Phases
Shoulder stiffness typically occurs in 3 phases: Untreated frozen shoulder has a duration of 18 – 24 months, but can take considerably longer in individual cases.
- Phase: Stiffening
- Phase: Stiffness
- Phase: Resolution
Symptoms
The symptoms are, as the name suggests, stiffness of the shoulder. The joint cannot be lifted beyond a certain point because the “reserve” of the joint capsule is necessary. In a healthy shoulder, the joint capsule has a few reserve folds to ensure that the arm can be moved sideways and upwards by as many degrees as possible (so-called abduction).
If this reserve of joint capsule tissue is missing due to shrinkage of the capsule, it is easy to explain that the mobility of the arm is limited. The extent of shoulder stiffness can be easily checked. The arm is lifted sideways away from the body. Care must be taken to ensure that the shoulder blade does not move with the arm, otherwise the movement will not come from the shoulder joint alone. Rotation, i.e. turning the arm inwards and outwards, is also restricted.
Therapy
Initially, can be treated with a cortisone – step-by-step scheme. This lasts for three weeks and the dose of cortisone is higher at the beginning of the treatment than at the end. The cortisone is supposed to inhibit the inflammation and thus also relieve the pain.
Painkillers can also be given additionally if required. Only when the cortisone treatment has been completed and the pain has been relieved can physiotherapy be started. The therapy of therapy-resistant frozen shoulder consists of a minimal surgical intervention to restore mobility and freedom from pain.
This is achieved by cutting open the joint capsule and removing inflamed tissue as necessary. This operation is performed arthroscopically. In this closed version, a camera is inserted into the joint from the outside, in addition to surgical equipment.
This allows “minimally invasive” surgery. After the operation, movement should be resumed as quickly as possible to prevent the capsule from shrinking again or becoming stuck. However, surgery does not guarantee a complete restoration or re-stiffening of the joint.
An important part of healing a stiff shoulder is the regular and conscious movement of the shoulders. It is not enough to do movement exercises 1-2 times a week together with physiotherapy. Here it requires independent and daily exercise of the shoulder.
At the beginning, warming up the shoulder is important. You can start by lifting and circling the shoulder. Then the stretched arms are lifted to the side and forward and lowered again.
The exercises should be performed for 30 seconds each. Helpful are all movements where the shoulder is first moved without too much force. At the beginning these movements are probably very difficult, painful and perhaps also demotivating.
However, the mobility will steadily improve. In addition, stretching exercises of the shoulder are very important, because only in this way can the tissue and the shoulder achieve more range of motion. To stretch the shoulder, the chest and back muscles, as well as the arm, neck and shoulder muscles must be stretched regularly.
It is recommended to stretch between 5 and 10 minutes every day. The next step is to strengthen the muscles. Here you can train with a Theraband or light weights.
If other problems, such as tears in the rotator cuff, are present, the exercises should be performed in consultation with the treating team. Strengthening exercises are, for example, side lifting (lifting the dumbbells from the side), front lifting (lifting the dumbbells in front of the body with the arm stretched out), shoulder pressing (slowly stretching the dumbbells over the head). But also the training of the inner and outer rotation is relevant.You can train these well with a Theraband.
Push-ups and back-extension or corresponding exercises on machines are helpful for strengthening the entire upper body. Together with the physiotherapist, an individual plan is usually worked out, which includes all exercises that can also be done alone at home or in the gym. Taping the shoulder is also useful for stiff shoulders.
In principle, kinesio taping can be learned and performed by anyone. However, it is usually more complicated to tap the shoulder, because there are many different structures. For the shoulder stiffness taping about 5 adhesive strips are needed, namely I- and Y-tapes.
The exact procedure is shown in various video explanations on different platforms on the Internet. Especially in the first phase of frozen shoulder, therapy with cortisone injections can relieve pain and reduce the inflammatory process. These injections are injected into the shoulder by the doctor over a period of 2 – 4 weeks.
During the entire period of a shoulder stiffness, the intake of painkillers is an important component for most patients. Various painkillers such as ibuprofen, diclofenac, aspirin or paracetamol can be taken. However, NSAIDs (non-steroidal anti-inflammatory drugs), such as ibuprofen and diclofenac, are particularly suitable, as they have an anti-inflammatory effect in addition to the pain-relieving effect.
If these painkillers are not sufficient, it can be discussed with the attending physician whether painkillers of the next level can be prescribed, the so-called low-potent opioids (e.g. Tilidine or Tramadol)In naturopathic use, a variety of wraps and compresses are recommended, to which an anti-inflammatory and healing-promoting effect is attributed. For example, wraps with curd cheese, onion, arnica, comfrey or vinegar are described. Rubbing the shoulder with St. John’s wort oil or arnica oil can also help. Acupuncture is another approach from alternative medicine. This is also offered in many orthopedic practices as a private service or in some cases as a service provided by the health insurance companies.
