Spontaneous, painful, jittery: the frozen shoulder at some point almost disappears as it came – if nothing else is behind it.
Risk factors, accompanying circumstances
Even if one does not know exactly why it comes sometimes to the “spontaneous” shoulder stiffness (primary form of the illness), then nevertheless some risk factors are well-known. These include disorders of the cervical spine, metabolic diseases such as diabetes (type 1 diabetes, type 2 diabetes) or thyroid dysfunction , strokes, autoimmune diseases, rarely Parkinson’s-Illness. Women are slightly more likely to be affected by primary shoulder stiffness than men, ages about 40 to 70 years. With time delay, both shoulders can fall ill. The primary shoulder stiffness is also called adhesive capsulitis. The name describes what happens here: in simplified terms, an inflammation with adhesions of the joint capsule and the surrounding tissue. The joint capsule is thickened and is very “tight” due to newly formed connective tissue – at the expense of mobility.
Secondary stiffness of the shoulder is possible as part of a rotator cuff syndrome (see above, “Chronic shoulder pain – calculus shoulder, tendon rupture”) or as an injury sequence, whether due to a long immobilization, after a herniated hernia at the shoulder, or after an intervention the shoulder or after other operations, also in connection with an accident. Secondary shoulder stiffness can then develop as a complication of acute infection of the shoulder joint or in shoulder osteoarthritis.
Symptoms: The problem starts with increasing shoulder pain, which can last for several months. Some sufferers call as triggers a wrong movement with the shoulder or an actually harmless fall. Often the whole thing comes out of nowhere. The pain occurs especially at rest and thus also at night and disturb the feeling sensitive. As the pain slowly recedes, stiffness increases. This phase can also take longer, about four to 12 months This concerns especially the raising and circling of the arm (active and passive) and thus all the daily movements of the arm at shoulder level, even more. Finally, after twelve to 36 months or later, the shoulder usually becomes more mobile again: really a game of patience.
Diagnosis: The doctor will rule out special causes. This is due to the exact documentation of the medical history, the careful physical examination and imaging techniques such as ultrasound and X-ray examinations. For example, with primary stiffness of the shoulder, the X-ray image of the shoulder is normal, at most occasionally showing a slightly reduced bone density. Also with regard to the risk factors in the form of other illnesses, a diagnosis is recommended with appropriate references; In-depth laboratory analyzes and diagnostic imaging procedures should therefore not be delayed.
Therapy: In the painful phase, pain relieving anti-inflammatories or a simple analgesic such as paracetamol may be used, sometimes even an opioid. In addition, the doctor uses cortisone – a few injections into the joint, combined with a topical anesthetic. The stiffening can be significantly improved by conservative measures, in particular an exercise treatment (physiotherapy) and manual therapy. The exercise therapy must take place over months every day with an increase in small steps according to improvement. If there is progress or if there is too much movement deficit, intervention in the context of joint arthroscopy (arthroscopy) can help. Adhesions can be loosened and the shrunken joint capsule split and widened. Arthroscopy also has diagnostic significance,
In the post-treatment phase, physiotherapy is again very important. Initially, a targeted pain relief may facilitate the practice. The shoulder exercises should “in flesh and those affected blood pass” in order to subsequently perform daily self. Of course, the doctor also deals with accompanying internal illnesses. Whether supportive psychological therapy is useful, you should talk to your family doctor.
Shoulder arthrosis is rather rare, as the main joint is little loaded. Most commonly affected: The Schultereckgelenk at the outer end of the clavicle
– Osteoarthritis = joint wear: arthrosis is caused by cartilage and bone abrasion on articular surfaces. The primary form is not based on other diseases. However, inflammation, swelling and effusions often occur in active disease phases. The damage finally reaches joints near the joints below the articular surface. As a result, the joint may deform and stiffen. If osteoarthritis is due to injury or other illness, it is secondary .
The smaller shoulder joint gets under pressure from all wear-prone lifts above the horizontal, for example in overhead sports or years of heavy bodywork involving the shoulder. Therefore, osteoarthritis (ACG osteoarthritis) develops more frequently in this second joint of the shoulder. In addition to chronic wear and tear, genetic factors and injuries such as shoulder articulation also play a role.
On the main joint of the shoulder can arthrosis ( osteoarthritis ) arise, for example in tendon tears in the region of the rotator cuff, in particular if the head of the humerus is constantly in contact with the acromion. Fractures of the upper arm – the head or shaft of the humerus – can also cause osteoarthritis . Then include rheumatic diseases ( rheumatoid arthritis ) to the classic triggers of secondary osteoarthritis, as well as circulatory disorders of the bone (so-called osteonecrosis, see below each).
Symptoms: If the shoulder joint is affected, one step may be visible there – perhaps as a result of a previous bursting ligament injury , causing the joint parts to move against each other. The shoulder, often the arm, hurts, especially when bringing the arm to the opposite side, for example when washing under the armpit or when moving overhead.
In the case of the shoulder joint , the shoulder in the front part is painful. Frequently patients also complain that the shoulder has become stiffer
Diagnosis: The details of the person concerned about current and past complaints and the physical examination by the doctor usually already point the way to the diagnosis. Among other things, the clinical examination includes an adduction test – the physician guides the arm of the affected side to the opposite side to check whether this movement is restricted due to pain and / or stiffness (see previous section: “Symptoms”). The domain of the diagnosis of joint wear and tear is still the X-ray. Supplementary examinations take place for special questions.
If these measures are not successful, an intervention in question, in which the worn joint portion is removed and optionally replaced by a tendon graft. This is possible, for example, at the shoulder joint – arthroscopically, ie as part of a joint mirroring, or as an open minimally invasive operation. Possible damage to the rotator cuff can be treated (see Acromioplasty in the section “Chronic Shoulder Pain: Calcification Shoulder, Tendon Rupture”).
A severely damaged, arthritic shoulder joint with constant pain can be replaced by an artificial joint (prosthesis). There are different types of prostheses for different degrees of joint damage, so even a younger age is no longer a limiting factor today.
– Example secondary osteoarthritis: circulatory disorder with tissue damage to the shoulder joint (osteonecrosis): If tissue is not sufficiently supplied with blood, it takes lasting damage. The circulatory deficiency can be caused by an injury (traumatic) or for other reasons (atraumatic, illness-related). In addition to the more commonly affected hip and knee joint, circulatory disorders can also occur at the shoulder, especially in the area of the humeral head, ie at the shoulder joint.
The damaged bone is less resistant to mechanical stress and breaks down as the injury progresses. Since it usually goes to the area close to the joints, damage to the sensitive articular cartilage is not enough. Consequence is a secondary arthrosis. The actual causes are unknown. For example, risk factors include working under pressurized air conditions, excessive alcohol consumption, pronounced lipid metabolism disorders, certain blood disorders, and connective tissue disorders such as lupus erythematosus (an autoimmune disease in which the immune system attacks the body, including the blood vessels, causing circulatory disorders). Also drugs, such as cortisone, are among the risk factors.
Symptoms: In those affected, shoulder pain at rest, such as at night, also increases during the day depending on the intensity of the shoulder work. It can come to audible joint noise and blockades. As the disease progresses, the radius of movement of the shoulder decreases. Depending on the (co-) responsible incident further complaints are possible.
Diagnosis: It is based in particular on the carefully-drawn medical history, the physical examination and imaging procedures. In addition to X-rays, these are usually magnetic resonance imaging, rarely scintigraphy. Also rare is a tissue sampling ( biopsy ) to exclude other bone diseases. Doctors know four disease states.
Therapy: As usual, the treatment depends on the diagnosis and the stage of the disease. In addition, it is important to get a handle on risk factors. As long as X-ray images show a normal contoured shoulder joint in addition to the first pathological changes (stages one and two), conservative measures are of primary importance, especially physiotherapy. In the three stages (damage to the joint-near bone) and four (osteoarthritis), surgical techniques are available. They range from interventions that can preserve the joint for the time being and relieve pain, to joint replacement. For example, a joint-preserving procedure is the tapping of the diseased bone (called core decompression), which relieves pressure from the bone, improves blood circulation, and relieves pain (rather, it does not make sense in stage four).