies from person to person.
Moderator: Since this disease can heal itself, why should it be treated?
Sun Changtai: The history of scapulohumeral periarthritis is often very long, usually 1-3 years. For such a long time, the shoulder joint has been painful and the activity has been restricted, which has brought a lot of inconvenience to daily life. After follow-up, we also found that most patients will leave varying degrees of pain or limited activities if they are not treated.
Compere: Is it possible for scapulohumeral periarthritis to recur after self-healing or healing?
Huang Gongyi: Generally speaking, scapulohumeral periarthritis is not easy to recur. It should be said that one shoulder will not recur after the onset, but the other shoulder may still suffer from scapulohumeral periarthritis.
Moderator: How to clearly judge whether you have scapulohumeral periarthritis?
Huang Gongyi: First of all, we can make a preliminary judgment from the age. The patient should be around 50 years old. In addition, the pain is mainly manifested in the upper and front sides of the shoulders, and sometimes it also affects the neck and elbow joint. Secondly, the dysfunction is obvious, joint contracture, arm abduction, forward lift and rotation are obviously limited. It is recommended that patients go to the hospital for diagnosis.
Sun Changtai: We also need to do some auxiliary tests for patients, such as taking X-rays of shoulders to judge whether patients have other diseases, such as tumors and inflammation.
Moderator: What are the shoulder diseases that are easily confused with fifty shoulders?
Huang Gongyi: 1, rotator cuff injury 2, long head tendinitis of biceps brachii 3, supraspinatus tendon tear is the most common shoulder disease in clinic, and it is also the most easily confused with fifty shoulders. The rupture of supraspinatus tendon is related to age, as shown in the figure: the tendon itself is aging, and it becomes brittle and easy to break after aging.
Moderator: Mr. Song from Beijing, aged 37. I started to have shoulder pain two months ago. It doesn't matter if you apply medicine and massage. I went to the hospital for examination and said it might be tenosynovitis of biceps brachii. How should I treat it?
Sun Changtai: This disease usually happens to younger patients. In the early stage, local physiotherapy was the main method. If the effect is not satisfactory, local blocking treatment can also be performed.
Moderator: Mr. Zhang from Sichuan, 52 years old. My right shoulder hurts badly when I move. The doctor diagnosed supraspinatus tendon rupture. What good treatment is there?
Huang Gongyi: If it is diagnosed as supraspinatus tendon rupture, it is generally difficult to heal itself. It is recommended to go to the hospital for surgery.
Sun Changtai: In the past, supraspinatus tendon rupture was reconstructed by incision. At present, arthroscopic surgery is usually used, which has the advantages of less trauma and quick recovery.
Compere: Is it ok to massage fifty shoulders?
Huang Gongyi: This is a misunderstanding in treatment, because in the acute pain period of 50 shoulders, it is necessary to reduce activities, and at the same time cooperate with some physical therapy and block therapy to achieve the purpose of relieving pain and diminishing inflammation. Incorrect treatment will aggravate the symptoms.
Moderator: How should we treat it after entering the freezing period?
Huang Gongyi: The main symptom at this time is dysfunction. Under general anesthesia, joint adhesion can be released by manual method, thus shortening the course of treatment and returning to normal daily life as soon as possible.
Moderator: Why do you have to have general anesthesia?
Huang Gongyi: Because muscles can be relaxed to the greatest extent under general anesthesia, adhesion can be fully released. Moreover, general anesthesia makes patients have no absolute pain stimulation, and can avoid some unexpected States, such as heart, blood vessels and cerebrovascular diseases.
Moderator: How long will the whole operation take?
Huang Gongyi: It usually takes 3-5 minutes to complete.
Moderator: Are there any complications in the operation?
Sun Changtai: The key lies in the operation process. Doctors must standardize their operations. Because the patient's long-term activities are limited, there may be some osteoporosis in the local area. If not handled properly, it may cause local fractures.
Moderator: Ms. Zhang from Jilin, 59 years old. When cleaning the glass at the end of last year, I accidentally fell off the wooden bench and landed on my back first. Later, my shoulders became weak and I couldn't lift my hands. The doctor said it was scapulohumeral periarthritis. Take medicine and massage. So far, the pain is not obvious, but I still can't lift my arm. What's going on here?
Huang Gongyi: From the narrative analysis, it may be rotator cuff injury or rotator cuff tear. It is recommended to go to the hospital for diagnosis.
Moderator: Ms. Wang from Shanxi, 5 1 year old. This year, I was holding a high railing on the bus, and my right shoulder was pulled when I braked suddenly. After that, my shoulder hurts until now. I can't comb my hair now. Do I have fifty shoulders?
Sun Changtai: According to the known information, it is probably fifty shoulders, but it needs a doctor to conduct a comprehensive examination and finally make a diagnosis.
Moderator: What are the training contents of fifty shoulders home rehabilitation training? What are the precautions in the training process?
Huang Gongyi: It is very important to exercise at the stage of fifty shoulders rehabilitation. The purpose of exercise is to increase the range of motion of joints and gradually increase the strength of joints. The basic principle of exercise is from light to heavy, from less to more. For example, you can do some bending and swinging movements at first, and use the gravity of upper limbs to improve the range of motion of joints. In addition, some hyperthermia and physical therapy during exercise are beneficial to functional rehabilitation.
Moderator: Mr. Tian, a 57-year-old from Guangdong, has pain in his left shoulder and back, but it only hurts when he exerts force. Is this periarthritis of shoulder? How to treat it?
Huang Gongyi: This condition may be related to muscle injury and needs further diagnosis.
Moderator: Mr. Wang from Beijing, 53 years old. I had a sudden pain in my left shoulder for two weeks. I can't sleep at night in pain. A Chinese medicine hospital diagnosed me as scapulohumeral periarthritis, taking Chinese medicine and massage, but I felt my shoulder hurt. What should I do?
Sun Changtai: Periarthritis of shoulder has a calcified supraspinatus tendinitis. The pain is very intense. You can take an X-ray of your shoulder. If calcification is found locally, a diagnosis can be made. In terms of treatment, some closed treatment can be carried out in the early stage, and arthroscopy can also be used. Because the pain is severe, and the patient is about 50 years old, which may be the early stage of 50 shoulders, the treatment should be mainly to relieve pain and diminish inflammation.
Moderator: Ms. Li from Beijing is 66 years old this year. I got scapulohumeral periarthritis at the age of 40. I was cured at that time. Now that I'm old, my shoulder is starting to hurt again. How to treat it?
Huang Gongyi: Generally speaking, scapulohumeral periarthritis is not easy to recur. The patient's age should consider whether the supraspinatus tendon is broken. It is recommended to go to the hospital for further examination. Don't arbitrarily think it is scapulohumeral periarthritis.
Moderator: Mr. Zhang from Qingdao, 38 years old. I dislocated my right shoulder five times. I usually have a pain in my shoulder. The doctor said I needed an operation. Is it necessary?
Sun Changtai: This does not belong to the category of scapulohumeral periarthritis, but because it has been dislocated for 5 times, it cannot be treated conservatively. It is recommended to have surgery according to the doctor's advice.
Moderator: Mr. Neimenglu is 54 years old. My shoulder is not only painful, but also swollen. Massage, physical therapy and taking anti-inflammatory painkillers are of little use. What's the matter? How to treat it?
Huang Gongyi: Generally, scapulohumeral periarthritis will not cause local swelling. You should go to the hospital as soon as possible to make a diagnosis and see if it is inflammation, tuberculosis, bacterial infection, tumor and other diseases of the shoulder joint.
Moderator: Ms. Du from Hubei, 57 years old. My shoulders hurt now. Is it periarthritis of shoulder?
Sun Changtai: Periarthritis of shoulder may cause pain on both sides at the same time, but it is unlikely. We should consider whether it is a cervical vertebra problem, and if it is, we should treat it symptomatically.
Huang Gongyi: Symmetric joint pain, young people should rule out rheumatoid arthritis, and the elderly should rule out osteoarthritis or proliferative and degenerative arthritis.
Moderator: Ms. Zhu from Tianjin, 46 years old. I had a pain in my right shoulder a month ago. I can't lift it. Painkillers are ineffective, and joints ring when you move them. What is the reason?
Huang Gongyi: There are many reasons that may lead to joint snapping and pain. These symptoms are not the characteristics of common shoulder pain, and further examination is recommended.