Ultrasound Guided Treatment of Scapulohumeral Periarthritis

Case Sharing

Understanding of Case: 

Chronic musculoskeletal pain usually originates from the tension, damage, adhesion or contracture of a local muscle fascia, and then breaks the mechanical balance, resulting in chronic strain pain. If the doctor can identify the originator and release it accurately with a needle knife under the guidance of ultrasound, it can often be cured quickly.

Case Description:

A 54-year-old male patient complained of right shoulder pain and limited activity for 1 year. A year ago, this patient suffered from right shoulder pain after throwing stones. Initially patient ignored the pain and later on applied medicines as a home remedy along with a few exercises using his own limited knowledge. The symptoms were not significantly relieved and gradually aggravated, accompanied by limited shoulder joint activities. When he raised his hand to comb his hair, put on clothes, and stretch his back to touch his spine, the pain was induced and radiated to the outside of his right elbow.

Physical examination: 

Tenderness around the right coracoid process, limited movement of the right shoulder, 80° flexion, 30° extension, 0° external rotation, 45° internal rotation, 60° abduction and 50° adduction. VAS score 6 points.

Ultrasonic examination:

The tendon and aponeurosis of the right rotator cuff are thickened, and no hydrops is found in each bursa. The activity of the right subscapular muscle was extremely poor, and the superficial aponeurosis was thickened; Thickening and contracture of the axillary joint capsule.

Diagnosis and Treatment Ideas

1. The patient is a typical case of periarthritis of the shoulder, and is currently in the freezing stage, with obvious pain and dysfunction.

2. The physical examination found that the external rotation of the shoulder joint was obviously limited, and the tenderness around the coracoid process was obvious. The muscle bone ultrasound scan found that the subscapular aponeurosis was significantly thickened, and the ductility of passive external rotation was poor. It can be confirmed that the subscapular muscle injury is the responsible cause. The adhesion of the Coracobrachial ligament and coracohumeral ligament is also one of the reasons for the limitation of shoulder external rotation.

3. Treatment scheme: release subscapular muscle, coracohumeral ligament and coracohumeral ligament with a needle knife under ultrasound guidance.

The diagnosis was periarthritis of shoulder.

Treatment Process

After two sessions of treatment, the pain of the patient's right shoulder and elbow was significantly relieved, and the pain was relieved during active and passive activities. After the later training of shoulder joint mobility, the right shoulder function basically returned to normal.

Summary:

1. Scapulohumeral periarthritis, also known as adhesive scapuloarthritis, is characterized by shoulder pain and limited movement. The lesions were mainly on the joint capsule, involving the surrounding synovium, fascia, tendon, and bursa. The patient was mainly limited in the function of subscapular muscle, accompanied by radiation pain. After the needle knife release treatment, satisfactory results were achieved.

2. The subscapular muscle is located in the front of the scapula, triangular in shape, starting from the subscapular fossa, the muscle bundle goes up through the front of the scapular joint and ends at the small tubercle of the humerus. The pain on the lateral side of the right elbow joint may occur after the injury of the subscapular muscle. It is considered that the radiation pain is caused by the injury of the subscapular muscle and transmitted along the muscle fascia chain of the upper limb -- the deep line behind the arm. Or can be understood as the pain point of the subscapular muscle.

Subscapularis pain point

3. Because the subscapular muscle is located in the space between the scapula and the thorax, and there are axillary nerves and blood vessels in the tendon, there is a great risk in needle knife treatment. In this case, the tendon and muscle abdomen were released under the guidance of ultrasound, and the needle tip position was displayed in real time, which was accurate, safe and efficient.

4. The reason why periarthritis of the shoulder is lingering and difficult to heal is that the patient is afraid to move the shoulder joint easily because of pain. The patient's shoulder and elbow pain symptoms were significantly relieved after treatment, which provided favorable conditions for the follow-up shoulder joint mobility training.