Limited shoulder movement

Introduction Shoulder joint activity is limited: shoulder joints can be restricted in all directions, abduction, lifting, internal and external rotation is more obvious, as the disease progresses, due to long-term disuse, joint capsule and shoulder soft tissue adhesion, muscle strength The gradual decline, coupled with the fixation of the patellar ligament to the shortened internal rotation position, limits the active and passive activities of the shoulder joint in all directions. When the shoulder joint is abducted, a typical "shoulder" phenomenon occurs, especially the comb. Clothes, face washing, akimbo and other movements are difficult to complete. In severe cases, the function of the elbow joint can also be affected. When the elbow is flexed, the hand cannot touch the shoulder of the same side, especially when the arm is extended.

Cause

Degenerative changes occur with age, and shoulder joints are more frequent in life. The surrounding soft tissues are often subjected to friction and compression from various aspects, which is prone to chronic strain.

an examination

Related inspection

Shoulder joint abduction test joint examination

(1) Pain in the shoulder: Initially, the shoulder has paroxysmal pain, most of which are chronic seizures. Later, the pain gradually worsens or pains, or the knife cuts the pain, and it is persistent. After the climate change or fatigue, the pain often occurs. Exacerbation, pain can spread to the neck and upper limbs (especially the elbows). When the shoulder is accidentally bumped or pulled, it can often cause tearing pain, shoulder pain, light night and heavy weight. The patient often complained that he woke up in the middle of the night and could not become a sputum. In particular, he could not lie on the side of the affected side. This situation is more obvious due to blood deficiency. If it is caused by cold, it is particularly sensitive to climate change.

(2) Limited shoulder movement: shoulder joints can be restricted in all directions, and the abduction, lifting, internal and external rotation is more obvious. As the disease progresses, the adhesion of the joint capsule and the soft tissue around the shoulder is caused by long-term disuse. The muscle strength gradually decreases, and the patellar ligament is fixed in the shortened internal rotation position and other factors, so that the active and passive activities of the shoulder joint are restricted in all directions. When the shoulder joint is abducted, a typical "shoulder" phenomenon occurs. In particular, combing, dressing, washing your face, akimbo and other movements are difficult to complete. In severe cases, the function of the elbow joint can also be affected. When the elbow is flexed, the hand cannot touch the shoulder of the same side, especially when the arm is extended.

(3) Fear of cold: suffering from shoulders and cold, many patients wrap their shoulders with cotton pads all year round, even in the summer, the shoulders do not dare to blow.

(4) tenderness: Most patients can reach obvious tender points around the shoulder joints, and the tender points are mostly in the long head sulcus of the biceps. The shoulder peak sag, the condyle, the attachment point of the supraspinatus muscle.

(5) Muscle spasm and atrophy: the muscles around the shoulders such as the deltoid muscle and the supraspinatus muscle may appear in the early stage, and the disuse muscle atrophy may occur in the late stage, and there are typical symptoms such as shoulder protrusion, inconvenience in lifting, and unfavorable back bending. The pain symptoms are alleviated.

(6) X-ray and laboratory examination: regular radiography, mostly normal, some patients can see osteoporosis, but no bone destruction, can see calcification shadow under the shoulder. Laboratory tests are more normal.

The diagnosis was based on the above clinical manifestations.

Differential diagnosis

Periarthritis of the shoulder is a degenerative change of the shoulder joint capsule and its surrounding muscles, tendons, ligaments, and bursa, and chronic aseptic inflammation characterized by pain and activity limitation in the shoulder joint and its surroundings, and even stiffness and rigidity. . Due to the anatomical and functional characteristics of the shoulder joint, some other different types of shoulder pain often occur inside and outside the joint, which need to be differentiated from the periarthritis of the shoulder to avoid disrepair and mistreatment, leading to adverse consequences.

Clinically common diseases associated with shoulder pain include: cervical spondylosis, shoulder dislocation, suppurative shoulder arthritis, shoulder tuberculosis, shoulder tumor, rheumatic, rheumatoid arthritis and simple supraspinatus tendon injury, Torsion of the rotator cuff, biceps tendon inflammation and tenosynovitis. These conditions can be manifested as shoulder pain and shoulder function limitation. However, because the nature of the disease is different, the lesions are not the same, so there are different complications for identification. Combined with the different characteristics of the pain and the different characteristics of functional activities, as well as reference auxiliary examination, differential diagnosis is not difficult.

First, the differentiation of shoulder and shoulder tuberculosis:

Shoulder joint tuberculosis is divided into synovial type and bone type tuberculosis, and simple synovial type tuberculosis is very rare. Tuberculosis of the right shoulder joint is more common than the left side. Bone-type joint tuberculosis can be divided into two types: bacterial type and dry type. The symptoms vary according to the type of disease. The course of the disease progressed slowly, and symptoms gradually appeared. Often pain, dysfunction is the first symptom. Pain often occurs below the deltoid muscle, which is painful when abducting and external rotation. The swelling of the deltoid muscle is most obvious. The sinus is formed in the late stage, often pierced in the weakest part of the joint capsule, that is, it is easy to pierce near the front of the axilla or deltoid. Bone atrophy is an initial X-ray of shoulder tuberculosis, especially bone atrophy of synovial tuberculosis can last for a long time. Shoulder joint tuberculosis is most common with total joint tuberculosis. Simple bone tuberculosis rarely causes bone joint dyskinesia or is only slightly restricted.

Periarthritis of the shoulder is also known as inflammation around the shoulder joint. It occurs mostly after the age of 50. The main clinical features are shoulder-arm pain and limited activity. It is a chronic aseptic inflammation of soft tissues such as muscles, tendons, ligaments and bursae around the shoulder joints.

X-ray findings are mainly: osteoporosis of the shoulder joint, large nodules or parts opposite the acromion end with cystic changes, hyperplastic sclerosis, and peripheral soft tissue calcification.

Early shoulder tuberculosis and frozen shoulder are characterized by clinical manifestations and X-ray findings, which are easily confused.

Second, the identification of periarthritis of shoulder and tumor around the shoulder:

Tumor growth around the shoulder can cause shoulder pain or activity dysfunction with the shoulder arm. The difference between it and the periarthritis of the shoulder is that the shoulder pain of the affected part is gradually worsened, and the painful part is gradually enlarged due to the growth of the tumor. The shape of benign tumors is multi-rule, soft and active, and the malignant tumors are irregular in shape and hard and fixed. Due to the compression of the tumor, functional limitations may occur, and some patients suffer from numbness in the shoulder arms and fingers.

The appearance of X-ray films is not the same due to the nature of the tumor, the location of the growth and the length of the disease. Generally, soft tissue tumors are not developed or only outlined in X-ray films. If the tumor erodes the bone tissue, X-ray films can be seen with varying degrees of bone destruction or even pathological fractures.

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