Frozen Shoulder

There are two types of frozen shoulder: a primary and a secondary type.
The primary type of frozen shoulder begins with an unspecific inflammation of the joint mucosa which may also be triggered by hormonal disorders or disorders of the blood glucose or lipid metabolism. It predominantly affects women in their 4th to 6th decade of life. At first, the disease is characterized by shoulder pain leading to an increasing disuse of the affected arm. In combination with the inflammation, this leads to a severe shrinking of the capsule which further restricts the movability of the glenohumeral joint. The disease progresses in phases and may even resolve spontaneously.
The secondary type of frozen shoulder may occur as a consequence of a long period of joint immobilization, surgery, an inflammation or injury. This type also leads to reduced movability of the joint due to the shrinking of the joint capsule.

Therapy

The objective of the treatment is to restore painless and complete movability of the glenohumeral joint.
At first, medicinal treatment using an "incremental cortisone regime" is administered for about 3 weeks. Only after completing this incremental regime, we recommend the commencement of passive physiotherapy within the painless range.
If the treatment objective cannot be reached using conservative measures, the shrunken joint capsule may be cut arthroscopically (closed method). In addition, the inflamed joint mucosa is removed.

Fig. 25: Initially, the anterior joint capsule is incised.  

 

Fig. 26: The posterior part of the joint capsule will be incised after the anterior capsular release.

Follow-up treatment

The patient has to stay at the clinic for only a few days in order to allow an early mobilization of the glenohumeral joint and to prevent repeated shrinking of the capsule. Already on the day after surgery, the arm must be moved under local anesthesia on the instructions of a physiotherapist. This is also required in order to prevent adhesions.

Ability to work

Return to work is possible after 3 - 4 weeks; in case of patients performing heavy physical work or predominantly activities above their head, the rehabilitation phase is extended to 6 - 12 weeks.

Ability to do sport

As a rule, with resumption of work, leasure activities may be resumed as well. Here, the individual type of sport and the specific strain on the shoulder girdle should be taken into account and discussed.