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各位朋友大家好，现在是“每天健康三分钟”时间，我是安阳道简医院的医生胡军辉，今天给大家讲讲肩周炎为什么会夜间疼痛。

肩周炎俗称“冻结肩”、“五十肩”、“凝肩症”，指肩关节周围的组织发生炎症（关节囊炎），导致周围组织增生增厚，并且与其他组织粘连在一起。许多得了肩周炎的人发现白天肩臂疼，晚上更加痛有的人睡着后疼醒！有的人甚至因持续疼痛而失眠！这是为啥呢？

1.炎症代谢产物-夜晚聚集：肩周炎的疼痛，一方面是由于无菌性炎症的充血和水肿压迫和牵张末梢神经（肌腱和韧带等属于致密组织，轻微的肿胀也会引起牵张反应）引起；

另一方面，炎症的刺激、充血、血流淤滞等使局部炎性产物积聚滞留，这些物质本身即有较强的刺激痛觉神经的效应，引起疼痛。此外，这些炎性产物能直接作用于小血管平滑肌，引起小血管扩张充血，使肿胀和淤滞加重，并且刺激血管壁，使血管壁通透性升高，血浆和白细胞渗出增加，使炎症泛发。当夜晚休息时，骨骼肌处于静息状态，其中小血管平滑肌紧张性较高，血流阻力较大，血流量较白天更少（使体内血液营养集中供应心、脑、肝、肾等重要脏器，以保障其功能活动）。当病变的肩关节炎症区供血量更少时，炎症的代谢产物不能被迅速运走和稀释、分解，在局部越聚浓度越高，对痛觉神经的刺激也越强。同时，由于这些代谢产物的浓度增高，使局部肿胀淤滞越重，牵张压迫也越强烈，所以夜晚时，病变区疼痛会加重。

2.夜晚环境影响小：白天，患者的注意力被工作、学习、人际交往分散了，而夜晚环境的影响小，患者的注意力更容易集中在肩部的疼痛上，因而觉得夜晚的疼痛更明显些。

3.肩关节周围组织长时间受压：夜晚睡眠时，患者的姿势固定，肩关节囊或其他肩关节周围组织可能长时间受压或牵拉，因而产生疼痛。

最后祝大家生活愉快，身体健康！了解更多心血管科普知识，请关注我们，咱们下期见。

【英文版】

Why does shoulder periarthritis patient meet nocturnal ache

Dear friends, nice to meet you!Now it is time for “Health talk for three minutes every day”,I'm Hu Junhui, a doctor from Anyang Daojian hospital.Today I will mainly share why does shoulder periarthritis patient meet nocturnal ache.

Scapulohumeral periarthritis, commonly known as "frozen shoulder", "Fifty shoulder" and "frozen shoulder syndrome", refers to the inflammation of the tissues around the shoulder joint (arthritis), leading to the proliferation and thickening of surrounding tissues and adhesion with other tissues.Many people with scapulohumeral periarthritis find that they have shoulder and arm pain during the day, and the pain is more severe at night than during the day. Some people will wake up from the pain after sleeping! Some people even suffer from persistent pain and insomnia!

Why is this?

First, accumulation of inflammatory metabolites at night: pain of scapulohumeral periarthritis, on the one hand, is caused by congestion and edema of aseptic inflammation, compression and stretch of peripheral nerves

On the other hand, the stimulation of inflammation, hyperemia, blood stasis and so on make the local inflammatory products accumulate and stay. These substances themselves have a strong effect of stimulating pain nerves and causing pain. In addition, these inflammatory products can directly act on the smooth muscle of small blood vessels, causing dilation and congestion of small blood vessels, aggravating swelling and stasis, and stimulating the vascular wall, increasing the permeability of vascular wall, increasing the exudation of plasma and white blood cells, making the inflammation widespread.

When resting at night, skeletal muscle is in a resting state, in which small vascular smooth muscle tension is higher, blood flow resistance is greater, blood flow is less than in the day (blood nutrition in the body is concentrated to supply the heart, brain, liver, kidney and other important organs to ensure their functional activities).

When the blood supply of the inflammatory area of the shoulder joint is less, the inflammatory metabolites can not be transported away, diluted and decomposed quickly.The higher the concentration in the local area,the stronger the stimulation to the pain nerve.At the same time, as the concentration of these metabolites increases,the more severe the local swelling and stasis,the stronger the tension and compression,so the pain in the lesion area will be aggravated at night.

Second, the influence of night environment on patients is small:during the day, patients' attention is distracted by work, study and interpersonal communication, while the influence of night environment on patients is small.Patients' attention is more likely to focus on shoulder pain, so they feel that the pain at night is more obvious.

Third, long time compression of tissues around the shoulder joint: when sleeping at night, the patient's posture is fixed, and the shoulder joint capsule or other tissues around the shoulder joint may be compressed or stretched for a long time, resulting in pain.

Finally, I wish you all a happy life and good health! To learn more knowledge about cardiovascular disease, please pay attention to us.See you next time.