Frozen shoulder

Frozen Shoulder: Description

Frozen Shoulder is a disease of the shoulder joint capsule and very often the cause of shoulder pain and stiff shoulders. It is also referred to as adhesive capsulitis – a shoulder capsule inflammation associated with adhesions and adhesions. Further names for this disease are humerocapsulitis adhaesiva, fibrous stiffened shoulder or fibrosa capsulitis.

In addition, the Frozen Shoulder (as “Periarthorpathia humeroscapularis ankylosans”) also falls under the collective term periarthritis humeroscapularis or periarthropathia humeroscapularis (PHS) – a group of degenerative diseases in the shoulder area, which are associated with a usually painful movement restriction of the joint.

The Frozen Shoulder occurs mainly between the ages of 40 and 60 years, with women being affected more frequently than men.

Primary and secondary shoulder stiffness

Physicians distinguish between a primary and a secondary form of Frozen Shoulder:

• Primary (idiopathic) Frozen Shoulder: independent disease that can not be attributed to any existing underlying disease. Most widely used.
• Secondary Frozen Shoulder: Result of other illnesses, injuries or operations in the shoulder area. Less common than the primary frozen shoulder.

Frozen Shoulder: Symptoms

The Frozen Shoulder often runs in phases characterized by different symptoms:

Phase 1 – Freezing Shoulder

The disease usually begins with sudden, severe shoulder pain, which are initially movement-dependent. Gradually, they develop into constant pain, which also occurs in peace – especially at night, they are noticeable.

The pain is triggered by an unspecific inflammation of the synovial mucosa (synovitis) and the capsule structures. As a result of this inflammation, adhesions and adhesions form in the joint and the joint capsule shrinks. This increasingly affects the mobility of the shoulder. This phase of “freezing” the shoulder generally lasts about four months.

Phase 2 – Frozen Shoulder

The second phase of Frozen Shoulder generally runs from the 4th to the 8th month. Pain occurs only at the beginning. The main symptom is now the stiff shoulder – the movement restriction of the joint reaches its peak.

Phase 3 – “Thawing Shoulder”

In many cases Frozen Shoulder begins to “thaw” slowly from about the 8th month. The sufferers are barely in pain, the shoulder slowly loses its stiffness. It can take months or years until the shoulder is fully mobile again. In general, this is only possible with the right therapy.

The times for the duration of the individual phases are only general. In individual cases, the phases can last differently long. There are also patients in whom Frozen Shoulder’s disease process continues for more than ten years. In some cases, the healing process is completely over.

Frozen Shoulder: causes and risk factors

The cause of the primary frozen shoulder is unknown.

Possible causes of secondary shoulder stiffness are:

• Injuries or diseases in the shoulder area such as a rupture of the rotator cuff (rotator cuff tear) or a painful entrapment of tendons or muscles in the shoulder joint (impingement syndrome)
• Operations in the shoulder area
• neurological causes such as a peripheral nerve disease, Parkinson’s disease or irritation / damage of nerve roots (radiculopathy)
• Metabolic diseases such as diabetes mellitus, Addison’s disease (disease of the adrenal cortex) or thyroid disease

A Frozen Shoulder also occasionally develops in patients taking sedatives from the group of barbiturates or psychotropic drugs (remedies for mental illness).

Frozen Shoulder: examinations and diagnosis

The first point of contact for suspected Frozen Shoulder and other shoulder pain is the family doctor. He can refer you to an orthopedist or shoulder specialist.

The doctor first asks you in detail about your complaints and your medical history (anamnesis). Possible questions are:

• Since when do you have shoulder pain?
• Are you often aroused by the pain at night?
• Did you have an accident, injury or shoulder surgery?
• What do you do for a living?

In the next step, the physical examination follows, whereby the doctor checks, among other things, the mobility of the shoulder.

X-ray examination of the shoulder does not give a specific result with a Frozen Shoulder. That is, the underlying changes of the disease are not visible in an X-ray. Nevertheless, the recording is useful to exclude other causes of shoulder pain such as a bone fracture, calcification or osteoarthritis.

Using ultrasound and magnetic resonance imaging (MRI), the physician can more accurately assess various structures in the shoulder joint (such as thickened ligaments or capsule portions), which can help diagnose Frozen Shoulder.

Frozen Shoulder: Treatment

Frozen shoulder therapy focuses on conservative (non-operative) measures adapted to the stage of the disease.

Measures such as ice treatments, electrotherapy or the hot roller (special heat treatment with massage) improve the blood circulation and relieve the initially severe pain of frozen shoulder. Exercises in the water (eg in the exercise bath) help to maintain the mobility in the first phase of the disease, to relieve the pain in the second phase and to widen the scope of movement in the third phase.

Physiotherapeutic exercises should be performed with caution and to the extent that they cause no pain, especially in the first phase of the disease. From the second phase of the disease, manual therapy can improve the range of motion of the affected shoulder. Again, the exercises should be performed only in pain-free range of motion and not exceed the limits of movement. The therapist can also show the patient home exercises, for example so-called pendulum exercises.

Even in the third stage of the disease, when Frozen Shoulder slowly “thaws” again, exercise training is very important. The patient should train consistently with the therapist and at home to be able to fully move the diseased shoulder as soon as possible.

Medicines on Frozen Shoulder

If necessary, patients with a frozen shoulder will receive analgesic and anti-inflammatory drugs, especially those from the group of non-steroidal anti-inflammatory drugs (NSAIDs such as diclofenac, ibuprofen, ASA). In phase 2 of a Frozen Shoulder, when the pain subsides, the administration of such analgesics can be reduced accordingly.

Sometimes patients with a frozen shoulder are given cortisone, such as a syringe in the shoulder joint or as a tablet. Cortisone has a strong anti-inflammatory effect.

Operation at Frozen Shoulder

If conservative measures in a Frozen Shoulder do not bring the desired success, an operation may be useful: As part of a joint mirroring (arthroscopy) under general anesthesia adhesions in the shoulder joint are solved. The joint becomes more mobile again. The procedure should only be performed by an experienced surgeon.

Frozen Shoulder: Disease course and prognosis

The treatment of Frozen Shoulder is tedious and requires patience from the patient. In general, the disease progresses over one to three years. Sometimes one heals Frozen shoulder not completely, but leaves in the long term movement restrictions.