Frozen shoulder 4.31/5 (13)

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Adhesive capsule, frozen shoulder

"Frozen shoulder". illustration: CDC [Public domain], via Wikimedia Commons

Definition

Frozen shoulder (frozen shoulder, adhesive capsulite) is a painful but not dangerous rheumatic inflammation of the shoulder.

  • The inflammation leads to increased connective tissue (fibrosis) and stiffness around the shoulder joint

Occurrence

About 3-5% of the population is attacked

  • Women make up 70% of cases and the age group 40-60 years is most at risk.

Disease Cause

The disease often begins as tendonitis after an overload or for unknown reasons. Risk factors are other diseases.

  • In diabetes mellitus (both type I and type II) get up to 20% frozen shoulder
  • Other dispositions are systemic connective tissue disease, metabolic disease, Dupuytren's contact clock (in the palm of the hand), strokes and injuries
  • If one has had frozen shoulder on one side, the possibility of corresponding on the other side increases
Adhesive capillary

Increased connective tissue and stiffness at “Frozen shoulder”. The Joint Clinic. CC SA BY 4.0

Symptoms

The course of the disease can be divided into four stages

  1. Frozen shoulder begins with strong shoulder pain both day and night. This first stage lasts from a few weeks to months
  2. Rheumatic inflammation of the tendons and other connective tissue surrounding the joint (joint capsule) causes thickening (fibrosis) and reduced mobility, so that the shoulder joint gradually solidifies partially or completely. At this stage, the joint stiffens and it becomes impossible to lift the arm or carry the hand on the back (decreased elevation and rotation)
  3. Stiffness (stage three) usually lasts up to one year
  4. Movement is getting better in stage four

Many people find that the other shoulder is also attacked later in the process.

Frozen shoulder

Frozen shoulder MR image. Li JQ, Tang KL, Wang J, Li QY, Xu HT, Yang HF, Tan LW, Liu KJ, Zhang SX - PLoS ONE (2011). Open-in.

Diagnosis

The history of sickness suspects frozen shoulder. On examination, (by testing passive movement of the joint) it is shown that the shoulder joint itself has become more or less stiff (impaired abduction and rotation) even when all muscles are relaxed.

  • MRI examination or evaluation with ultrasound can confirm the diagnosis
    • One detects thickened joint capsule and tight joint in the shoulder joint
  • On ultrasound examination, a reduced movement of the supraspinatus tendon can sometimes be observed in the joint
  • Blood tests are expected to be normal

Treatment

For pain, tablets such as paracetamol (Paracet, Pinex) or NSAIDs (ibuprofen, naproxen, diclofenac, etc.) are used. At an early stage (stage one), injection with cortisone may also be useful.

  • Against rigidity, it is recommended in gentle movements, for example, to allow the arm to swing freely
  • Physiotherapists are often contacted to customize this treatment
  • Operation or attempting to loosen the stiffness with force is rarely advantageous

Prognosis

Frozen shoulder does not attack other parts of the body, and in the longer term the prognosis is good, although some will have sustained reduced mobility.

  • After two to three years, about 90% will have regained almost normal range of motion and are without any particular pain

Literature


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