Wang Xiaoning, 50, is a white-collar worker in an enterprise. He is usually busy with his work and likes to play play badminton in his spare time. In recent months, his right shoulder has gradually developed dull pain. At first, he thought it was muscle fatigue after exercise and did not pay attention. However, the symptoms are worsening day by day, with difficulty raising the arms when dressing, feeling as if the shoulders are "stuck" when washing hair, and even waking up from the pain when turning over at night. Mr. Wang thinks he may have frozen shoulder, after all, several of his friends around him have similar problems. He endured the pain, tried hot compress and massage, but the situation did not improve, and even felt the strength in his shoulders weakening. Finally, he came to the hospital for treatment. After a careful examination, the doctor told him, 'Your condition is not like frozen shoulder, it's more likely to be a ruptured rotator cuff.' What is the problem with a ruptured rotator cuff? In fact, although both are 'shoulder pain', the treatment is very different. The wear and tear of the crane, coupled with two major damages, first comes the structure of the shoulder joint. The shoulder joint can be regarded as one of the most flexible joints in the human body, and can be called the most flexible "robotic arm" in the human body. It is mainly composed of bones, muscles, and ligaments. The shoulder joint is like a 'crane', and the scapula and humeral head are like the steel arm of the crane, responsible for supporting the body; Muscles and ligaments are like 'conveyor belts', responsible for pulling and lifting the steel boom. The muscles and ligaments around the shoulder joint constitute the "rotator cuff" of the shoulder joint. The rotator cuff of the human body is a very precise structure, mainly composed of the subscapularis muscle, supraspinatus muscle, infraspinatus muscle, and teres minor muscle. These four groups of muscles tightly wrap around the humeral head, allowing the shoulder joint to flexibly lift up and down and move back and forth. However, the "crane" of the shoulder joint cannot maintain vitality forever. As people age, this "crane" will wear and age, and the two most common diseases are frozen shoulder and rotator cuff injury. The two are both related and different. Shoulder periarthritis, also known as "frozen shoulder" or "adhesive shoulder joint capsule inflammation", commonly known as "fifty shoulder", is more common in people around the age of fifty. This is a complex chronic inflammatory disease, which is related to various factors such as age, chronic strain injury, trauma, braking, and systemic diseases. Shoulder periarthritis is like a lack of "oil" in the bearings of a crane. As chronic inflammation in the shoulder joint worsens, the joint capsule thickens and adheres, limiting the movement of the shoulder joint, accompanied by joint pain and discomfort after movement. The causes of rotator cuff rupture can be classified into two categories: "acute trauma" and "chronic strain injury". Acute trauma includes direct impact of the shoulder on the ground during a fall, strong pulling during exercise, or sudden violent impact, which may result in instantaneous tendon rupture. Chronic strain injury is common in occupational or sports populations that require frequent "excessive movements", such as swimmers, badminton enthusiasts, and those who work with household chores for a long time. The rotator cuff tendons gradually wear out in long-term repeated friction and eventually rupture beyond the compensatory limit. This process can be vividly understood as the failure mechanism of the crane transmission belt. Whether it is sudden external impact or years of mechanical wear and tear, it can cause cracks or even fractures in the rotator cuff tendon of the "transmission belt", leading to chain reactions such as shoulder joint pain, limited mobility, and decreased strength. Distinguish between two types of pain and treat them accordingly. The typical symptoms of shoulder periarthritis are persistent shoulder pain and limited mobility. This type of shoulder pain is usually persistent dull pain, which may worsen at night and seriously affect sleep quality. This type of pain is diffuse and may radiate to the upper arm but not beyond the elbow joint. Limited mobility is manifested as restricted shoulder movement in multiple directions. For example, it is difficult to raise hands above the head and back, and hands cannot reach the opposite scapula. Many patients' shoulders gradually become frozen, making it difficult for them to perform daily movements. As the condition progresses, the shoulder muscles may also atrophy. The pain of rotator cuff rupture is more "specific", for example, when the arm is abducted or raised to 60 to 120 degrees, the pain will significantly intensify, but may ease again beyond this angle, forming a so-called "pain arc". In addition, patients with rotator cuff rupture often feel weak in the shoulders, especially during abduction and external rotation, and even movements such as holding bowls and twisting towels become difficult. Unlike shoulder periarthritis, the initial restriction of movement in rotator cuff rupture may not be significant, but as the condition progresses, the restriction of movement will gradually worsen. Shoulder rotator cuff injury and shoulder periarthritis sometimes have similar pain, so a professional physical examination and imaging examination by a doctor are needed. For example, in terms of physical examination, patients with shoulder periarthritis generally have limited shoulder mobility and will experience pain no matter which direction they move. Patients with rotator cuff rupture may experience significant weakness or severe pain during special physical examinations related to the rotator cuff, such as empty cup tests and arm drop tests. Imaging is also an important means of distinguishing between the two. Regarding shoulder periarthritis, joint imaging used to be the "gold standard" for its diagnosis, but is now being replaced by non-invasive MRI and ultrasound examinations. However, joint imaging still has special value in evaluating changes in shoulder joint capsule volume for the diagnosis of shoulder periarthritis. For example, normal shoulder joint capsule volume is about 28 milliliters to 35 milliliters, while frozen shoulder patients can only inject 5 milliliters to 10 milliliters of contrast agent. MRI of shoulder periarthritis may show thickening of the joint capsule, fluid accumulation, tissue adhesion, etc. For rotator cuff injuries, ordinary X-ray imaging has limited diagnostic value for rotator cuff injuries, but can exclude skeletal structural abnormalities; Ultrasound examination has become the preferred screening method, which can dynamically observe the sliding of tendons with an accuracy rate of over 85%. Of course, MRI can clearly display the location and degree of tendon tear, and has irreplaceable value in the diagnosis of rotator cuff injury. The purpose of differentiation is to promote different treatment plans in the future. The treatment of shoulder periarthritis is mainly conservative, and the key is to "move up" and gradually restore the range of motion of the shoulder joint. In the early stages, pain can be relieved through rest, hot compress, physical therapy, and other rehabilitation exercises such as climbing walls and holding hands behind the body to avoid joint adhesions. Some patients require manual release of the shoulder joint under anesthesia or arthroscopic shoulder joint clearance to restore normal function. The treatment of rotator cuff rupture needs to be determined based on the degree of rupture and the specific condition of the patient. If it is a mild tear, conservative treatment such as rest, physical therapy, and medication can be attempted first. But if it is a severe tear, especially when it affects daily activities, surgical repair is often required, such as minimally invasive arthroscopic rotator cuff repair surgery. After the surgery, systematic rehabilitation training is also needed to help restore shoulder function. It can be seen that the goals of the two treatment strategies are very different. Distinguishing which type of situation it is can help implement appropriate treatment plans, rather than adopting "completely opposite" plans or delaying the best intervention expectations. Readers should not forget to pay more attention to the use and protection of their shoulders while distinguishing between the two types of pain. (New Society)