The term frozen shoulder or stiff shoulder is used by medical professionals to describe a condition in which there is significant restriction of movement and eventual stiffening of the shoulder joint. The symptoms are due to inflammation in the shoulder capsule. Frozen shoulder is a self-limiting disease that heals on its own after some time.
What is frozen shoulder?
Frozen shoulder, also known as frozen shoulder, has been known since 1872. This independent clinical picture is an active and passive stiffening of the shoulder joint. This is usually accompanied by severe pain. It usually affects men and women between the ages of 40 and 70, who often already suffer from a metabolic disorder such as diabetes. Frozen shoulder syndrome also occurs more frequently in heart and lung patients. Frozen shoulder syndrome heals on its own after several years, but some sufferers are left with a movement deficit that cannot be reversed. So far, physicians cannot predict how the disease will progress and how severe the remaining limitations will be.
Causes
Frozen shoulder syndrome occurs more often after traumatic causes, such as a broken bone in the shoulder. After such an injury, the shoulder is usually rested for a period of several weeks or even months, and as a result, frozen shoulder occurs. The same applies to diseases in the shoulder area, such as a rotator cuff tear, as well as age-related shoulder wear and tear. Infections that lead to pain and a relieving posture can also cause frozen shoulders. In all of these cases, experts refer to frozen shoulder as secondary to a previous injury or illness. In most cases, however, it is instead a case of primary frozen shoulder, in which no clear trigger can be identified. In some cases, this even occurs spontaneously.
Symptoms, complaints, and signs
A so-called frozen shoulder is associated with clear symptoms, so that a self-diagnosis is quite possible. Many affected individuals complain of a dull pain that persists even at rest. The entire range of motion of the shoulder is very limited, so that every movement hurts very much. The pain of frozen shoulder does not start suddenly, but occurs much more insidiously. At the beginning, there is only a slight pulling sensation in the shoulder area. After several days, the pain spreads throughout the entire shoulder, so that movement is significantly restricted. In particularly bad cases, redness appears immediately in the shoulder area. In many cases, the skin is very warm at this point, which can be counteracted with permanent cooling. A frozen shoulder is accompanied by severe pain, which can even spread to the arm. Those who choose not to seek treatment from a physician at this point must expect a significant worsening of the symptoms that occur. On the other hand, those who decide to seek treatment can quickly and effectively alleviate the pain in the shoulder. Only those who opt for medical and drug treatment will be able to enjoy a full recovery.
Diagnosis and course
Diagnosis is very easy in the case of Frozen Shoulders. Usually, it is the affected person himself who consults a doctor because of the limited movement and pain. If no direct cause can be identified, the attending physician will conduct a comprehensive discussion with the patient and then arrange for imaging procedures such as an ultrasound examination or an X-ray. These provide information about any damage that may be causing the frozen shoulder. An MRI may also be helpful. Frozen shoulder syndrome is a self-limiting condition and heals on its own after a period of time. In many cases, movement restrictions of varying intensity remain afterwards, which may significantly limit the life of the affected person. At the present stage of research, it is not yet possible to determine how long healing will take and what consequential damage will remain.
Complications
If frozen shoulder remains untreated for a long period of time, various complications such as shoulder osteoarthritis or disease recurrence may develop. As a result of the chronic pain, further poor posture may occur, leading to new problems. In addition, sleep disturbances, irritability and fatigue often occur. Basically, a frozen shoulder is associated with a decrease in the general well-being and quality of life of the affected person. The limited mobility often leads to a withdrawal from social life – psychological complaints such as depressive moods or inferiority complexes can be the result. Major complications are very rare with surgical procedures such as keyhole surgery. Sometimes infections, wound healing disorders and vascular or nerve injuries can occur. It is also possible for movement to worsen again and for residual stiffness to remain. The side effects of pain medications should also be considered. Those typically prescribed may cause discomfort such as gastrointestinal problems, headaches, and skin irritation, among others. If other illnesses are present or if other medications are taken, interactions can occur. Finally, the improper use of natural remedies can also cause problems. The same applies to procedures such as acupuncture, biofeedback or magnetic therapy.
When should you see a doctor?
Medical treatment should always be sought for frozen shoulder. In most cases, self-healing does not occur with this condition, so the sufferer will always need medical treatment. A doctor should be consulted if there is very severe pain in the shoulders. This pain also occurs at rest and can also have a negative effect on the sleep of the affected person. Often, the pain from the shoulders spreads to the neighboring regions of the body, causing very severe discomfort there as well. A doctor should also be consulted if movement is restricted. Furthermore, a warm spot on the skin at the shoulders can indicate frozen shoulder and should be examined if it does not disappear on its own. Especially after an injury or after an accident, a doctor should be consulted. This may involve seeing an orthopedic surgeon or a general practitioner. In emergencies or severe injuries, an emergency physician should be called or the hospital should be visited directly.
Treatment and therapy
The success of treatment for frozen shoulder is determined primarily by the underlying cause of the condition. The goal of therapy should always be to achieve a pain-free full range of motion of the shoulder. In mild cases, for example even after an injury, physiotherapeutic exercises help. These gradually increase the range of motion. The affected person can also perform certain exercises at home and thus contribute to his or her healing. At the same time, it is possible to administer anti-inflammatory drugs. The administration of cortisone results in an improvement of the condition in many patients. The medication can be administered in tablet form or as an injection. If the frozen shoulder persists, it may be necessary to move the joint under anesthesia. In so-called anesthesia mobilization, the patient is anesthetized and the shoulder joint is moved in all directions for several minutes. During this procedure, it is also possible to use arthroscopic tools to penetrate the joint and remove the inflamed synovial membrane. This method ensures a reduction in pain and can also significantly increase the mobility of the shoulder through subsequent anesthesia mobilization. Which treatment method is used also depends largely on the severity of the symptoms.
Prevention
Frozen shoulder can only be prevented to a limited extent, since in many cases it occurs spontaneously and without an obvious trigger. Secondary frozen shoulder, although it has a definite cause, is also difficult to prevent. However, it is possible to improve the condition and reduce the duration of frozen shoulder syndrome by starting appropriate physiotherapeutic measures as early as possible. If symptoms such as a stiff shoulder or pain when moving the shoulder joint occur more frequently, it is advisable to consult a doctor.This person can make a diagnosis and, if necessary, initiate appropriate therapy, which may prevent progression of the disease.
Follow-up care
Aftercare for frozen shoulder is required if it needs to be treated surgically, which is usually done by arthroscopy. In this case, the patient undergoes treatment under inpatient conditions for approximately five days and is given a pain catheter through which almost pain-free physiotherapeutic exercises are made possible. Physiotherapeutic follow-up treatment of frozen shoulder begins immediately after surgery. Early therapy is considered urgent. Pain therapy is administered as needed beforehand. In addition, the patient performs both active and passive movement exercises under the guidance of a physiotherapist. With the help of a motorized motion splint, the affected shoulder can be moved three times a day for 30 minutes. In most cases, inpatient therapy takes five to eight days. Follow-up care is then provided by an orthopedist on an outpatient basis. In total, the physiotherapeutic treatment, which follows a fixed schedule, lasts about three months. The patient’s incapacity to work depends on his or her workload. As a rule, it is between three and six weeks with a normal healing process. The follow-up treatment of frozen shoulder is considered to be labor-intensive. For example, the patient must also complete a special home program at home. He also needs a lot of patience. For example, it can take up to six months before the treated shoulder can be moved completely and freely again.
Here’s what you can do yourself
Patients suffering from a “frozen shoulder” need patience above all. Both the pain and the stiffness in the shoulder usually regress on their own. However, this can take months. During this time, patients can also help to improve their condition themselves. After a sports injury or an accident, physiotherapy should be started in good time to prevent a stiff shoulder from occurring in the first place. Even in the case of sponataneous frozen shoulder, where the causes are often unknown, physiotherapy exercises help to speed up recovery considerably. Initially, it is often necessary to take painkillers immediately before the physiotherapy session so that the measure remains bearable for the patient. For mild to moderate pain, over-the-counter medications from the pharmacy are usually sufficient. After consulting with the attending physician, the patient can also take these if the pain, which is often particularly severe in a resting position, prevents him or her from sleeping. Compresses also help, although some patients respond better to heat and others to cold. Here, the affected person must find out for himself which temperature position has a favorable effect on him. In the case of cold treatments, the compresses or the ice pack should always be applied for only a short time, about 30 seconds to one minute. This often results in almost complete disappearance of the pain for several hours.
