FROZEN SHOULDER

The term frozen shoulder already says a lot about the disease. There is a ‘freezing’ of the shoulder joint. This means that the shoulder joint becomes increasingly immobile and stiff. Often, a frozen shoulder is accompanied by pain. It results from a change/inflammation/thickening of the joint capsule tissue, which may involve shrinkage of the capsule.

The joint capsule surrounding the shoulder joint allows an extensive range of motion typically. The joint capsule is comparable to a bellows.

If you expand it, the material is stretched; if you compress it again, wrinkles are formed. The same happens with the joint capsule during movement.

In the case of a frozen shoulder, these wrinkles can stick together and shrink, with the result that you are no longer able to move your arm as usual. It is essential to mention here that the causes are often unknown. In most cases, these adhesions resolve after a certain period, and the shoulder becomes mobile again on its own.

Essentially, a frozen shoulder proceeds in 3 stages. The time of the stages can be very different for each affected person and can last between 6 and 24 months.

In the first stage (acute/inflammatory phase), the mobility of the shoulder/joint capsule is still given, but during this time, there is often inexplicable and severe pain. After a certain period, however, a restriction of mobility is frequently experienced.

A typical symptom in the second stage of frozen shoulder can be the ‘freezing’ of the shoulder. The mobility has decreased considerably. Sometimes the pain may reduce dramatically during this stage. In the third stage, the ‘thawing’ phase, the frozen shoulder again becomes mobile.

An X-ray can be performed to evaluate the bone structures, significantly if the frozen shoulder is associated with trauma (fracture, tendon rupture, etc.). In the case of a primary frozen shoulder, no damage to the bone structures would be apparent.

To evaluate frozen shoulder, other causes must first and foremost be excluded. Ultrasound is used to examine the shoulder dynamically to assess the range of motion. Here, a thickening of the joint capsule and other accompanying symptoms (e.g., injuries, etc.) can be detected. In the arthro-MRI, the size of the joint capsule is determined with the aid of contrast agents. If there is no longer a flexion crease (recessus axillaris), no contrast agent can enter the crease, which often indicates a frozen shoulder.

In the acute phase, an attempt can be made to relieve the pain through NSAIDs. If this does not have the desired effect, cortisone can be infiltrated. It is vital to ensure that the medication is injected into the joint (glenohumeral joint). With the help of an ultrasound or X-ray, the precise place of application can be determined.

Another option is the use of cortisone ‘pulse’ therapy. This means cortisone is administered in pill form at regular intervals over some time. With each treatment, the dose is reduced by half. One starts with a high dose of cortisone and gradually decreases the amount. Physical therapy in warm water can have a positive effect on flexibility. Regular movements and stretching exercises are allowed up to the tolerance of pain.

Surgical treatment (arthroscopy) can be performed when inflammatory reactions are no longer present, and no other conservative treatment has been successful.

In the early stages of frozen shoulder, no surgery should be performed, as it may increase the likelihood of recurrence of the disease.

In surgical intervention, the joint capsule undergoes a minimally invasive procedure. This procedure aims to detach the capsule completely  (360°) and mobilize the shoulder under anesthesia to restore mobility.