Frozen Shoulder

The shoulder joint is a complex system consisting of bones, ligaments, bursae and tendons and is formed by the head of the humerus (head of the humerus) and the glenoid cavity, which is part of the scapula (shoulder blade). Above this joint lies the acromion (roof of the shoulder). The shoulder joint is surrounded by a joint capsule.

The joint capsule of the shoulder joint consists of connective tissue and ligaments and can thicken and lose elasticity in the course of inflammatory processes. As a result, there is severe pain in the shoulder joint and, in the further course, a considerable restriction of movement of the affected arm in all directions. The cause of this is the shrinkage of the capsule, which is referred to as frozen shoulder or frozen shoulder.

Frozen shoulder affects 2-5% of the population (women more often than men). It occurs mainly in people over the age of 40.

Signs of frozen shoulder may include:

• Sudden severe pain during movements or even at night at rest
• Significant restriction of movement in all directions of motion

Shoulder stiffness typically progresses in three phases:

1. In the freezing stage, inflammation of the joint capsule leads to a sudden, strongly painful and increasing restriction of movement. This phase usually lasts between several weeks and months.
2. During the plateau phase (frozen stage), the pain gradually decreases, but the shoulder stiffness is full-blown due to the thickening and adhesion of the joint capsule.
3. In the thawing stage, pain is usually minimal to nonexistent, and the shoulder increasingly regains function and mobility.

Causes of frozen shoulder include:

• primary: cause unknown
• secondary: consequence of operations, injuries or other diseases of the shoulder (e.g. shoulder arthrosis, calcified shoulder)

The causes of frozen shoulder can be divided into primary and secondary.

Primary frozen shoulder develops without a triggering event. Possible causes are hormonal changes (e.g. menopause or thyroid disorders) or metabolic disorders (e.g. diabetes mellitus). However, it can also occur without concomitant diseases. In this case, recurrent inflammation of the joint capsule occurs, which subsequently leads to thickening and adhesion of the joint capsule.

The secondary form of frozen shoulder is a secondary condition as a reaction to a fall or prolonged immobilization, e.g. after surgery, tendonrupture (rotator cuff rupture) or other diseases (e.g. shoulder arthrosis, calcified shoulder).

Our shoulder specialists will ask you about your complaints in a detailed consultation (anamnesis). This is followed by a functional examination of the affected shoulder, in which above all the mobility is checked. This is usually sufficient to establish the diagnosis of frozen shoulder.

In order to differentiate frozen shoulder from other pain-causing diseases of the shoulder joint, especially in the early stages, further imaging diagnostics such as an X-ray or magnetic resonance imaging (MRI) are recommended.

Conservative therapy

The following conservative therapies are available:

• Drug therapy: painkillers, cortisone in tablet form
• Injection of cortisone into the shoulder joint (intraarticular) and under the acromion (subacromial)
• Physical therapy: heat, electrotherapy (TENS)
• Physiotherapy
• Shock wave therapy

To achieve a reduction in pain and an inhibition of inflammation, painkillers from the group of non-steroidal anti-inflammatory drugs (NSAIDs), or cortisone tablets can be taken. If the pain is very severe, the inflammation of the joint capsule can be reduced by a targeted injection of cortisone into the shoulder joint.

Both physiotherapy and cold or heat applications can have a positive effect on the symptoms, depending on the phase. Especially in the first phase of severe pain in the shoulder joint, cold in the form of cooling pads can bring pain relief. It is important that the cooling pad is not placed directly on the skin, but wrapped with a kitchen towel.

During the first phase of physiotherapeutic treatment, the focus is on moving the shoulder joint as finely as possible, depending on the pain, in order to keep the capsule as elastic as possible. Furthermore, the shoulder/neck muscles are relaxed by means of massage and moist heat. In addition, guided exercises that can be integrated independently into everyday life can be performed.

In the second and third phases, manual mobilization of the shoulder joint increasingly comes to the fore in order to restore the length of the constricted capsule. Here, too, targeted, guided stretching exercises for the musculature and movement exercises for joint mobilization should be performed independently at home in a supportive manner. Swimming in warm water (thermal bath) is often found to be very positive.

Also the electrotherapy (TENS) or shock wave therapy can be applied with the aim of improving the metabolic situation in the capsule and tendon area.

Operation

Indications for surgery are a high degree of suffering on the part of the patient and an unsuccessful conservative therapy. In this case, conservative physiotherapeutic treatment should have been carried out intensively for at least half a year.

Surgery to remove the trigger may be discussed, especially in cases of secondary frozen shoulder, such as those caused by a torn tendon or impingement syndrome.

Surgery for frozen shoulder is performed arthroscopically, i.e. minimally invasive by means of a joint endoscopy. The adhesions of the joint capsule are loosened (arthroscopic arthrolysis), so that the range of motion of the affected shoulder improves again.

OP at a glance:

• Operation time: 60 min
• Anesthesia: General anesthesia
• Clinic stay: inpatient
• Fit for work: 3-4 weeks
• Return to sports (RTS): 6-12 weeks, depending on the sport.

Immediately after the operation, physiotherapeutic mobilization should begin to prevent renewed adhesions of the joint capsule.