Frozen Shoulder: painful frozen shoulder

First, there is severe pain, then increasing immobility in the Shoulder. This is how the frozen shoulder syndrome, also called frozen Shoulder or adhesive capsulitis (also called capsulitis), shows up. But why do you get a frozen shoulder? Can psychological causes lead to a frozen Shoulder? Which exercises can help, and what role does diet play? You can find answers to these questions and more information about frozen Shoulder here.

What is a Frozen Shoulder?

Frozen Shoulder means “frozen shoulder” in German. The name describes what this disease is about very well. After an initial phase of pain, the joint in the Shoulder becomes stiff, and its mobility is severely restricted. This movement restriction of the shoulder joint is an inflammation and the subsequent adhesion of the shoulder joint capsule.

Frozen Shoulder affects more women than men and usually occurs in middle age.

 

Symptoms: How does a frozen shoulder manifest itself?

Depending on the phase of the disease, a frozen Shoulder brings different symptoms. The duration of the individual stages varies significantly from person to person. The following times are, therefore, only rough guidelines.

Phase 1: “Freezing Shoulder”

In the beginning, the disease is characterized by insidious, ever-increasing shoulder pain. These occur mainly when moving but can also occur at rest and severely disturb sleep at night. The pain is due to inflammation of the synovial membrane and joint capsule. In this first phase, the mobility of the shoulder joint is not yet restricted. How long the pain phase lasts varies. It can last up to three months.

 

Phase 2: “Frozen Shoulder”

During this phase, the pain gradually subsides. The increasing adhesion and adhesion of the capsule tissue leads to a shrinkage of the shoulder capsule. There are sometimes extensive restrictions on the shoulder joint movement and its stiffening. The Shoulder feels like “frozen”. This stage usually lasts between four and eight months.

Phase 3: “Thawing Shoulder”

After about eight months, the Shoulder slowly becomes more mobile; it “thaws out”. There is hardly any pain during the thawing phase. However, the shoulder joint can take months to years to regain full mobility.

Frozen Shoulder: Cause often unknown

While the origin of frozen Shoulder has been widely researched from a medical point of view, the causes are largely unknown. Depending on the triggers, two different forms of frozen Shoulder are distinguished.

 

Primary frozen Shoulder

Frozen Shoulder is the most common form and occurs without apparent cause. It cannot be traced back to any existing illness or previous injury. It is also called idiopathic frozen Shoulder.

Secondary frozen Shoulder

In this form, a frozen shoulder follows another illness or an accident. Examples of possible causes include:

• Immobilization of the shoulder joint after an injury (such as a rotator cuff tear or contusions )
• Impingement Syndrome
• Calcified Shoulder
• shoulder infection
• Wear and tear of the shoulder joint (hemarthrosis)
• Diabetes
• thyroid disorders
• Diseases of the heart, lungs or cervical spine

Shoulder pain: psychological causes

It is often physical triggers, such as injuries to the Shoulder, that cause shoulder pain. However, psychological causes can also lead to complaints in the shoulder area. When faced with stress, fear or worry, many people pull their shoulders up, resulting in poor posture and tension in the shoulder muscles. Pain in the Shoulder that can be traced back to psychological causes thus falls under the heading of psychosomatics. Whether the clinical picture of a frozen Shoulder is also a result of psychological stress can only be speculated about.

 

Differentiation from other shoulder diseases

Frozen Shoulder, impingement syndrome, calcified Shoulder or omarthrosis are diseases of the Shoulder that are associated with pain. When making the diagnosis, it is therefore crucial to differentiate it from other shoulder diseases. Imaging methods such as X-rays or ultrasound usually do not show any changes in the joint structure in a frozen Shoulder.

In contrast, with the calcified Shoulder, calcareous deposits and impingement syndrome, an inflammation of the bursa and a constriction between the head of the humerus and the acromion can become visible.

The doctor can also use a test to distinguish frozen Shoulder from other shoulder disorders. This is the so-called inferior glide test. With a frozen shoulder, this test triggers pain in the Shoulder, but not with impingement syndrome or osteoarthritis.

Treatment: What helps with a Frozen Shoulder?

The first goal of treatment for a frozen shoulder is to achieve freedom from pain and full mobility of the shoulder joint. The type of therapy depends on the underlying cause of the disease and the phase in which the frozen Shoulder is.

Conservative procedures such as physiotherapy or osteopathy can be used, as can expansion of the shoulder joint through injections (distension arthrography) or various pain-relieving and anti-inflammatory drugs. In up to 90 per cent of patients, conservative treatment of the stiff Shoulder is successful.

Surgery is usually only an option if conservative therapy has not been successful, the course of the disease is protracted, and the level of suffering is very high.

physical therapy and exercise

In the early phase of the disease, which is usually characterized by pain, the focus is on pain relief. Intensive movement is often difficult to achieve. Physiotherapeutic treatment is therefore only recommended in the second and third phases of the stiff Shoulder to improve shoulder joint mobility.

Suppose the Shoulder becomes increasingly mobile and pain-free in the third phase of the disease. In that case, you can also do gentle sports like swimming and physiotherapy to strengthen the shoulder muscles.

 

exercises to do at home

You can stretch your shoulders with a variety of exercises. Some stretching exercises can also be done on your own at home. Pain should be avoided in all exercises.

Below are some examples of shoulder exercises that can help with a frozen Shoulder:

1. While standing, allow the affected arm to swing loosely back and forth to the side of your body with small movements for about three minutes. You can also stand with the healthy side of your body next to a stable chair and hold on to it, lean forward slightly and swing the diseased arm slightly sideways in front of your body.
2. While standing, use your other arm to raise the arm on the affected side to chest height and keep it straight. Grasp your arm at the elbow and gently pull it towards your upper body. Do the stretch for about 20 seconds.
3. Stand in front of a wall and touch the wall with the fingertips of your affected arm at about the level of your navel. Slowly and carefully “crawl” up the wall with your fingers, as far as possible without pain, and then carefully lower it back down. The sound arm can support the other if necessary.

osteopathy

The goal of osteopathic treatment is to loosen stuck fascia and loosen blockages. A significant improvement in symptoms can occur with specific massage techniques from osteopathy, which are used repeatedly.

medication

Both anti-inflammatory drugs and painkillers, including so-called NSAIDs ( ibuprofen, diclofenac ) or steroids ( cortisone ), are used to treat frozen shoulders. Drug therapy plays an important role, especially in the first phase of a frozen Shoulder, as this is characterized by severe pain. Pain relief is also a prerequisite for the successful implementation of physiotherapeutic exercises. However, medication only temporarily improves symptoms. Due to their side effects, they are not suitable for long-term use.

 

Operation

If an operation is necessary, it is usually minimally invasive. This means only small skin incisions are made to minimize tissue damage. The joint capsule is detached during the operation, and adhesions are removed. Painkillers are then given, and passive movement training and physiotherapy are started immediately. Surgery can shorten the duration of frozen shoulder disease.

Distensionsarthrografie

A saline solution containing cortisone is injected into the joint under local anaesthesia. The fluid introduced stretches the joint, which can help alleviate symptoms and increase mobility. The cortisone also has an anti-inflammatory effect. However, this treatment can be excruciating, so it is not recommended nowadays.

Other treatment approaches

There are also other treatment approaches for frozen shoulders, but their effectiveness in frozen shoulders has not been scientifically proven:

• Cell-biological regulation therapy (matrix therapy): With this therapy, the metabolism in the Shoulder and the natural vibration of the muscles are to be improved with the help of a particular massage device to shorten the duration of the disease.
• Ultrasound therapy: Ultrasound waves generate heat in the shoulder tissue, promote blood circulation and loosen adhesions.

 

What role does nutrition play?

A stiff shoulder is caused by inflammation in the joint. Some foods are suspected of supporting inflammatory processes. This includes animal foods, especially those high in arachidonic acid, such as pork, sausage, or butter.

Other foods, conversely, can inhibit inflammation by counteracting acidification in the body. These so-called alkaline foods include fruit, vegetables, fish, and vegetable oils such as linseed, olive, and rapeseed. An anti-inflammatory diet can help the body fight inflammation in the shoulder joint.

Frozen Shoulder and Disability

Restricted mobility and pain associated with a frozen shoulder can mean the job can no longer be carried out temporarily. Understandably, people who do physical work are more likely to be temporarily unable to work due to a stiff shoulder than people with an office job. How long the affected person cannot work and how long a sick note is required depends on the severity of the symptoms and the profession.