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Header: Frozen Shoulder

Frozen Shoulder – Stiff Shoulder - Adhesive Capsulitis – Shoulder Pain

‘It started gradually some time ago with a light pulling in the shoulder, but the pain became increasingly stronger and distressing. Moreover, it became difficult and painful to even move my shoulder’. The disease behind this condition is called shoulder stiffness, frozen shoulder or adhesive capsulitis. The treatment of a frozen shoulder requires a lot of patients and motivation on the part of those persons affected by it. Due to modern diagnostics and targeted treating methods, with an appropriate therapy this painful disease can be effectively treated. 

Causes: Frozen Shoulder / Adhesive Capsulitis

The by far most common type of a „stiff shoulder“ is the so-called “primary frozen shoulder", i.e. primary adhesive capsulitis. Here the cause for motion loss or pain is neither indicated in the medical history nor in a clinical examination, or radiographic evaluation. Without external cause, inflammation sets in at the joint capsule with subsequent occurring adhesions. It is typical that the patient first complains of pain that increases over time. Finally, movement of the shoulder joint is limited and painful.

A "secondary frozen shoulder" refers to the disease resulting from another disease or injury of the shoulder. For example, not moving the shoulder for a longer time after an accident, leads to a shrinking of the joint capsule and the ligaments. This results in limited mobility. A third, however rare causes for a frozen shoulder can the osteoarthritis of the shoulder joint. Bone spurs that form during the course of joint degeneration are causing friction resulting in a limitation of movements.

Symptoms: Frozen Shoulder / Adhesive Capsulitis

The disease „primary frozen shoulder“ is a lengthy illness during which the patient suffers from severe pain and partially an extreme loss of motion. Symptoms of primary frozen shoulder have been divided into three phases. During the first phase, pain especially during rest and sleep periods, are characteristic. The shoulder becomes increasingly stiff, whereby especially the outer movement of the shoulder is strongly limited. During the second phase, generally the pain lessens, however motion is still limited. The third phase involves recovery or thawing and is of variable duration. Usually, the disease disappears during this third phase by itself.

Diagnosis: Frozen Shoulder / Adhesive Capsulitis

Important is in particular the medical history of the patient, in particular, if the pain in the shoulder occurred without explainable causes, the symptoms worsened and movement of the shoulder has become limited. This will provide the decisive indications for establishing a correct diagnosis. Additional examinations, e.g. ultra sound, X-rays, or magnetic resonance imaging (MRI) help to exclude other causes, such as other diseases. Comprehensive examinations and special test procedures can further ascertain an accurate diagnosis.

Schulter Schultersteife CapsulitisVideo: Schulter Schultersteife Capsulitis

Conservative treatment: Frozen Shoulder / Adhesive Capsulitis

The treatment depends on the cause and the extent of the movement limitations and the affect such limitation has on the life quality of the patient. In each case, however, it is essential to recognize and diagnose a frozen shoulder at the earliest stage possible to avoid intensity of inflammation and increasing movement limitations.

Once the diagnosis is confirmed, the emphasis is on long-term anti-inflammatory therapy. Very effective is a cortisone injection which has a depot effect directly into the capsule joint so that the anti-inflammatory drug can act directly. The in most cases simultaneously taken medication anti-inflammatory tablets (dicofenac, ibuprofen, prednisolone) can thereby be kept to a minimum.

Subsequently administered homeopathic preparations (for example, Traumeel) may help the residual inflammation to regress or reduce the risk of a renewed flaring-up of the inflammation. Supporting the pain therapy, acupuncture treatments may be helpful in addition to cold packs.

For all types of shoulder stiffness, the emphasis is on physical therapy. The physician should discuss the cause of stiffness and the treatment concept with the physiotherapists. It is also important that the patient performs appropriate exercises to further improve the shoulder mobility.

Surgical treatment: Frozen Shoulder / Adhesive Capsulitis

If despite intensive conservative therapy the condition does not improve and if motion of the shoulder remains limited, an arthroscopy of the shoulder should be considered.

In many cases, it is possible to cure the stiffness through arthroscopic surgery.

In these surgical procedures with less trauma for the patient (minimally invasive), the shoulder is examined by means of optical instruments. Through an incision of about 3 mm in size, the smallest instruments are than accurately target the problem zone in the shoulder. Viewing the procedure on a screen, the existing adhesions can then be resolved and if necessary, the shrunken joint capsule expanded. The once common practice of a so-called "mobilization under anesthesia,” which meant to forcefully mobilize the shoulder, should today no longer be practiced.

Arthroscopy is a very successful and low-risk procedure to treat a frozen shoulder. The once commonly practiced " mobilization under anesthesia “, which involved a forceful mobilizing of the shoulder, should no longer be practiced.

Postoperative treatment: Frozen Shoulder / Adhesive Capsulitis

It is essential to gently mobilize the shoulder immediately after the arthroscopy. Appropriate physical therapy, possibly in combination with electrotherapy, should take place several times per week.

In addition, the patient should learn simple exercises that he or she can perform without supervision. Measures that improve the blood circulation, such as hot and cold showers and rubbing ice onto the shoulder, also support the healing process.

Specialists: Frozen Shoulder / Adhesive Capsulitis

For an optimal treatment of Frozen Shoulder / Stiff Shoulder / Adhesive Capsulitis, the shoulder experts at the Klinik am Ring are particularly well-qualified. Stefan Preis, M.D. and Jörg Schroeder, M.D., senior physicians at the Practice and Department of Orthopedics and Sports Traumatology at the Klinik am Ring in Cologne, specialize together with their team in the treatment of knee and shoulder disorders. In 2004, they founded the WEST GERMAN SHOULDER KNEE & CENTER, Cologne. The team consisting of eight specialists treats more than 10,000 patients per year. The team performs more than 2500 knee and shoulder surgeries per year of which about 1000 are arthroscopic surgeries.

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