 Diagnosis (Shoulder) |
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Doctors |
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Rehabilitation |
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Service |
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 Frozen shoulder – stiffening of the shoulder |
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Stiffening in the shoulder can be caused by a variety of painful syndromes, collectively referred to as secondary frozen shoulder. However, in the majority of cases shoulder stiffness arises as a separate syndrome in its own right (primary frozen shoulder). Endogenous factors, e.g. hormonal changes (menopause) or other hormonal syndromes (diabetes, thyroid gland), are some of the possible causes. The syndrome has various stages, which are characterised by different symptoms. The “freezing phase” usually starts with sudden and considerable pain that is particularly strong at night or when at rest. A successive and sometimes very spontaneous restriction of mobility sets in, often overnight. After a few weeks to a few months the “plateau phase” then follows, which does not lead to any further restriction of function. The pain gradually lessens. In the “thawing out” phase, stage 3, hardly any pain is felt. The shoulder begins to function increasingly well. The main problem from a prognostic point of view is the unpredictable duration of the disorder. In general the disorder lasts for around one to two years. There are however considerably longer individual cases that last over ten years. For longer-term cases it is certainly not appropriate to simply recommend patience. Specific treatment should be introduced, depending on the extent of the reduction in quality of life. Specific treatments – whether conservative or minimally invasive – can be planned very individually with a calculable prognosis. |
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It is useful to carefully introduce muscle relaxing measures. The execution of manual therapy methods that are useful in other circumstances only serves to frustrate the patient in the first phase. During the primary freezing phase there is no chance of stopping the syndrome and process of shrinkage – neither by physiotherapy nor by a minimally invasive operation. In this case competent, analgetic treatment is of particular use, whereby latest generation medication can drastically reduce the symptoms but not completely eliminate them. Specific treatment, whether conservative or minimally invasive, should not be introduced until the plateau phase. It is not until this stage that competent treatment can be successful. The chances for success of purely conservative measures can be estimated at an early stage by taking into consideration various therapeutic aspects. The processing of special, conventional radiological images gives us a clear prognosis. If there is evidence of a moderate to major accompanying mechanical narrowing syndrome, then it is recommendable to carry out arthroscopic therapy early on, whereby the viscous circle of the narrowing must be eradicated. At the same time the completely adhered layer of the synovial bursa is freed, a process that includes microsurgical widening and freeing of the joint capsule – similar to opening a zipper. Using this kind of atraumatic and minimally invasive operation we are able to restore full mobility, without any kind of manipulation, as soon as the patient is under anaesthetic. However, that level of mobility cannot be maintained after the operation, i.e. on completion of the muscle relaxing anaesthetic. |
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 | | Condition after capsule release |
It does, though, bring about a clear improvement in the overall function at an early stage, so that the physiotherapist then has the chance and the mechanical basis to be able to work competently at an entirely different level. A subsequent period of around six months is to be expected before complete functionality is restored. However, a high degree of improvement in quality of life and complete relief from pain can be expected much earlier. If the special series of x-rays for determining different therapies rules out a mechanical narrowing problem, there is an 80 percent chance of success using conservative treatment. |
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Inflamed shrinkage and adhesion of joint capsule (red) and bursa (grey) |
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Conservative treatment involves intensive manual therapy, combined with and supplemented by a subacromial and intraarticular series of injections.
The latter serves to introduce anti-inflammatory substances into the subacromial lubricating layer and into the actual shoulder joint, and stretches these structures by introducing a suitable volume of liquid (distension treatment). In summary it can be remarked that painful and stubborn stiffness in the shoulder can by all means be successfully treated.
Planning should always allow for a treatment period of around six months for the complete restoration of the functionality of the shoulder. |
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