You are on page 1of 34

Scapulohumeral

Periarthritis

1
6.6: Scapulohumeral Periarthritis

Scapulohumeral periarthritis is a disorder characterized by extensive


congestion, exudation, edema, thickening and adhesion of the
surrounding ligaments, tendons and articular capsules due to acute and
chronic injury of the shoulder, resulting in nonspecific inflammation and
restricting movement of the shoulder.

The disorder is also called Periarthritis of shoulder; Adhesive Capsulitis

Usually seen among people around 50,


Higher morbidity among females than males

Frozen Shoulder
2
6.6: Scapulohumeral Periarthritis

Names in TCM:

Coagulation of the shoulder


Jian Ning Zheng

Shoulder leakage of wind (Omalgia)


Lou Jian Feng

3
6.6.1: Scapulohumeral Periarthritis
-TCM Pathogenesis

Deficiency of kidney Qi fails to Excessive motion or traumatic injury


produce sufficient essence to Impairment of tendons and joints
nourish the marrow

Insufficient marrow fails to Stagnation of Qi and blood


nourish the liver and spasm of tendons

Loose bones and joints and Stiffness of tendons


tendon flaccidity and muscles

Shoulder Periarthritis
4
5
6.6.2: Scapulohumeral Periarthritis
-Clinical manifestation
Development of Symptoms

Pain Restricted motion Muscular atrophy

1. The onset of the disorder is slow and gradual.

2. The patient has a history of chronic shoulder strain. (cold, wind, damp
attack). Acute shoulder strain, dislocation of shoulder, bone fractures
of the upper limb.

3. Early Stage:
soreness and pain of the shoulder are evident due to weather change,
fatigue or cold.
stiffness and fear of motion.

6
6.6.2: Scapulohumeral Periarthritis
-Clinical manifestation

4. Later Stage:
continuous pain over the whole shoulder, radiating to the cervix and elbow.
Painful more severe during the night (disturbing sleep and making the patient
afraid of lying on the affected side)

5. Severe pain happen when the shoulder is pulled and dragged.

6. Early dysfunction is usually caused by pain, while late dysfunction by


joint adhesion.
Active motion and passive motion are restricted, resulting in difficulty in
(1)combing hair, (2)dressing up, (3)taking off clothes, (4)washing faces,
(5)standing akimbo.

7. Atrophy in deltoid muscle and supraspinatus. (The extent of atrophy


depend on the duration of the disorder)

7
6.6.2: Scapulohumeral Periarthritis
-Clinical manifestation

8. Evident of tenderness at:


Jianliao (SJ 14), Jianyu (LI15), Bingfeng (SI12), Jianzhen (SI9)
Deltoid muscle
Supraspinatus
Infraspinatus
Teres Minor
Subscapularis

9. Longer duration of disorder, muscular atrophy of the shoulder


and convex acromion may develop.

10. X-ray shows:


Usually no signs of abnormality;
Postmenopausal osteoporosis;
Irregular shadow of calcification over the surrounding soft tissue

8
Jianliao (SJ 14)

Bingfeng (SI12)
Jianyu (LI15)

Jianzhen (SI9)

9
6.6.3: Scapulohumeral Periarthritis
-Diagnosis

Essential for Diagnosis

1. The onset of the disorder is slow and gradual. The patient has a
history of cold attack and chronic strain on the shoulder.

2. Tenderness is extensive and pain sites change with joint motion.

3. Dyskinesia is evident, leading to limitation of motion in all


directions.

4. Long duration of the disorder may develop into muscle laxation,


stiffness and atrophy

10
6.6.4: Scapulohumeral Periarthritis
-Treatment

Therapeutic principles

1. Activating blood to dispel stasis

2. Soothing tendons to unblock collaterals

3. Loosing adhesion

11
6.6.4: Scapulohumeral Periarthritis
-Treatment
Locations of Acupoints

Shoulder joint and deltoid mucle

Jianjing (GB21)

Jianyu (LI15)

Binao (LI14)

Quchi (LI11)

Jianzhen (TE14)

Tianzong (SI11)

12
Jianjing (GB21)

Jianyu (LI15)

Binao (LI14)

Quchi (LI11)
13
Jianzhen (TE14)

Tianzong (SI11)

14
6.6.4: Scapulohumeral Periarthritis
-Treatment
Basic Manipulations

1. The patient is in a sitting position. The doctor raises the affected arm to
an angle of 60 degree and then performs pressing, kneading, circular
rubbing or one-finger pushing manipulations on anterior, lateral and
posterior sides of the shoulder and the upper arm. (The manipulation is
often combined with the activities of abduction, backward extension and
passive rotation of the affected arm for about 5 minutes)

2. Pressing and kneading Jianjing, Jianliao, Jianyu, Jianzhen,


Tianzong, Binao and Quchi about one minute each.

3. Pressing, kneading, plucking the anterior side of the shoulder, short


head of biceps, rotator cuff muscles. The manipulations should be
done slowly and deeply with mild force about 2 minutes.

15
6.6.4: Scapulohumeral Periarthritis
-Treatment

4. Applying rolling, pressing, kneading, plucking with fingers and


traction manipulations alternately on the scapular and posterior
shoulder; applying grasping and pinching on Jianjing and deltoid
muscle. Perform the above manipulations for about 5 minutes.

5. The doctor holds the affected shoulder with one hand and supports
the elbow of the affected side with the other, then swinging the arm
circularly in a gradual increasing amplitude for about 1 minute.

6. The doctor stands behind the affected shoulder, putting one hand
under the armpit of the affected side, and keep the elbow flexed with
the other hand. Then raising the affected arm with one hand and
pushing the elbow inward with the other to loosen joint adhesion.

16
6.6.4: Scapulohumeral Periarthritis
-Treatment

7. Rubbing around the shoulder until hot sensation is achieved and from the
shoulder to the forearm for 3-5times.

8. Finally abducting the affected shoulder to a 60 degree angle and perform


shaking manipulation.

17
6.6.4: Scapulohumeral Periarthritis
-Treatment

Cautions

1. The patient should keep the shoulder warm and avoid wind, cold and
damp.

2. The patient should reduce the body activity during acute onset of the
disorder to prevent increased inflammatory exudation; whereas in
adhesion term, the patient should keep doing exercise.

18
Lateral humeral
epicondylitis

19
6.7: Lateral Humeral Epicondylitis

Lateral epicondylitis is caused by sprain or chronic strain of the carpal


extensor tendon resulting mostly from rotation of the forearm with
improper exertion, injuring the radial aspect of extensor muscle of the
wrist of the forearm, causing nonspecific inflammation, stimulating the
nerve ending and periost, leading to a series of symptoms.

Swollen humeral epicondyle, pain and


restricted motion;
Tennis Elbow Mostly seen among workers who often
rotate the forearm
20
6.7.1: Lateral Humeral Epicondylitis
-Pathogenesis
Rotation of forearm forwards
+
Wrist joint stretches backward

Extensor carpi radialis contract

Pulling the tendon area,


leading to acute injury

Long term rotation causing


strained and pulled of radial
muscles

Chronic injury
21
6.7.1: Lateral Humeral Epicondylitis
-Pathogenesis

TCM pathological

Exterior of elbow joint = Large Intestine meridian of hand-Yangming

Invasion of wind, cold and dampness

Stagnation of Qi and blood

Adherence of tendons

Spasm and pain of joints

Difficult in flexion and extension


22
6.7.2: Lateral Humeral Epicondylitis
-Clinical manifestation
Symptoms

1. Acute onset is usually marked by obvious sprain or history of sprain

2. Pain in lateral aspect of the affected elbow, along the extensor muscle of the
wrist.

3. Weakness of the forearm in rotation and grasping. Aggravated after fatigue


or rainy days.

4. Aggravation of pain when:


Forearm rotates and the wrist stretches backward
Lifting, pulling holding or pushing, especially when twisting towel

23
6.7.2: Lateral Humeral Epicondylitis
-Clinical manifestation

5. Local swelling and tenderness:


in the external condyle of humerus (indicate injury at the beginning of
extensor carpi radialis brevis musculus)
In the upper part of external condyle of humerus (indicates injury at the
beginning of extensor carpi radialis long musculus
Near the small radial head (hint of annular ligament and radial collateral
ligament injury)

6. The extensor muscle tension test and Mill test are all positive.

7. X-ray shows:
No abnormal change
Some may appear external condyle of humerus appears unsmooth and
density increases

24
25
26
6.7.3: Lateral Humeral Epicondylitis
-Diagnosis

Essential for Diagnosis

1. History of acute injury or chronic injury.

2. Pain or tenderness in the anterior region of the external humeral


epicondyle, dragging sensation of aching and distending pain in the
radial aspect of the forearm.

3. It is difficult for the patient to carry things. The pain will get worsened
when twisting towel.

4. Positive in Mill Test.

27
6.7.4: Lateral Humeral Epicondylitis
-Treatment

Therapeutic principles

1. Activating blood and resolving stasis

2. Soothing tendons and unblocking


collaterals

28
6.7.4: Lateral Humeral Epicondylitis
-Treatment
Locations of Acupoints

Anterior region of the external humeral epicondyle, muscles of


the radial aspect of the forearm

Quchi (LI11)

Quze (PC3)

Shousanli (LI10)

Hegu (LI4)

29
Quchi (LI11)

Shousanli (LI10)

30
Hegu (LI4)

Quze (PC3)

31
6.7.4: Lateral Humeral Epicondylitis
-Treatment
Basic Manipulations

1. The patient takes a supine position or a sitting position. The


doctor rolls from the radial aspect of the elbow to the radial
aspect of the forearm, and pressing, kneading with the thumb,
and plucking Quchi, Shousanli, Hegu for about 5 minutes.

2. The doctor uses one-finger pushing manipulation, pressing


and kneading on the anterior region of the external humeral
epicondyle, flicking alternatively for 5 minutes

32
6.7.4: Lateral Humeral Epicondylitis
-Treatment

3. (a)The doctor presses the tenderness on the anterior region of the


external humeral epicondyle with the thumb of one hand while
holding the epicondyle region of the internal humeral epicondyle
with the other four fingers; (b) holding the wrist with the other hand
to pull and stretch to the opposite direction; (c) then flexed the
elbow joint slowly to make the forearm rotate until the elbow is
impossible to be bent; (d) extended the forearm quickly and pulled
backwards for 3 times in a succession so as to tear the bursa
synovialis to absorb effusion.

4. Press and knead from the anterior region of the external humeral
epicondyle to the radial aspect of the extensor muscle of the wrist
with the thumb; then rub from the radial aspect of the forearm to
humeral epicondyle till it is warm in local area.

33
6.7.4: Lateral Humeral Epicondylitis
-Treatment

Cautions

1. During the period of treatment, avoid excessive rotation of the forearm and
stretching the wrist backwards.

2. The local area should be kept warm.

34