Shoulder Pain

Record of first visit: 12/09/08

Name:

Gender: Male

Date of Birth: 01/06/61

Chief complains: Shoulder Pain

Descriptions

A: Asking

Present illness complains: He got shoulder pain from his job 4 years ago. He needed to carry the heavy thing on both shoulder at that time. Also, he often use computer in that period. Now, he felt heaviness, sore and stabbing pain on both shoulders. The pain radiates from “jianJing to JianLiao, to TianZong. Left shoulder has limited movement. The uncomfort feeling reduced after massage and hot compression, and aggravated in cold and damp weather, or after using computer. He has no chill and fever and sweating. He has normal defecation, urination. Generally, he has good appetite and prefer taste of sweet and cold drink.

Past History: NAD

Lifestyle: Retired and relaxed life

Family history: NAD

B:Inspection

General: 8/10 vitality

Others: the tendon around the medial border of the left shoulder is enlarged and swollen

Tongue: Dim color, less and dry coating, with crack on the central, teeth mark on the edge of tongue

C:Auscultation/olfacation

Sound: NAD

Odours: NAD

D: Palpation

Body aears: NDA

Pulse: slippery

Case Summery

WS:

Definition: Frozen shoulder, or adhesive capsulitis, is a condition that creates pain and stiffness in the shoulder joint — severely limiting your ability to move your shoulder normally.

Cause: Frozen shoulder may be the result of inflammation after a shoulder injury or shoulder surgery. In most cases, however, frozen shoulder develops for no apparent reason in individuals over age 40. It's also more likely to appear in women.

Symptoms:

Phase one - the 'freezing', painful phase. This typically lasts 2-9 months. The first symptom is usually pain. Stiffness and limitation in movement then also gradually build up. The pain is typically worse at night, and when lying on the affected side.

Phase two - the 'frozen', stiff phase. This typically lasts 4-12 months. Pain gradually eases but stiffness and limitation in movement remain and can get worse. All movements of the shoulder are affected but the movement most severely affected is usually rotation of the arm outwards. The muscles around the shoulder may waste a bit as they are not used.

Phase three - the 'thawing', recovery phase. This typically lasts 5-24 months. The stiffness gradually goes and movement gradually returns to normal, or near normal

Treatment: It includes Anti-inflammatory painkillers, Ordinary painkillers, Shoulder exercises, Physiotherapy…

A steroid injection ,which brings good relief of symptoms for several weeks in some cases. Steroids reduce inflammation.

Surgery, an operation is sometimes considered if other treatments do not help. Techniques that are used include:

.Manipulation. This is a procedure where the shoulder is moved around by the surgeon while patients are under anaesthetic..Arthroscopic capsular release. In this procedure the tight capsule of the joint is released with a special probe.

TCM:
Aetiology and Pathology

Bi syndrome cause chronic pain, especially it is characterised as throbbing or stabbing, is a sign of Qi and Blood Stagnation. It occurs due to Blood deficiency. Blood nourishes Qi and Qi moves Blood, so when blood is deficient, stagnation of Blood will occur. Qi and Blood Stagnation can in turn be related to weakness of the Liver, Kidney, Spleen and Heart, which in turn can be caused by emotional stress, over strain, lack of adequate sleep and nutrition, and disturbed body rhythm. In some situations Bi syndrome can be triggered by invasion of the channel system by pathogenic Wind, Cold, Damp and/or Heat, known as Bi syndrome. Bi syndrome is usually a chronic disorder, but may be acute or have occasional flare-ups brought on by current pathogenic invasion. In chronic situations, a situation where Pathogenic Wind Cold or Wind Heat enters the body without causing immediate symptoms. It then incubates in the body for some time, emerging later towards the Exterior and giving rise to tiredness, weakness, muscle and joint pain and sleeplessness.

Differentiation of Patterns of Disharmony

The following patterns could apply to a patient with bi syndrome, either singly or in combination:

Deficiency Patterns

-Deficient Spleen leading to Deficiency of Qi and Blood

Fundamental to the replenishment of Qi and Blood is the Spleen’s functions of transforming food, producing Blood and nourishing the tissues. When Spleen is deficient, Qi and Blood will be deficient.

-Deficient Yin of Kidney and Liver

When Kidney and Liver Yin are deficient, empty Heat will rise causing headache, anxiety, insomnia, muscular weakness and low back pain.

-Deficient Liver Blood

When Liver Blood is deficient, there will be mental restlessness, muscular weakness,spasms and cramps.

-Deficient Yang of Kidney and Spleen

When Yang is deficient there will be cold and obstruction. Deficient Spleen Yang will lead to deficiency of Qi and there will be breathlessness, tiredness,lack of appetite and oedema. Deficient Kidney Yang will lead to low sexual vitality, low back pain, oedema and lassitude.

Excess Patterns:

Stagnation of Qi and Blood

When Blood is deficient it will fail to nourish Qi and Qi will fail to move Blood. Thus Qi and Blood will stagnate, causing localised obstruction and sharp, stabbing or throbbing pain.

Invasion by Pathogenic Wind

When Wei Qi is deficient Pathogenic Wind can enter the channels and lodge in the muscles and skin. Wind patterns are characterised by numbness, spasms, convulsions, dizziness or pain that consistently changes in intensity and location. Wind tends to effect the upper part of the body, particularly the head, neck and face, as well as the outermost parts of the body, such as the skin and the muscles. Wind can combine with Cold, Heat and Damp, potentiating their effects and enabling them to invade the body more easily.

Shao Yang Syndrome

When the Pathogenic Factor remains lodged between the Exterior and the Interior the person will be subject to alternating chills and fevers, sore throat, muscle and joint pain and irritability.

Latent Pathogenic Factor

When a person’s vitality is low at the time of invasion of Pathogenic Wind, the pathogen may be driven to the Interior, usually as Heat or Damp Heat, where it will weaken Qi and/or Yin. In this condition the person is predisposed to further invasion of exterior pathogens, leading to a cycle of invasion and deficiency.

Comprehensive patient resources are available at www.patient.co.uk

Diagnosis

A, Diagnosis: Frozen Shoulder

B, Syndrome Differentiation: Qi and blood stagnation underline spleen deficiency

C, Explanation: Patient’s shoulder got injury 4 years ago, it causes local qi and blood stagnation. Also, the dim color tongue and slippery pulse show qi and blood stagnation. Shoulder stabbing pain shows the local blood and qi stagnation. The teeth mark and preferring the taste of sweet shows the spleen

deficiency, and the deficiency of spleen cause dampness retention, which cause the heaviness on the shoulder.

Treatment:

A, Principles: promote qi and blood circulation, and tonify the spleen

B, Methods:

Needling: Local, JianYu,Jianjing,JingbaiLao, a shi points

Distal: Zu San Li, YinLinQuan

Explanation: JianYu,Jianjing,JingbaiLao, a shi points , promote local qi and blood circulation; Zu San Li and YinLinQuan can tonify the spleen and reduce the dampness.

Life Style Advice: Avoid cold and sweet food, eat herb like, ShanYao, QianShi…exercise shoulder, “climbing up” , keep body warm and use hot compression on shoulder…