Brief overview
- Symptoms:In phase 1 severe shoulder pain, partly at rest and at night, phase 2: stiff shoulder with less pain, phase 3: mobility of the shoulder increases again
- Causes: Unknown in primary form, possible causes of secondary form: Injury or surgery to the shoulder, neurological causes, metabolic or thyroid disease.
- Diagnosis: taking of medical history by a physician, checking the mobility of the shoulder, imaging techniques such as X-ray, ultrasound or magnetic resonance imaging (MRI)
- Therapy: Ice or heat treatment, physiotherapy or exercise baths, analgesic and anti-inflammatory drugs, cortisone administration, rarely surgical interventions
- Prognosis: Sometimes protracted course over several years, sometimes no complete healing and long-term restriction of movement.
- Prevention:No special recommendation, since causes of the primary form are unknown.
What is Frozen Shoulder?
Physicians also refer to frozen shoulder as adhesive capsulitis. The name refers to 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, frozen shoulder (also known as “periarthropathia humeroscapularis ankylosans”) falls under the collective term periarthritis humeroscapularis or periarthropathia humeroscapularis (PHS) – a group of degenerative diseases in the shoulder region that are associated with a usually painful restriction of joint movement.
Frozen shoulder occurs primarily between the ages of 40 and 60, with women more commonly affected than men.
Primary and secondary frozen shoulder
Medical experts distinguish between a primary and a secondary form of frozen shoulder:
- Primary (idiopathic) Frozen Shoulder: independent condition that cannot be attributed to any existing underlying disease. Most common.
What are the symptoms of Frozen Shoulder?
Frozen Shoulder often progresses in phases characterized by different symptoms:
Phase 1 – “Freezing Shoulder”.
The condition usually begins with sudden, sharp shoulder pain that is initially movement-dependent. Gradually, they develop into constant pain that also occurs at rest – they are particularly noticeable at night.
Phase 2 – “Frozen Shoulder
The second disease phase of Frozen Shoulder generally extends from the fourth to the eighth month of the disease. Pain occurs only initially. The main symptom is now the “frozen” shoulder – the restriction of movement of the joint reaches its peak.
Phase 3 – “Thawing Shoulder
In many cases, Frozen Shoulder begins to slowly “thaw” around the 8th month. The affected person hardly has any pain anymore, and the shoulder slowly loses its stiffness. It may take months or years before the shoulder is fully mobile again. As a rule, this is only possible with the right therapy.
What are the causes and risk factors of frozen shoulder?
The cause of primary frozen shoulder is unknown.
Possible causes of secondary frozen shoulder are:
- Injuries or diseases in the shoulder area, such as a rotator cuff tear (rotator cuff rupture) or a painful impingement of tendons or muscles in the shoulder joint (impingement syndrome)
- Surgery in the shoulder area
- Neurological causes such as a disease of the peripheral nerves, 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 disorders
Frozen shoulder occasionally develops in patients taking sedatives from the barbiturate group or psychotropic drugs (drugs for mental illness). It is also more common in patients who have been pre-treated with protease inhibitors, such as HIV sufferers.
How is a frozen shoulder examined and diagnosed?
The first point of contact for suspected frozen shoulder and other shoulder pain is your family doctor. He or she may refer you to an orthopedist or shoulder specialist.
The doctor will first ask you in detail about your symptoms and medical history (anamnesis). Possible questions are:
- How long has the shoulder pain been present?
- Do you have frequent pain at night that prevents you from sleeping?
- Have you had an accident, injury, or surgery to your shoulder?
- What do you do for a living?
- Do you have any pre-existing conditions or what diseases run in your family?
The next step is a physical examination, during which the doctor checks the mobility of the shoulder, among other things.
X-ray examination of the shoulder does not reveal any specific findings in the case of frozen shoulder. That is, the underlying changes of the disease are not visible in an X-ray. Nevertheless, the image is useful to rule out other causes of shoulder pain, such as a bone fracture, calcification or osteoarthritis.
How is frozen shoulder treated?
The main focus of frozen shoulder therapy is on conservative (non-surgical) measures, adapted in each case to the stage of the disease.
Physiotherapeutic exercises, especially in the first phase of the disease, should only be performed with caution and to an extent in which they do not cause pain. From the second phase of the disease, manual therapy can be used to improve the range of motion of the affected shoulder. Again, the patient performs the movements to an extent that does not cause pain. The therapist shows the patient exercises to do at home, such as so-called pendulum exercises.
Movement training is also very important in the third stage of the disease, when the frozen shoulder slowly “thaws out” again. Consistent training with the therapist and at home is important to regain full mobility of the diseased shoulder as soon as possible.
Various electrotherapeutic measures are sometimes offered, such as laser or magnetic field therapy. However, the efficacy of these treatments for frozen shoulder has not been adequately studied.
Local disturbances in metabolism are thought to contribute to the inflammatory processes of frozen shoulder. In general, symptoms of some metabolic disorders can be reduced by eliminating certain foods. However, there is currently no conclusive evidence as to what, if any, dietary changes may have an impact on the progression of frozen shoulder.
Medication for frozen shoulder
If necessary, patients with frozen shoulder receive painkilling and anti-inflammatory medications, primarily from the group of non-steroidal anti-inflammatory drugs (NSAIDs such as diclofenac, ibuprofen, ASA). In phase two of a frozen shoulder, when the pain subsides, the treating physician reduces the administration of such painkillers accordingly.
Sometimes the patient receives cortisone, for example as an injection into the shoulder joint or as a tablet. Cortisone has a strong anti-inflammatory effect.
If conservative measures for frozen shoulder do not produce the desired results and symptoms persist, surgery may be needed. There are two options:
During a joint endoscopy (arthroscopy) under general anesthesia, the surgeon loosens adhesions in the shoulder joint. This makes the joint more mobile again. Only appropriately specialized surgeons perform this procedure.
During so-called anesthesia mobilization (or manipulation), the shoulder is moved gently and in a controlled manner under anesthesia so that existing adhesions in the shoulder capsule tear.
Course of the disease and prognosis
Treatment of frozen shoulder is lengthy and requires patience on the part of the patient. In general, the course of the disease extends over one to three years. Sometimes a frozen shoulder does not heal completely, but leaves long-term movement restrictions.
Are there preventive measures?
Since the causes of frozen shoulder, at least the primary form, are not known, there are no specific recommendations for the prevention of this disease according to the current state of knowledge.
