Pain & Acupuncture

Frozen Shoulder & TCM

By Markov ⋅ March 6, 2009 ⋅  Print This Post ⋅ Post a comment

Frozen Shouler is most often due to inflammation-induced adhesion. Most times, frozen shoulder is due to Adhesive Capsulitis (粘连性关节囊炎). It’s is often just called “Fifty-year Shoulder” (五十肩) here in China, since most people get this when they have accumulated around fifty years of age.

Here is more on shoulder anatomy.

Difference between Capsulitis, Bursitis and Tendonitis

According to aafp, capsulitis is the umbrella term to designate inflammation of the glenoid cavity. Primary Idiopathic Adhesive Capsulitis is when this condition is not due to some nameable underlying reason. Secondary Adhesive Capsulitis is when an underlying condition is the cause – e.g. bursitis (滑囊炎) or tendonitis (肌腱炎).

More Definitions Translated

The bursa (滑囊), a sac-like thing that reduces friction between bone/muscles/tendons around a joint, is made up of synovial fluid ( 滑液) that is wrapped around by the synovium aka synovial membrane (滑液膜).

Synovitis (滑液膜炎) is best explained in reference to the knee joint. In Rheumatoid Arthritis (类风关), an autoimmune reaction causes inflammation of the synovium, which is normally thin and secretes a healthy amount of synovial fluid, but now secretes watery fluid that doesn’t provide adequate lubrication. Here is a very good paper on the synovium and synovitis.

Also note the difference between tendon (肌腱) and tendon sheath (腱鞘). Often we see 腱鞘炎 being translated as “tendonitis,” when 肌腱炎 would be more precise.

Note though that most times – go google the internet to see for yourself – some of the terms above are used interchangeably, especially synovitis and bursitis, since the problem area is the synovial bursa, and inflammation doesn’t happen in isolation.

Tendonitis of the Shoulder Joint

During abduction (外展) of the arm, the rotator cuff compresses the glenohumeral joint in order to allow the large deltoid muscle to further elevate the arm. In other words, without the rotator cuff, the humeral head would ride up partially out of the glenoid fossa, lessening the efficiency of the deltoid muscle. During flexion (屈) of the arm infraspinatus and subscapularis act as joint stabilizers. During extension (升) subscapularis and supraspinatus help stabilize the shoulder joint. Subscapularis stabilizes the joint during external rotation. (Source: Wikipedia)

Four muscles beginning at various points on the scapula (肩胛骨) become tendons attaching to the humerus (肱骨):

• supraspinatus (冈上肌): abducts shoulder joint
• infraspinatus (冈下肌): externally rotates shoulder joint
• teres minor (小圆肌): externally rotates shoulder joint
• subscapularis (肩胛下肌): depresses head of humerus keeping it within the glenohumeral joint during arm elevation.

These four muscles are called the rotator cuff. There are two more muscles – deltoid (三角肌) and teres major (大圆肌) – that also connect the scapula and humerus, holding the head of the humerus in the glenoid cavity (关节盂) of the scapula.

See this wiki image: http://en.wikipedia.org/wiki/File:Gray412.png

It’s often during sports that you encountered a tear in your rotator cuff, usually in the tendons, leading to shoulder tendonitis, rotator cuff injury or other monikers for the same thing. Some people may not need the heavy impact of sports and may incur injury just from having a weak rotator cuff and some ill-designed movement of the shoulder. This is not frozen shoulder BUT may cause secondary adhesive capusulitis.

Back to Adhesive Capsulitis

We now know that Frozen should may be designated primary or secondary. We also know that it will go away on it own after a while, and that they will be relapse. So what can be done to treat it?

Sources:

1. http://en.wikipedia.org/wiki/Bursa_(anatomy)
2. http://www.istd.org/training/anatomy/synoviumandsynovitis.html
3. http://en.wikipedia.org/wiki/Rotator_cuff

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