Frozen shoulder
Martina Feichter studied biology with an elective subject pharmacy in Innsbruck and also immersed herself in the world of medicinal plants. From there it was not far to other medical topics that still captivate her to this day. She trained as a journalist at the Axel Springer Academy in Hamburg and has been working for since 2007 - first as an editor and since 2012 as a freelance writer.
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Medical professionals describe a disease of the shoulder joint capsule as frozen shoulder. Those affected have severe shoulder pain at first, which then gradually subsides, while the shoulder becomes increasingly stiff at the same time. This frozen shoulder can spontaneously resolve itself after years. Read more about the cause, symptoms and diagnosis of a frozen shoulder, exercises and other therapeutic measures!
Frozen shoulder: description
Frozen shoulder is a disease of the shoulder joint capsule and very often the cause of shoulder pain and frozen shoulder. It is also known as adhesive capsulitis - an inflammation of the shoulder capsule associated with adhesions and adhesions. Other names for this clinical picture are humerocapsulitis adhaesiva, fibrous frozen shoulder or capsulitis fibrosa.
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 usually associated with a painful restriction of movement of the joint.
The frozen shoulder mainly occurs between the ages of 40 and 60, with women more often affected than men.
Primary and secondary frozen shoulder
Doctors differentiate between a primary and a secondary form of the frozen shoulder:
- Primary (idiopathic) frozen shoulder: an independent disease that cannot be traced back to any existing underlying disease. Most common.
- Secondary frozen shoulder: Result of other illnesses, injuries or surgeries in the shoulder area. Less common than primary frozen shoulder.
Frozen shoulder: symptoms
The frozen shoulder often runs in phases that are characterized by different symptoms:
Phase 1 - "Freezing Shoulder"
The disease usually begins with sudden, severe shoulder pain that is initially dependent on movement. Gradually they develop into permanent pain that also occurs at rest - they are particularly noticeable at night.
The pain is triggered by a non-specific inflammation of the joint mucous membrane (synovitis) and the capsule structures. As a result of this inflammation, agglutinations and adhesions form in the joint and the joint capsule shrinks. This increasingly affects the mobility of the shoulder. This shoulder “freezing” phase generally lasts about four months.
Phase 2 - "Frozen Shoulder"
The second phase of the frozen shoulder disease generally extends from the 4th to the 8th month. Pain only occurs initially. The main symptom is now the stiff shoulder - the restriction of movement of the joint is at its peak.
Phase 3 - "Thawing Shoulder"
In many cases, the frozen shoulder begins to slowly “thaw” around the 8th month. Those affected hardly have any pain, the shoulder slowly loses its stiffness. It can take months or years before the shoulder is fully mobile again. In general, this is only possible with the right therapy.
The times given for the duration of the individual phases are only general. In individual cases, the phases can last different lengths. There are also patients in whom the frozen shoulder disease process takes ten years. In some cases there is no healing at all.
Frozen shoulder: causes and risk factors
The cause of the primary frozen shoulder is unknown.
Possible causes of secondary frozen shoulder are:
- Injuries or diseases in the shoulder area such as a tear in the rotator cuff (rotator cuff rupture) or painful entrapment of tendons or muscles in the shoulder joint (impingement syndrome)
- Operations in the shoulder area
- neurological causes such as a disease of the peripheral nerves, Parkinson's disease or irritation / damage to nerve roots (radiculopathy)
- Metabolic diseases such as diabetes mellitus, Addison's disease (disease of the adrenal cortex) or thyroid diseases
A frozen shoulder also occasionally develops in patients who take tranquilizers from the group of barbiturates or psychotropic drugs (drugs against mental illness).
Frozen shoulder: examinations and diagnosis
The first point of contact if you suspect a frozen shoulder or other shoulder pain is your family doctor. He can refer you to an orthopedic surgeon or shoulder specialist.
The doctor will first ask you in detail about your symptoms and your medical history (anamnesis). Possible questions are:
- Since when did the shoulder pain exist?
- Do you often wake up from pain at night?
- Have you had an accident, injury or shoulder surgery?
- What do you do for a living?
The next step is the physical examination, during which the doctor checks the mobility of the shoulder, among other things.
The X-ray examination of the shoulder does not reveal any specific findings in the case of a frozen shoulder. This means that the underlying changes in the disease are not visible in an X-ray. Nevertheless, the intake is useful in order to rule out other causes of shoulder pain such as a broken bone, calcification or osteoarthritis.
Using ultrasound and magnetic resonance imaging (MRI), the doctor can assess various structures in the shoulder joint (such as thickened ligaments or capsule parts) more precisely, which can help with the diagnosis of frozen shoulder.
Frozen shoulder: treatment
The focus of frozen shoulder therapy is on conservative (non-surgical) measures that are adapted to the stage of the disease.
Measures such as ice treatments, electrotherapy or the hot roller (special heat treatment with massage) improve blood circulation and alleviate the initially severe pain of the frozen shoulder. Exercises in the water (e.g. in the exercise pool) help to maintain mobility in the 1st phase of the disease, to alleviate the pain in the 2nd phase and to expand the range of motion again in the 3rd phase.
Physiotherapy exercises should be carried out with caution, especially in the first phase of the disease, and to an extent that they do not cause any pain. From the 2nd phase of the disease onwards, manual therapy can improve the range of motion of the affected shoulder. Here, too, the following applies: The exercises should only be performed with pain-free range of motion and should not exceed the limits of movement. The therapist can also show the patient exercises for at home, for example so-called pendulum exercises.
Movement training is also very important in the third stage of the disease, when the frozen shoulder slowly "thaws" again. The patient should train consistently with the therapist and at home in order to be able to move the diseased shoulder fully again as soon as possible.
Medicines for frozen shoulder
If necessary, patients with a frozen shoulder receive analgesic and anti-inflammatory drugs, especially 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 painkillers can be reduced accordingly.
Sometimes cortisone is given to patients with a frozen shoulder, for example as an injection into the shoulder joint or as a tablet. Cortisone has a strong anti-inflammatory effect.
Operation for frozen shoulder
If conservative measures do not bring the desired success with a frozen shoulder, an operation can make sense: As part of a joint specimen (arthroscopy) under general anesthesia, adhesions in the shoulder joint are loosened. This makes the joint more flexible again. The procedure should only be performed by an experienced surgeon.
Frozen shoulder: disease course and prognosis
The treatment of the frozen shoulder is tedious and requires a lot of patience from the patient. The disease generally extends over one to three years. Sometimes a frozen shoulder does not heal completely, but leaves movement restrictions in the long term.
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