A frozen shoulder (adhesive capsulitis) is an increasing limitation of movement in the shoulder joint. Patients between 40 and 60 years of age are mostly affected. In 30 per cent of patients, both shoulders are affected, but generally not at the same time. Frozen shoulder is basically a self-limiting disease. That means it can also heal without medical treatment. A frozen shoulder takes between one and three years to heal. Ten to twenty per cent of those affected, however, retains permanent restrictions.
A distinction is fundamentally made between primary and secondary shoulder stiffness:
- Primary shoulder stiffness: It is the most widespread form and cannot be traced back to any pre-existing illness or injury.
- Secondary shoulder stiffness: It occurs as a result of other diseases. Injuries or operations on the shoulder can also trigger secondary shoulder stiffness.
Causes of a frozen shoulder
The causes of primary shoulder stiffness are not known. Secondary shoulder stiffness can have several causes. These include shoulder injuries such as rotator cuff tear or fractures and bruises. However, operations in the shoulder area can also lead to a frozen shoulder. Some specific diseases, such as diabetes mellitus or thyroid diseases, increase the risk of a frozen shoulder.
Symptoms of a frozen shoulder
The symptoms of a primary frozen shoulder differ from the symptoms of a secondary frozen shoulder.
Symptoms of a primary frozen shoulder
A primary frozen shoulder can be divided into three phases characterised by different symptoms:
- Stage I (freezing initial phase): The disease begins with sudden and severe pain in the shoulder. The symptoms are particularly severe at night and it is no longer possible to sleep on the affected side.
- Stage II (frozen, stiffening phase): The pain in the shoulder joint slowly diminishes, but mobility is increasingly limited. Particular pain is caused by external rotation and abduction of the shoulder. The limitation of the joint is most noticeable in this phase.
- Stage III (thawing, solution phase): Shoulder mobility improves after six to 18 months. The shoulder “thaws”. In many cases, patients can move their shoulder fully again, but minor symptoms remain in some cases.
Symptoms of a secondary frozen shoulder
Secondary shoulder stiffness typically occurs after injury or surgery. Degenerative diseases of the shoulder can also lead to shoulder stiffness. In the event of a secondary frozen shoulder, phases are less clearly recognisable in the course of the disease.
Diagnosis: How to recognise a frozen shoulder
A thorough patient consultation (anamnesis) takes place at the start of our diagnostics. Our shoulder specialists must precisely record the exact circumstances of the occurrence, the dynamics and your current situation. This is followed by a physical examination. The diagnosis of a frozen shoulder is usually a clinical diagnosis.
A frozen shoulder often occurs with other structural injuries to your shoulder. Our most important task is therefore to identify the cause of your existing pain. It is often not the small tear in the rotator cuff that is responsible for your limited movement, but a frozen shoulder.
Following the physical examination, we use imaging procedures for further diagnosis. Using magnetic resonance imaging (MRI), we see the inflammatory process in your articular capsule by administering a contrast agent.
Conservative frozen shoulder therapy
In most cases, a frozen shoulder can be treated without surgery. In general, different pillars are taken into consideration for the conservative treatment of your frozen shoulder:
- Pain management
- Shoulder injections
- Cortisone shock therapy (tablets)
- Anti-inflammatory drugs (NSAIDs)
Surgical treatment methods
Frozen shoulder: Surgery by specialists
If you suffer from primary shoulder stiffness, surgery can usually be avoided. Only if conservative treatment of a frozen shoulder does not bring any improvement can surgery be useful. During this, specialists relieve the adhesions and shortenings of your articular capsule ,perform this procedure minimally invasively by means of arthroscopy (keyhole surgery). During frozen shoulder surgery, they treat the underlying causes as well as the shoulder stiffness.
The surgery on your frozen shoulder is performed using a combination of local anaesthetic and general anaesthetic. Most pain stimuli are eliminated with the regional anaesthetic (pain catheter). This allows to use a low dosage of your general anaesthetic. You will benefit greatly from the combination in the days following the operation. The pain catheter remains in place for the first few days after the surgery on your frozen shoulder. This allows you to move painlessly the day after the operation and perform your first exercises.
Frozen shoulder: Therapy after the operation
The therapy after the operation is simple and there are no essential requirements. You can move your arm as far as the pain allows. It is important that you start with everyday activities early after the operation. The regained mobility should be maintained through early exercises. It is important to find the right balance between training and avoiding irritation. This is exactly where our experts can help you.