Outline:
Scapulohumeral periarthritis is a chronic nonspecific inflammation occurring in the articular capsule of shoulder joint and the ligament, muscular 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. A pain gradually develops in the shoulder, which is sore, vague or stabbing in nature. In the case of sudden onset, the pain is severe and usually radiates to the upper arm and elbow. Or the pain worsens at night.
 
3. There are many points of tenderness around the shoulder. Both active and passive movements of the shoulder joint are limited, which is especially serious in abduction, extorsion and elevation movement. The patient with a long course suffers from muscular atrophy, particularly in the deltoid muscle.

4. The course is generally within one year, it may be one to two years in some cases.

Treatment
The scapulohumeral periarthritis is marked by a long duration and a slow effect. Therefore, the patient should have confidence and cooperate with the doctor during the treatment, strengthen functional exercises so as to enhance the effects.

Tendon-smoothing manipulation:
The patient sits erectly. The operator first massages the anterior, posterior and lateral regions of the shoulder for 5 or 6 minutes. Then, he holds the deltoid muscle with his thumb and index-and-middle fingers of right hand in opposition, plucking it perpendicularly to the course of the muscle bundle for 5 to 6 times, and then plucking the supraspinous muscle and muscles of thorax around the pain loci respectively for 5 or 6 times. Holding the shoulder with his left hand and grasping the hand with his right hand, he applies pulling, shaking and rotating manipulations on the shoulder joint. Finally, he helps the patient to practice movements of abduction, adduction, anteflexion and postextesion.
 
In performing the above manipulations, pain to different extents may result. Take care that the force should be moderate so that the patient could stand it. Once every other day, 10 times make up a course of treatment.

Herbal therapy  
Internal treatment based on syndrome differentiation  

(1) Syndrome of blockage by pathogenic wind-cold  
Main symptoms and signs:
There is shoulder pain with slight impairment of the shoulder joint in movement, aversion to wind and cold; the pain is aggravated by invasion of wind and cold, but alleviated by warmth; pale tongue with thin and white coating, floating-tense or stringy pulse. This is often seen at the early stage of scapulo-humeral periarthritis.

Therapeutic methods:
Expelling wind and cold, relaxing tendons and activating collaterals.

Recipe and herbs:
Modified Sanbi Decoction. Specifically, Duhuo ( Radix Angelicae Pubescentis )10 g, Fangfeng ( Radix Ledebouriellae Divaricatae )10 g, Chuanxiong (Rhizoma Ligustici Chuanxiong)10 g, Niuxi ( Radix Achyranthis Bidentatae )10 g, Chishaoyao (Radix Paeoniae )10 g, Qinjiao (Radix Gentianae Macrophyllae )12 g, Danggui (Radix Angelicae Sinensis )12 g, Fuling ( Poriae )12 g, Xuduan ( Radix Dipsaci )12 g, Shengdihuang ( Radix Rehmanniae )15 g, Xixin (Herba Asari)3 g and Gancao ( Radix Glycyrrhizae )3g.

(2) Syndrome of qi and blood stagnation  
Main symptoms and signs:
Pain or swelling in the shoulder, which worsens at night, diminished movement of the shoulder joint, ecchymoses on the tongue with white or thin-yellow coating, stringy or thready-choppy pulse. This is often seen in the early and middle stages of scapulohumeral periarthritis.

Therapeutic methods:
Promoting blood flow to remove the stasis, activating qi flow to stop pain.

Recipe and herbs:
Modified Shentong Zhuyu Decoction. Specifically, Danggui (Radix Angelicae Sinensis)15 g, Qinjiao (Radix Gentianae Macrophyllae)10 g, Chuanxiong (Rhizoma Ligustici Chuanxiong)10 g, Qianghuo ( Rhizoma seu Radix Notopterygii )10 g, Moyao (Myrrha)10 g, Wulingzhi (Excremebtum Trogopteri )10g, Xiangfu ( Rhizoma Cyperi Rotundi )10 g, Niuxi ( Radix Achyranthis Bidentatae )10g,Dilong (Lumbricus)10 g, Honghua ( Flos Carthmi )6 g, and Gancao (Radix Glycyrrhizae)3 g.
 
(3) Syndrome of qi and blood deficiency  
Main symptoms and signs:
Aching pain in the shoulder aggravated on exertion, impaired movement of shoulder joint, or accompanying muscular atrophy, pale tongue with white coating, thready-week or deep pulse. This is often seen at the late stage of scapulo-humeral periarthritis.

Therapeutic methods:
Replenishing qi and blood, relaxing tendons and activating collaterals.

Recipe and herbs:
Modified Bazhen Decoction. Specifically, Dangshen ( Radix Codonopsitis Pilosulae )10 g, Baizhu ( Rhizoma Atractylodis Macrocephalae )10 g, Fuling ( Poriae )10 g, Danggui ( Radix Angelicae Sinensis)10 g, Shudihuang (Radix Rehmanniae Praeparata )12 g, Baishaoyao (Radix Paeoniae Atba )10 g, Jixueteng ( Caulis Spatholobi)12 g, Chuanxiong (Rhizoma Ligustici Chuanxiong )6 g, Guizhi ( Ramulus Cinnamomi Cassiae )6 g, Gancao ( Radix Glycyrrhizae)5 g, Shengjiang (Rhizoma Zingiberis Recens ) 3 pieces, and Dazao (Fructus Ziziphi Jujube) 2 pieces.

External therapy:   
Haitongpi Decoction may be chosen for fumigating and washing; or Goupi Plaster or Tianhe Gutong Plaster is externally applied; orhot compress with Kanli Sands is chosen.

Functional exercise:    
The patient with scapulohumeral periarthritis at the non-acute stage should be asked to do active functional exercises on the shoulder joint. Under the supervision of a doctor, he practices abduction, extorsion, retroextension and elevation movements, which should be done from small to large in range step by step. The exercise can be aided by hand pulling a pulley or fingers climbing wall movement to enlarge the range of the shoulder joint movement. The exercise is done two or three times a day, each for 5 to 10 minutes. The patient should be encouraged not to be afraid of pain, and the exercise should not be given up because of pain. But for a few patients at their acute stage of inflammation, the exercise should be suspended.

Acupuncture therapy:     
Acupoints: Jianyu (LI 15), Jianliao (TE 14), Binao (LI 14), Jugu (LI 16), Quchi (LI 11), or "painful spots", retain the needles for 20 minutes; or added by moxibustion, once a day.

Hydro-acupuncture therapy:
Two to four milliliters of 1% procaine plus 12.5 mg prednisolone are used for point-injection respectively in anterior, lateral and posterior painful points of the shoulder, 1 to 2 ml for each point, once a week, two or three times make a course. Danggui Injection or Danshen Injection may also be chosen for point-injection, once every other day.