五十肩　四十肩

The symptoms of age-related shoulder pain

加齢変性に伴い肩の関節が拘縮したりして、今まで通りに肩が動かなくなる症状を、四十肩・五十肩、医学的には肩関節周囲炎と言います。40～50代に多く見られる症状で、肩を動かしたときに痛みが生じたり、腕を後ろに回せなかったり、肩が上げられないなどの症状が特徴です。肩こりと似ていますが、肩こりは筋肉の緊張や拘縮、硬結が原因です。四十肩、五十肩は、腱板が炎症を起こして関節包に広がる症状なので原因が異なります。肩こりは、若い人でもなりますが、四十肩、五十肩は、加齢変性が主で、老化に伴い筋肉や腱の柔軟性が失われることが原因とされています。原因としては、四十肩・五十肩は、肩甲骨と上腕骨を繋いでいる肩関節の筋や腱が損傷し、痛みが生じます。特徴的な症状は、肩がズキズキと痛む、腕が上がらない、後方に腕が回らない、寝ていると痛くて目が覚める（夜間痛）、洋服の袖に手を通すときや、高い場所の物を取る時など手を伸ばしたときにも痛みが誘発されます。四十肩・五十肩のほかには、腱板損傷や石灰沈着性腱板炎、上腕骨二頭筋長頭炎などがあります。四十肩、五十肩と、併発してこれらの症状が起こることもあります。鍼灸接骨院としての治療は、鍼や灸で炎症を抑えて痛みを緩和させていきます。患部を温めて血行を改善させると痛みが和らぎます。患部が拘縮し、腕が上がらない、肩関節の可動域が制限されている場合は、疼痛が治まった時点で、無理のない範囲に動かし、症状を緩和をしていきます。就寝時、仰向けで寝ているときは、肩関節が体幹より下がるため、肩関節に負荷がかかります。日中起きているときよりも就寝時に痛みが現れる（夜間痛）のは、これも原因のひとつです。この場合は、肩関節の下に、タオルを畳んでいれたりして肩への負担を減らします。疼痛緩和の兆しがみえたら、徐々に可動域訓練などで、肩関節の柔軟性を回復させていきます。痛みの初期の段階で、痛いからと、何の治療もしないで放置して過ごしていると徐々に肩は動かなくなることがあります（フローズンショルダー・凍結肩）。鍼灸治療では、肩関節への負担軽減・血行促進・筋肉の緊張緩和などのアプローチをしていきます。

The symptoms of age-related degenerative changes, such as contractures of the shoulder joints, which prevent the shoulder from moving as it has in the past, are referred to as 40- and 50-year-old shoulders, or medically as periarthritis. 40- and 50-year-olds are most commonly affected, and symptoms include pain when moving the shoulder, inability to rotate the arm back, and inability to lift the shoulder. It is similar to stiff shoulders, but stiff shoulders are caused by muscle tension, contracture, and rigidity. Forty and fifty shoulders have different causes because they are symptoms of inflammation of the rotator cuff and spread to the joint capsule. Stiff shoulders can occur even in younger people, but forty and fifty shoulders are primarily due to age-related degeneration, which is caused by the loss of flexibility of muscles and tendons as they age. As a cause, the muscles and tendons of the shoulder joint connecting the shoulder blade to the humerus are damaged, resulting in pain in the forty and fifty shoulder. Characteristic symptoms include throbbing pain in the shoulder, inability to raise the arm, inability to rotate the arm backward, waking up with pain when sleeping (nocturnal pain), and pain that is also induced when reaching up to put your hand through a sleeve of clothing or to pick up an object from a high place. In addition to the 40- and 50-shoulder conditions, there are also rotator cuff injuries, calcific rotator cuff tendinitis, and long head of biceps brachii. These symptoms may occur concurrently with the 40- and 50-shoulder conditions. Treatment as an acupuncture and moxibustion clinic uses acupuncture and moxibustion to reduce inflammation and relieve pain. Warming the affected area to improve blood circulation will relieve pain. If the affected area is contractured and the arm cannot be raised or the range of motion of the shoulder joint is restricted, the patient can be moved to a comfortable range of motion once the pain subsides to relieve symptoms. When sleeping on one's back, the shoulder joint is lower than the trunk, which places a greater load on the shoulder joint. This is one of the reasons why pain appears more frequently at bedtime than when awake during the day (nocturnal pain). In this case, fold a towel under the shoulder joint to reduce the load on the shoulder. After signs of pain relief are seen, the flexibility of the shoulder joint is gradually restored through range-of-motion exercises. In the early stages of pain, if the shoulder is left untreated because of pain, it may gradually become immobile (frozen shoulder). Acupuncture treatment will take the approach of reducing stress on the shoulder joint, promoting blood circulation, and relieving muscle tension.