Frozen shoulder is a condition describing chronic restriction of movement of shoulder and, often, associated with pain.
Frozen shoulder is a condition describing chronic restriction of movement of shoulder and, often, associated with pain. Movement restriction is due to adhesive capsulitis of the shoulder joint. Impingement of tendons with or without inflammation causes mild to severe pain.
Symptoms and signs:
Patient often presents with chronic shoulder pain with limitation of movement. Patient may have difficulties in combing, dressing or even feeding. This condition is associated with varying severity of pain, which may interfere with sleeping, or daily activities. The usual age of patient is around fifty and that is why this is well-known as 'Fifty Shoulder' in Chinese.
Examination reveals limitation of movement in all directions, particularly external rotation and internal rotation. The acromio-clavicular joint, glenohumeral joint capsule, and coracoids process are tender. There is muscle weakness. Pain may be referred to the neck and down to the elbow or even forearm and hand.
Cause and biomechanics considerations:
Adhesive capsulitis may be initiated by trivial injury of the rotator cuff tendon(s). Unaccustomed or repetitive movements, such as reaching out for subjects above head or below the cabinet, may impinge and injure these tendons. Without proper medical attention, localized inflammation will cause capsule adhesion, impingement of shoulder movements and mild degree of movement restriction. Patient may try to overcome movement restriction and further traumatized the adhered capsule. This will cause a viscous cycle of injury, inflammation and adhesion.
The "freezing" or painful stage: It may last from six weeks to nine months. Patient may have varying severity of pain and the shoulder gradually loses motion.
The "frozen" or adhesive stage: This stage generally lasts four months to nine months. The shoulder is stiff as suggested by the word “frozen”, but the pain often lessens.
The "thawing" or recovery: Shoulder motions gradually improve. This generally lasts five months to 26 months.
The diagnosis is usually clinical. X-rays are usually normal unless there is coexisting bony fracture, acromial spurs causing the impingement. Muscle tears can be detected by MRI or musculoskeletal ultrasound imaging. The latter is more effective in picking up and in the confirmation impingements dynamically during assessment by a musculoskeletal physician. Musculoskeletal ultrasound can also demonstrate active inflammation, if there is, by using the colour flow mapping.
Treatment depends on symptoms and signs of the patient. The aims are to control symptoms, improve motions, strengthen rotator cuff muscles and return to normal daily activities. Analgesics often are required to control pain especially the night pain at bed time. When there is evidence of ligament or tendon tears, musculoskeletal physicians often offer prolotherapy to trigger tissue repair. Shoulder mobilization after injection is useful to break the adhesions and regain joint motions. Prescribed exercises are indispensible to improve the stability and retrain the weaken muscles. Occasionally, surgery is required to repair cartilaginous injury and joint capsule damages.
五十肩 / 冰凍肩
第一是"啟凍期"或"疼痛期"。此階段可持續 6 星期至 9 個月。病人可能會有不同程度的痛症，肩膀會慢慢喪失活動的功能。
第二是"凍結期"或"黏連期"。一般持續 4 至 9 個月。肩膀感覺僵硬，就好像"凍結"了；但痛症往往有所減輕。
第三是"解凍期"或"康復期"。肩關節的活動度逐步改善。此階段通常持續 5 至 26 個月。
五十肩的診斷通常是臨床的。X光檢驗結果一般都顯示肩關節正常，除非同時有骨折，或有肩峰骨刺引起的肩膀夾擠。磁力共振掃描或肌骼超聲波造影皆可檢測出肌肉撕裂的情況。肌骼科醫生為病人進行評估時，肌骼超聲波造影比起磁力共振掃描可以更有效地檢查及確定肩關節活動時夾擠的情況。肌骼超聲波造影的彩色血流圖像（Colour flow mapping）能顯示出炎症是否有活動性。
HKIMM ASM 2018
Refresher Course Musculoskeletal Medicine
Date: 13 – 15 July 2018
Day 1: Ballroom, 2/F., Courtyard by Marriott, I On Ping Street, Shatin, Hong Kong
Day 2 & 3: Room 306,3/F., Choh-ming Li Basic Medical Sciences Building, The Chinese University of Hong Kong, Shatin, Hong Kong
HKIMM MSKUS Workshop 2018
Diagnostic Musculoskeletal Ultrasound & Injection Technique Workshop
1 – 2 December 2018