Frozen shoulder

Synonyms

• Shoulder fibrosis
• adhesive subacromial syndrome
• Periarthropathia humeroscapularis adhaesivia (PHS)
• stiff shoulder

English: frozen shoulder

definition

The Frozen shoulder belongs to the degenerative changes of the Shoulder joint. The joint is restricted in its mobility due to inflammation and a shrinkage of the joint capsule.

Summary

The “frozen shoulder” is a restriction of movement of the shoulder joint due to inflammation that occurs on the joint capsule, which leads to capsule shrinkage.
If the joint capsule has shrunk, the freedom of movement of the shoulder joint is restricted.
There are different forms of frozen shoulder. Pain is an accompanying symptom. First and foremost, cortisone treatment is sought as therapy. However, if the joint does not respond to this treatment, or if the disease is prone to relapse, surgery is an option. The joint capsule is cut open. Ideally, the joint can move freely again after a few weeks. However, patients should exercise caution for a while longer when exercising. First of all, the joint must be strengthened and stiffened prevented by physiotherapy.
The therapy is often difficult and should be carried out by doctors who specialize in this disease, as in many cases a permanent restriction of movement and pain can remain.

causes

The frozen shoulder is usually a consequence of repeated unexplained irritation or inflammation of the Synovial fluid. The problem occurs within the joint.

There are two types of frozen shoulder:

• Primary frozen shoulder:

  It starts with inflammation of the synovial membrane and occurs preferentially in women between the 40th and 60th year of life on. Since this is painful, those affected usually tend to spare the joint and move as little as possible. This protection adds to the fact that the Inflamed joint is leads to a Shrinkage of the joint capsule.
  The mobility of the joint is now restricted. The frozen shoulder can recede spontaneously. It usually runs in phases.
  One risk factor is that Sugar disease.

• Secondary frozen shoulder:

  Secondary frozen shoulder can result from prolonged immobilization of the joint (plaster of paris, bandage), injuries, e.g. Shoulder dislocation, Wear or a Lime shoulder or surgery. Inflammation can also be a trigger. Here, too, there is a shrinkage of the joint capsule.

Appointment with a shoulder specialist

I would be happy to advise you!

Who am I?
My name is Carmen Heinz. I am a specialist in orthopedics and trauma surgery in the specialist team of .

The shoulder joint is one of the most complicated joints in the human body.

The treatment of the shoulder (rotator cuff, impingement syndrome, calcified shoulder (tendinosis calcarea, biceps tendon, etc.) therefore requires a lot of experience.
I treat a wide variety of shoulder diseases in a conservative way.
The aim of any therapy is treatment with full recovery without surgery.
Which therapy achieves the best results in the long term can only be determined after looking at all of the information (Examination, X-ray, ultrasound, MRI, etc.) be assessed.

You can find me in:

• Lumedis - your orthopedic surgeon
  Kaiserstrasse 14
  60311 Frankfurt am Main

Directly to the online appointment arrangement
Unfortunately, it is currently only possible to make an appointment with private health insurers. I hope for your understanding!
You can find more information about myself at Carmen Heinz.

Frozen shoulder after surgery

One reason for the development of a frozen shoulder is that an operation has taken place in the shoulder area. This may include surgery to reduce symptoms in cases of tight shoulder (Impingement), at arthrosis or with torn tendons (Rotator cuff rupture) be. A more common reason, however, is the operation for a humerus head fracture, for example after a fall.

After the operation it is Part of the follow-up treatment that the arm is held still and carried in an arm splint or bandage. Depending on the operation, this can be indicated between 3 and 6 weeks. The main danger of immobilizing the arm is the development of frozen shoulder. Through the lack of movement and stretching of the capsule and the ligaments in the shoulder leads to shrinkage and sticking in these.

It is therefore a central concern of the surgeon and the physiotherapist that the Arm not worn in the bandage for longer than absolutely necessary becomes. The early passive exercise of the arm by a physiotherapist enables the arm to be moved without affecting the outcome of the operation, but at the same time reducing the risk of frozen shoulder.

If the arm is not adequately exercised, the patient runs the risk of frozen shoulder. It is therefore important that patients comply with the instructions of the doctor or physiotherapist regular and structured exercises for the arm carry out.

Besides operations on the shoulder you can After surgery on and in the skull, abdomen or thorax (rib cage), shoulder stiffness occurs postoperatively. But this is very Rare and is not one of the more common complications of such operations. The Stiff shoulder after breast surgerye.g. in breast cancer (breast cancer) is also Rare described. In all these operations, however, it is also true that good and regularly performed exercises for the shoulder greatly reduce the risk of frozen shoulder.

Phases

The frozen shoulder typically has 3 phases:

1. Phase: Stiffening
2. Phase: stiffness
3. Phase: resolution

The untreated frozen shoulder lasts 18-24 months, but in individual cases it can last significantly longer.

Symptoms

The symptoms are, as the name suggests, stiffness of the shoulder. The joint can no longer be lifted beyond a certain point, as this requires the "reserve" of the joint capsule.
In a healthy shoulder, the joint capsule has a few reserve folds in order to guarantee that the arm can move as high as possible to the side and upwards (the so-called abduction). If this reserve of joint capsule tissue is missing due to its shrinkage, it can easily be explained that the mobility of the arm is restricted.

Read more on this topic at: You can tell when you have frozen shoulder by these symptoms

Diagnosis of frozen shoulder

The extent of the Frozen shoulder can be easily checked. The arm is lifted up to the side away from the body. It must be ensured that the shoulder blade does not move with it, otherwise the movement will no longer come from the shoulder joint alone. Rotation, i.e. turning the arm inwards and outwards, is also restricted.

therapy

Initially, you can treat with a cortisone - 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 said to inhibit inflammation and thus also relieve pain. Painkillers can also be given if necessary. Physiotherapy / physiotherapy can only be started when the cortisone treatment has been completed and the pain has been relieved.

The therapy of the therapy-resistant frozen shoulder consists of a minimal surgical intervention to restore mobility and to ensure freedom from pain. This is achieved by cutting open the joint capsule and, if necessary, cutting out inflamed tissue. This operation is carried out arthroscopically. In this closed variant, in addition to surgical equipment, a camera is also inserted into the joint from the outside. This allows "minimally invasive" surgery.

After the operation, movement should be resumed as soon as possible to prevent the capsule from shrinking again or sticking.
However, surgery does not guarantee complete restoration or re-stiffening of the joint.

Read more about treatment options for frozen shoulder at: This is how a frozen shoulder is treated

Exercises

An important part of healing a frozen shoulder is that 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 one independent and daily exercise the shoulder.

At the beginning this is Warming up the shoulder important. You can start pulling up and circling your shoulder. Then the straight arms are raised to the side and forwards and then lowered again. The exercises should be performed for 30 seconds each. All movements in which the shoulder is first moved without applying too much force are helpful. At first, these movements are likely to be very difficult, painful, and perhaps demotivating. The mobility will improve steadily.

Also are Shoulder stretching exercises very important, as this is the only way for the tissue and shoulder to gain 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 advisable every day between 5 and 10 minutes to stretch.

The next step is that Strengthening the muscles. Here you can train with a Theraband or light weights. If there are other problems, such as tears in the rotator cuff, then the exercises should be carried out in consultation with the treating team. Examples of strengthening exercises are this Lateral raise (lateral lifting of the dumbbells), that Front raises (the dumbbells are raised in front of the body with the arm extended), the Shoulder press (the dumbbells are slowly stretched over the head). But that too Internal and external rotation training is relevant. You can train this well with a Theraband.

For the Strengthening the entire upper body Push-ups and back extensions or corresponding exercises on equipment are beneficial. Together with the physiotherapist, an individual plan is usually worked out that includes all exercises that can also be performed alone at home or in the gym.

Kinesio tape for frozen shoulder

Taping the shoulder is also useful for frozen shoulder. Basically it can Kinesio taping to be learned and performed by everyone. But it is mostly on the shoulder more complicated to tapebecause there are many different structures here. For taping the frozen shoulder Approx. 5 adhesive strips are required, namely I and Y tapes. The exact implementation is shown in various video explanations on different platforms on the Internet.

Medication

Therapy can be used, especially in the first phase of frozen shoulder Cortisone injections Relieve pain and reduce the inflammatory process. These syringes are injected into the shoulder by the doctor over a period of 2 to 4 weeks. Over the full period of a frozen shoulder is in most patients that Taking painkillers an important part. Various pain relievers, such as Ibuprofen, Diclofenac, aspirin or Paracetamol be taken. But above all the NSAIDs (Non-steroidal anti-inflammatory drugs), such as ibuprofen and diclofenac, as these are also a anti-inflammatory effect to have. If these painkillers are not sufficient, the attending physician can discuss whether painkillers of the next level, the so-called low-potency opioids (e.g. tilidine or Tramadol)

homeopathy

In naturopathic use, a Variety of wraps and envelopes recommended, which are believed to have anti-inflammatory and healing properties. For example, wraps with quark, onion, arnica, Comfrey or vinegar. In addition, rubbing the shoulder with Johannis herbs- Oil or arnica oil will help. Another approach from alternative medicine is the acupuncture on. This is also offered in many orthopedic practices as a private service or sometimes also as a health insurance service.

How long will you be on sick leave?

If there is a frozen shoulder you do not have to be written sick or unable to work. However, if the patient does heavy physical work or has to carry out work that requires regular and complex shoulder movement, the attending physician must discuss the extent to which he is unable to work or whether a temporary assignment in other areas of activity can be agreed with the employer can. Should be a Frozen shoulder surgery then the patient will usually be for Written for 3 - 4 weeks unable to work. Then, depending on the pain, it must be tested how quickly the patient can get back to work.

prophylaxis

As the cause of the capsule shrinkage or inflammation has not been conclusively clarified, no preventive measures can be recommended.
Inflammation of each other's shoulder cannot be prevented either.

Duration

The frozen shoulder usually goes through three phases. JDepending on the cause, severity and type of treatment, frozen shoulder ideally resolves in between 9 and 18 months. If there are additional causes such as osteoarthritis or defects in the rotator cuff, the healing process can be delayed. B.If the course is not ideal, it can take several years for the frozen shoulder to completely cure.

The first phase, the initial or inflammatory phase, is characterized by pain that also occurs at night, and takes about 9-12 months on.

In the second phase, also known as the stiffening phase, patients complain of a loss of movement and can often no longer perform everyday tasks and movements. This phase can be between 4 and 12 months last for.

The last and third phase is called the defrosting phase and kcan last for several years in the worst case. It involves slowly returning the mobility of the shoulder. Good physiotherapy treatment is a key component here. There may well be phases here where things are going better or worse.

The complete course of healing can individually very different be. So here is one good cooperation with the doctor and the physiotherapist is important.

forecast

The frozen shoulder can resolve itself spontaneously. A few weeks of rehabilitation are necessary after an operation in order to slowly restore full mobility. The patients can also do sport again, but should especially exercise that stresses the shoulder (tennis etc.) with your doctor beforehand.