Periarthritis of the shoulder is a chronic, degenerative, and inflammatory condition affecting the shoulder joint capsule and the surrounding soft tissues. This condition most commonly occurs in people around the age of 50 and is more prevalent in women. It is also known as “senile shoulder” or “frozen shoulder.” The condition is often caused by trauma, exposure to cold, and chronic overuse. Consequently, in Traditional Chinese Medicine, it is also referred to as “shoulder stiffness,” “leaking shoulder wind,” or “frozen shoulder.”
I. Clinical Manifestations
Pain gradually develops in one or both shoulders—manifesting as aching, dull pain, or a stabbing sensation. The pain worsens at night or during shoulder movement. Active and passive range of motion in all directions is restricted, with the most pronounced limitations in abduction, external rotation, elevation, and extension. In long-standing cases, shoulder muscle atrophy may occur, and there may be one or two tender points in the shoulder, such as beneath the acromion or in the anterior shoulder region.
II. Differential Diagnosis and Treatment
Early Stage
(1) Primary Symptoms: Aching or stabbing pain in the shoulder; stiffness and discomfort in the affected limb; or numbness in the fingers. These symptoms are often related to changes in weather and physical exertion.
(2) Treatment Principles: Warm the meridians and dispel cold; unblock the collaterals and relieve pain.
(3) Chinese Herbal Formula: Modified Juanbi Decoction. Add herbs according to symptoms: For aversion to cold and cold limbs, add Cinnamomum twig (Gui Zhi) and Asarum (Xi Xin); for severe pain, add processed Frankincense (Zhi Ru Xiang) and Myrrh (Mo Yao); for wandering pain, add Gentiana (Qin Jiao), Pueraria root (Ge Gen), and Mulberry twig (Sang Zhi), etc.
Middle Stage
(1) Main Symptoms: In cases with a prolonged course of illness, there is soreness, distension, and stabbing pain in the shoulder and neck, along with limited range of motion in the shoulder joint.
(2) Treatment Principle: Relax the tendons, activate the meridians, remove blood stasis, and relieve pain.
(3) Chinese Herbal Prescription: Huoxue Shujin Decoction with modifications.
Late Stage
(1) Main Symptoms: Worsening dull pain in the shoulder, muscle atrophy, and marked limitation of movement in the affected limb, particularly in upward elevation, abduction, and extension. May present as “frozen shoulder”—stiffness of the shoulder joint. Some patients may also experience dizziness, vertigo, insomnia, and vivid dreams.
(2) Treatment Principles: Tonify the liver and kidneys; relax the tendons and activate the meridians.
(3) Chinese Herbal Prescription: Modified Bu Shen Huo Xue Decoction. Mulberry twigs (Sangzhi), sliced turmeric (Pian Jianghuang), and cinnamon twigs (Gui Zhi) may be added to the formula to enhance its efficacy in unblocking the meridians and relieving pain.
III. Other Therapies for Periarthritis of the Shoulder
Acupuncture Therapy: Primary acupoints: Jianyu, Jianzhen, Binao, and Tiaokou; auxiliary acupoints: for pain on the inner side of the shoulder, add Chize, Taiyuan, and Yinlingquan; for pain on the outer side of the shoulder and in the scapular region, add Houxi and Tianzong; for pain on the front of the shoulder, add Hegu, Quchi, and Zusanli. Use fine needles with a dispersing technique, retain the needles for 30 minutes, once daily.
Electroacupuncture Therapy: This involves the use of an electroacupuncture device for treatment, yielding better results than standard body acupuncture alone. The acupoint selection is the same as for body acupuncture therapy. Administer once daily for 30 minutes per session.
Electro-pulse Stimulation Therapy: This method uses a multi-functional therapy device to treat diseases through electrical pulse stimulation of acupoints, based on the theories of Traditional Chinese Medicine’s meridian system. The acupoints are the same as those used in manual acupuncture, with each session lasting 30–45 minutes. This therapy has analgesic, anti-inflammatory, antispasmodic, and sedative effects, and helps regulate cerebral cortex function. It can treat a wide range of conditions and is particularly effective for disorders of the nervous and musculoskeletal systems, such as trigeminal neuralgia, neurogenic headaches, sciatica, peripheral facial nerve palsy, paralysis, enuresis, soft tissue strains, rheumatic and rheumatoid arthritis, tenosynovitis, and cervical spondylosis.
Auricular Acupuncture: This method involves treating diseases by applying acupuncture, bloodletting, or pressure to acupoints on the ear. It is simple and convenient, yielding good results for a wide range of conditions. For frozen shoulder, this method involves strong stimulation of acupoints such as the Shoulder, Shoulder Joint, Clavicle, Adrenal Gland, and Shenmen, treating 2–3 acupoints per session, once daily.
Treatment with a Field Effect Therapy Device: This method utilizes a safe, low-voltage 50 Hz alternating current to generate an alternating electromagnetic field within a special coil. The thermal effect of the coil produces a far-infrared radiation field with a wavelength of 8–16 micrometers, which is applied to the affected area of the body. It helps unblock meridians, warm the meridians and dispel cold, relieve spasms and reduce swelling, and reduce inflammation and relieve pain. It can treat a variety of common and chronic conditions, such as rheumatoid arthritis, frozen shoulder, lumbar muscle strain, sciatica, gastric disorders, adnexitis, dysmenorrhea, and sprains and strains of bones, joints, and muscles.
Massage and Tuina Techniques: Knead and tap the “Shoulder Well” (Jianjing) acupoint 30 times each; knead the “Shoulder Ridge” (Jianyu) and “Inner Shoulder Shu” (Jianneishu) acupoints 50 times each; grasp and knead the pectoral muscles 20 times; and press and knead the “Bend of the Elbow” (Quchi), “Hand Three Miles” (Shousanli), “Outer Pass” (Waiguan), and “Union Valley” (Hegu) acupoints 30 times each; combine these with shoulder joint exercises including elevation, forward flexion, backward extension, abduction, and circular rotation.
Based on the author’s more than 30 years of clinical experience and the varying manifestations of patients’ conditions, applying one or more of the above methods can yield significant results within a short period.