Scapulohumeral Periarthritis

QU LIUXIN

SOUTHEAST UNIVERSITY ZHONGDA HOSPITAL

1.Shoulder joint (ball and socket) 1)Composition: head of humerus and glenoid cavity of scapula
2)Feature:Articular surface Capsule: Thin and lax

Attachments Tendon of long head of biceps brachii

Glenoid labrum Coracohumeral ligament 3)Movements: flexion, extension, adduction, abduction, medial and lateral rotation, circumduction

Outline
Scapulohumeral periarthritis is a chronic nonspecific inflammation occurring in the articular capsule of shoulder joint and the ligament, musclar tendon and synovial bursa around it, also called periarthritis of shoulder. It often occurs in people around 50 years of age, especially in women. The disease is also called frozen shoulder, fifty-year-old shoulder, etc. It is mainly characterized by pain of the shoulder and disturbance of activity of shoulder joint. The disease is mostly caused by trauma or by invasion of pathogenic wind, cold and dampness. It is of a trend towards spontaneous cure, the period of which is about two years according to the previous reports.

Major points for diagnosis

1. The patient is usually about 50 years old. 2. In the early stage, scapulohumeral periarthritis mostly occurs in one side, and only in fewer cases seen in both sides. It is manifested by shoulder pain, difficulty in movement sometimes involving the upper limb, nomadic pain aggravated at night to the extent that the patient can not fall asleep, or is woken by it.

 3. In the advanced stage, its symptoms are manifested by adhesion of the shoulder joints, marked limitation to their movement, inability for the patient to place his hands behind himself. There are also rigid, tense sensations or atrophy in the muscles of the shoulder and marked tenderness around the shoulder joints. The abduction test is positive. 4. The course is generally within one year, it may be one to two years in some cases.

The real pathogeny

Majority of researcher think that the pathogeny of scapulohumeral periarthritis are inflammation of the articular synovia, the tendons around the joint, the intrinsic ligamentous capsular bands, the paratendinous bursae (especially the subacromial), or the bicipital tendon sheath. Calcareous tendinitis and attritional disease of the rotator cuff, with or without tears, are incidental lesions. If the pathogeny above is true, the spontaneous cure of the patient of scapulohumeral periarthritis will be impossible. The real pathogeny of scapulohumeral periarthritis is the degeneration of cervical spine or cervical spondylopathy.

 cervical spondylopathythe nerve was compressed or stimulated the nerves innervate the muscles the movement of the muscle will be abnormal the position of scapula will be changed movements of the shoulder joint will be limited too the position of scapula changing: Inferior angle of scapula deviate toward outside, Inferior angle of scapula deviate toward medial

Normal of scapula

Treatment
1. Thumb pressing manipulation It can be found the problem in cervical spine with palpation, have the patient sit. The operator stands by the affected side of the patient with the same side elbow holding the patients head, and presses the affected vertebral laminae toward the opposite side, and presses vertical to the origin of the trapezius on occiput and origin of the levator scapula. 2. Grasping and pinching manipulation 3. Lifting manipulation or pulling manipulation 4. Block therapy

Inferior angle of scapula deviate toward outside

presses vertical to the origin of the trapezius on occiput and origin of the levator scapula.

Trapezius muscle
Actions Because the fibers run in different directions, it has a variety of actions, including: scapular elevation (shrugging up or lifting the shoulders) scapular retraction (drawing the shoulder blades toward the midline) scapular depression (pulling the shoulder blades down)

Origin and insertion

It arises from the external occipital protuberance and the medial third of the superior nuchal line of the occipital bone (both in the back of the head), from the ligamentum nuchae, the spinous process of the seventh cervical (both in the back of the neck), and the spinous processes of all the thoracic vertebrae, and from the corresponding portion of the supraspinal ligament (both in the upper back). the superior fibers proceed downward and laterally. They are inserted into the posterior border of the lateral third of the clavicle. the inferior fibers proceed upward and lateralward. They converge near the scapula, and end in an aponeurosis, which glides over the smooth triangular surface on the medial end of the spine, to be inserted into a tubercle at the apex of this smooth triangular surface. the middle fibers proceed horizontally. They are inserted into the medial margin of the acromion, and into the superior lip of the posterior border of the spine of the scapula.

Innervation
The accessory nerve supplies motor fibres to the trapezius muscle (the accessory nerve being purely motor). Sensation including pain and proprioception travel via C3 and C4 ventral rami. The trapezius is not innervated by dorsal rami despite being placed superficially in the back, since it is a muscle of the upper limb.

levator scapulae
Origin and insertion It arises by tendinous slips from the transverse processes of the atlas and axis and from the posterior tubercles of the transverse processes of the third and fourth cervical vertebrae. It is inserted into the vertebral border of the scapula, between the medial angle and the triangular smooth surface at the root of the spine.

Actions and nerves

If the head is fixed, the levator scapul raises the medial angle of the scapula. If the shoulder is fixed, the muscle inclines the neck to the corresponding side and rotates it in the same direction. The levator scapula, along with the trapezius muscle, makes a shrug possible. Nerves The levator scapula are supplied by the third and fourth cervical nerves, and frequently by a branch from the dorsal scapular.

 Inferior angle of scapula deviate toward medial

 Lifting manipulation or pulling manipulation Cervical traction Block therapy

 Lifting manipulation The patient sits with the head bending slightly forward. The assistant stands before the patient to fix the body by pressing shoulders (two assistants are much better). The operator stands behind the patient with knees bending slightly, holds the mandible with crossed hands, makes the chest close to the patients head, and pulls superiorly. (Or meanwhile rotates gently based on the clinic manifestation and X-ray). The cluck sound shows the success of manipulation.

Traction therapy
Traction test should be done before traction treatment. If the traction test is positive, it will be good for patient. Traction can alleviate muscular spasm, enlarge intervertebral spaces and relieve symptoms of compression and stimulation. Usually traction in sitting position with occipitomandibular cloth band is used intermittently. The weight for traction should be from 6 kg to 14 kg, depending on patients weight and degree of endurance. Great attention should be paid to the direction and angle of the traction because they are very important. Once to two times a day, each for 15 minutes.

blocking therapy
5 to 10 millimeters of 1% procaine plus 30 mg prednisolone are used for injection at the intertubercular sulcus and transverse process of C4. Insert the needle then pullback NO BLOOD, then inject liquid to the surface of periost.

 Thanks for attention