Synonyms
- Shoulder Fibrosis
- Adhesive subacromial syndrome
- Periarthropathia humeroscapularis adhaesivia (PHS)
- Stiff shoulder
Definition
Shoulder stiffness is one of the degenerative changes of the shoulder joint. The joint is restricted in its mobility due to inflammation and shrinkage of the joint capsule.
Summary
The “frozen shoulder” is a movement restriction of the shoulder joint due to inflammation of the joint capsule, which causes shrinkage of the capsule. If the joint capsule has shrunk, the shoulder joint is restricted in its freedom of movement. There are various forms of frozen shoulder.
Pain is an accompanying symptom. Primarily, cortisone treatment is sought as therapy. However, if the joint does not respond to this treatment, or if the disease tends to relapse, surgery may be considered.
In this case the joint capsule is cut open. After a few weeks, the joint is ideally free to move again. Patients should, however, remain cautious during sports activities for a while. First of all, the joint must be strengthened during physiotherapy and renewed stiffening must be prevented. Therapy is often difficult and should be carried out by doctors who have specialized in this disease, since in many cases a dour movement restriction and painfulness can remain.
Causes
Frozen shoulder is usually the result of repeated unexplained irritation or inflammation of the synovial fluid. The problem takes place inside the joint. There are two forms of frozen shoulder: It begins with inflammation of the joint mucosa and occurs primarily in women between the ages of 40 and 60.
Since this is painful, those affected usually tend to take care of the joint and move it as little as possible. This sparing adds to the fact that the joint is inflamed and leads to shrinkage of the joint capsule. The mobility of the joint is now restricted.
The stiffness of the shoulder may regress spontaneously. It usually proceeds in phases. One risk factor is sugar disease.
Secondary shoulder stiffness can occur as a result of prolonged immobilization of the joint (plaster, bandage), injuries, e.g. shoulder dislocation, wear and tear or a calcified shoulder or surgery. Inflammation can also be a possible trigger. Here, too, shrinkage of the joint capsule occurs.
- Primary shoulder stiffness:It begins with inflammation of the joint mucosa and occurs primarily in women between the ages of 40 and 60. Since this is painful, those affected usually tend to take it easy on the joint and move it as little as possible. This sparing adds to the fact that the joint is inflamed and leads to shrinkage of the joint capsule.
The mobility of the joint is now restricted. The stiffness of the shoulder may regress spontaneously. It usually proceeds in phases.
One risk factor is sugar disease.
- Secondary shoulder stiffness:Secondary shoulder stiffness can occur as a result of prolonged immobilization of the joint (cast, bandage), injuries, e.g. shoulder dislocation, wear and tear or a calcified shoulder or surgery. Inflammation can also be a possible trigger. Here, too, shrinkage of the joint capsule occurs.
One reason for the development of shoulder stiffness is that surgery has taken place in the shoulder area.
This can be an operation to reduce the symptoms of shoulder soreness (impingement), osteoarthritis or torn tendons (rotator cuff rupture). A more common reason is also surgery for a fracture of the head of humerus, for example after a fall. After the operation, it is part of the post-operative treatment that the arm is first kept still and worn in an arm splint or bandage.
Depending on the operation, this may be indicated for between 3 and 6 weeks. The main risk of immobilising the arm is the development of frozen shoulder. The lack of movement and stretching of the capsule and ligaments in the shoulder causes shrinkage and adhesions in them.
It is therefore a central concern of the surgeon and physiotherapists postoperatively that the arm is not worn in the bandage longer than absolutely necessary. Early passive exercise of the arm by a physiotherapist allows the arm to be moved without compromising the surgical result, but at the same time reduces the risk of shoulder stiffness. If the arm is not exercised adequately, the patient runs the risk of a stiff shoulder.It is therefore important that patients perform regular and structured exercises for the arm according to the instructions of their doctor or physiotherapist.
In addition to shoulder operations, postoperative shoulder stiffness can also occur after operations on and in the skull, abdomen (abdomen) or thorax (chest). However, this is very rare and is not one of the more frequent complications of such operations. Shoulder stiffness after breast surgery, e.g. in the case of breast cancer, is also rarely described. With all these operations, however, it is also true that good and regularly performed exercises for the shoulder greatly reduce the risk of a stiff shoulder.