|Classification according to ICD-10|
|M75.0||Adhesive inflammation of the shoulder joint capsule
- Frozen shoulder
|ICD-10 online (WHO version 2019)|
As Frozen Shoulder ( English for "frozen shoulder" - Syn: painful frozen shoulder , adhesive capsulitis , Duplay syndrome ) refers to a high degree, pain-related cancellation of the mobility of the shoulder joint . A painful frozen shoulder can have a wide variety of causes, the term merely describes the clinical fact of pain-related loss of mobility. In contrast to a blockage or a single mechanical disorder such as tendinitis or osteoarthritis , mobility is greatly reduced in all three possible planes of movement with the painful shoulder stiffness.
If the cause is known, one speaks of a "secondary" frozen shoulder , otherwise of a "primary" or " idiopathic ". The latter form can also be referred to as "adhesive capsulitis". The term Periarthropathia humeroscapularis , coined by Duplay in 1872 for a traumatically caused painful stiffening of the shoulder and previously or incorrectly also used synonymously for Frozen Shoulder, is an imprecise collective term for (formerly regarded as a manifestation of "soft tissue rheumatism") diseases of the soft tissue covering of the shoulder or all diseases of the subacromial space.
Anatomical features of the shoulder joint
The joint socket on the shoulder blade is very small in relation to the humerus head and the joint is mainly guided by the muscles and the joint capsule . Therefore, the range of motion in the shoulder joint is very large and the capsule is very wide. As a result, in every position this capsule wrinkles on one side or the other . Are certain movements in the shoulder joint z. B. permanently avoided due to painful changes or through immobilization measures, these folds can stick together and a specific movement restriction of the shoulder joint forms (so-called capsule pattern in the passive joint examination).
Another possible cause of the restriction of movement is a shortening of muscles that move the joint and have to give way when moving in the opposite direction.
The maximum age of primary painful frozen shoulder is 40 to 60 years; Men and women are equally affected. In up to 30% of the cases it occurs on both sides. It is seen more frequently in patients with diabetes mellitus , thyroid dysfunction and lipid metabolism disorders .
The cause of the primary form is unknown; in addition to operations and injuries , the secondary can also be based on diseases of the subacromial space , long-term immobilization, especially changes in the rotator cuff , such as a tear .
The primary form characteristically runs in three stages: At the beginning there is synovitis , which is arthroscopically recognizable and which increases in the further course (additionally in this stage occurrence of joint capsule irritation - "capsulitis"), until in the end stage there is atrophy of the joint capsule ( Shrinkage and sticking lead to a reduction in the size of the joint interior. The course of the disease can last one to four years, the prognosis is good, but minor restrictions may remain.
- Stage 1 (initial phase): The focus is on increasing pain on the move, which can be severe to unbearable and worsens, especially at night. Restricted movement is often not noticed by the affected person at first. This stage usually lasts three to nine months.
- Stage 2 (stiffening phase): In this stage the pain slowly subsides - there is a significant decrease in mobility, especially when the arm is turned outwards or inwards or spread apart. Towards the end of this phase, the shoulder may be completely restricted in its movement. This stage can last up to fifteen months.
- Stage 3 (solution phase): The now stiffened and no longer painful shoulder slowly becomes more mobile again because the inflammatory changes in the joint capsule recede. The affected shoulder joint is ultimately only insignificantly restricted in its mobility or even fully mobile again. This stage lasts an average of nine months.
In addition to operations and injuries, typical causes are diseases of the subacromial space, long-term immobilization and, in particular, changes in the rotator cuff.
The interior of a bursa is not in direct contact with the bloodstream. If bleeding occurs - in the case of any injuries - the body cannot reabsorb the blood, as in other parts of the body. Over time, this blood turns into a chalky, brittle material that remains in the bursa. An unfavorable movement is often enough to pinch this lime plug. The surrounding tissue swells, the space in the shoulder joint is functionally reduced (there is no space for the anatomical structures) , and every movement hurts.
Another explanation for an inflammation of the bursa is the combination of overloading due to too much pressure from the humerus, which rises too far upwards when spreading (humeral head elevation or disturbed movement, see below - the bursa is not so well suited as a shifting layer) with one too trophics disturbed by pressure (supply situation of the tissue). Lime tends to be deposited where the tissue pH value is too low (that is, the tissue is too acidic).
- Rotator cuff injuries
Injuries and tears of the rotator cuff occur as an acute consequence of accidents at a young age as well as a multifactorial, essentially degenerative clinical picture in advancing age. The latter, in particular, can lead to the clinical picture of a frozen shoulder if the shoulder joint is unstable and osteoarthritis increases.
- Impingement Syndrome
When impingement (pinching) it is probably the most common cause of a painful shoulder stiffness. The opinion about the causes of the impingement is not yet uniform; several causes are usually mentioned.
The rotator cuff pulls between the head of the humerus and the roof of the shoulder. This is also where the subacromial bursa is located (see above). There is relatively little space there, depending on the shape of the bones. The acromion including the joint to the collarbone (shoulder-corner joint) and the ligament (ligamentum coracoacromiale) running to the raven beak extension of the shoulder blade are called the "shoulder roof". If a tendon in between is irritated, it swells and the already small space is then even more narrowed with pain and a disruption of the structure of the tendon / rotator cuff. This happens especially when the movement is disturbed when the arm spreads apart (see injuries to the rotator cuff and disturbed sliding downwards).
Chronic overloads with small tears in the tendons or the joint lip ( Bankart lesion ), forced throwing sport and age-related atrophy of the rotator cuff on the shoulder are also possible.
Arthrotic changes in the joint, especially in the shoulder joint (acromioclavicular joint), result in osteophytes that can grow in the shape of a hook into the space in which the humeral head or the rotator cuff is moved. Here, too, a painful restriction of movement is the result.
The consequences of injuries as well as excessive strain can lead to damage to the shoulder joint. Particularly severe osteoarthritis is found in people who have been dependent on forearm crutches for a long time because of other diseases . The degenerative changes then also lead to a painful restriction of movement. In the advanced stage, as with other joints, the condition of activated osteoarthritis can occur, in addition to the degenerative changes, inflammatory reactions then occur.
- Arthritic irritation
Just like any other joint in the body, the shoulder can also be affected by inflammatory processes ( arthritic irritation ).
Metastases from cancerous tumors that have settled in the head of the humerus are less common, but their therapeutic consequences must be clearly distinguished .
Characteristic are severe pain in the shoulder and upper arm area, pronounced paralysis of the shoulder and upper arm muscles and an atrophy of the denervated muscles that is visible early in the course of the disease.
Undetected fractures in osteoporosis can trigger the same symptoms, but are usually associated with a significant bruise that can seep into the hand. These breaks are rarely overlooked.
It should not be forgotten that many tension disorders of the shoulder muscles are (partly) caused by internal tension - "carrying too much on the shoulders" etc.
The frozen shoulder can easily be determined from the clinical findings with the sometimes considerable restriction of movement. However, since no statement has yet been made about the cause of these symptoms, a more detailed examination must follow. This basically includes conventional X-ray diagnostics and the determination of suitable laboratory parameters for the detection of inflammatory causes. In addition, ultrasound , magnetic resonance imaging (MRT) and, in rare cases, arthrography or arthroscopy can also be useful.
The cervicobrachial syndrome is often accompanied by pain, limited shoulder. The carpal tunnel syndrome often causes pain throughout the arm to the shoulder. Treatment of the shoulder is of no use in either case.
therapy and progress
The frozen shoulder often has a slow disease course that lasts for years. Half of the patients still have symptoms after two years and 15% have permanent impairment.
The therapy is primarily conservative with pain therapy and intensive physiotherapy during the predominantly stiff phase of the disease. Anesthesia mobilization is also required in this phase. H. Movement of the shoulder beyond the stiffness under anesthesia , and the arthroscopic incision of the joint capsule (capsular release) helpful.
- Entry on Frozen shoulder in Flexikon , a Wiki of the DocCheck company
- Martina Feichter: Frozen Shoulder in the NetDoktor portal , December 14, 2016.
- MJ Page, S. Green, S. Kramer, RV Johnston, B. McBain, M. Chau, R. Buchbinder: Manual therapy and exercises for frozen shoulder (adhesive capsulitis, frozen shoulder). Translation by G. Diermayr, M. Lohkamp and C. Braun. Cochrane Collaboration , August 26, 2014 (treatment success compared to glucocorticoid injections).
- ↑ a b c d e V. Echtermeyer: Praxisbuch shoulder. Thieme Verlag, 2004, ISBN 3-13-102212-4 , p. 167 ff. (Online)
- ↑ Periarthropathia humeroscapularis. Summary from Current Rheumatology. Volume 4, 1979, Part 1, pp. 65-79; Part 2, pp. 123-131, by FJ Wagenhäuser: In: M. Aufdermaur u. a. (Ed.): Rheumatology C. Special Part II: Spine, Soft Tissues, Collagen Diseases. (= Handbook of Internal Medicine. Volume 6.2.C). Springer, Berlin / Heidelberg 1983. ISBN 978-3-642-88229-6 .
- ↑ Jürgen Wehner: Painful frozen shoulder - Periarthropathia humeroscapularis - PHS In: Medizinfo.
- ↑ Ludwig Heilmeyer , Wolfgang Müller: The rheumatic diseases. In: Ludwig Heilmeyer (ed.): Textbook of internal medicine. Springer-Verlag, Berlin / Göttingen / Heidelberg 1955; 2nd edition ibid. 1961, pp. 309-351, here: pp. 342-346: The soft tissue rheumatism (fibrositis, muscular rheumatism, myalgia, panniculitis ), in particular p. 345 f. ( The humeroscapular periarthritis ).
- ↑ Wolfgang Miehle: Joint and spinal rheumatism. Eular Verlag, Basel 1987, ISBN 3-7177-0133-9 , pp. 175.
- ↑ pain network Austria: Periarthropathia humeroscapular.
- ^ CJ Wirth: Orthopedics and orthopedic surgery. Thieme Verlag, ISBN 3-13-125661-3 , p. 115. (online)
- ↑ J. Duparc et al. a .: Surgical techniques in orthopedics and traumatology. Urban & Fischer-Verlag, 2005, ISBN 3-437-22526-X , p. 31. (online)