FROZEN SHOULDER

Frozen shoulder is one of the most common shoulder diseases. It can occur spontaneously, i.e. primarily without an explainable cause (idiopathic) or secondarily after an injury or a surgical procedure. 

The typical process is divided into 3 phases:

1st phase (the “freezing”, also known as freezing shoulder): In this phase, an inflammation-like change occurs in the joint capsule, which can be extremely painful. The pain occurs when you move, especially when you lift your arm, but often also when you are resting or sleeping at night. Because of the pain, the patient uses his arm and shoulder less and adopts a protective posture. This freezing phase lasts about 4, sometimes up to 9 months.

2nd phase (being “frozen”, the actual frozen shoulder): As a result of the inflammatory adhesions and adhesions, the joint capsule shrinks. As a result, the mobility of the shoulder suffers extremely and the patient can hardly move his arm. At the same time, the pain usually decreases significantly. This phase lasts on average about 4 months.

3rd phase (the “thawing”): In this phase, the inflammatory processes decrease. Healing is slow, but the shrunken joint capsule remains reduced in size. The pain is significantly reduced and the shoulder slowly becomes more mobile again, it is thawing out again, so to speak. The time it takes to thaw varies; for some affected people it takes years before they can move their shoulder normally again.
In secondary frozen shoulder, the shoulder joint capsule sticks together and shrinks due to shoulder diseases such as: B. a shoulder fracture or impingement syndrome or even through operations on the shoulder.

These are the conservative treatment options:

• Pain therapy. Pain-relieving and anti-inflammatory medications such as diclofenac or ibuprofen help against acute pain. They can be taken in tablet form, some are also available as a gel or ointment to rub in.
  
• Cortisone injection. If the symptoms are very severe, infiltration with cortisone (e.g. triamcinolone) with an injection directly into the joint can help to reduce the inflammation somewhat and relieve the pain. Cortisone injections are used cautiously because cortisone itself can lead to tendon degeneration. In most cases we injected a mixture of a pain-relieving medication and some cortisone.

• Cortisone as tablets. Some studies have shown that taking cortisone tablets in a strictly controlled range can relieve the symptoms of frozen shoulder and patients can regain quality of life. When taking cortisone, however, it is important to note that it can lead to severe side effects in some illnesses, such as diabetes mellitus. Therefore, cortisone therapy should always be carried out in consultation with your family doctor.

• Nerve block. If the pain is severe, it is possible to block the sensitive nerve fibers of the shoulder. To do this, an anesthetic medication is injected near the nerve path. This possibility is reserved for very severe disease progression.

• Physiotherapy. Careful stretching and movement exercises are appropriate when the acute pain subsides, i.e. in phases 2 and 3 of the disease. This is intended to maintain shoulder mobility and, if possible, to expand it again. At the beginning, the patient does not move the shoulder himself, but the movements are carried out by the physiotherapist. Active exercises are added later, e.g. B. arm swinging with and without weight. 

• Manipulation under anesthesia. In this method, also known as anesthesia manipulation, the doctor moves the shoulder of the patient, who is completely relaxed due to anesthesia, in all directions. This is intended to loosen stuck structures and expand the joint capsule again. Usually 2 to 3 treatments are necessary.

• Operation. Here the doctor expands the joint capsule by making incisions in several places as part of an arthroscopy.