Frozen shoulder

The joint capsule

Each joint is surrounded by a capsule. It holds the joint together and, in most cases, the ligaments that additionally reinforce the capsule run inside it. The inside of the capsule is lined with synovial fluid, the inner membrane that produces synovial fluid and thus nourishes the joint. Irritation of the capsule can be very painful.

The course

In frozen shoulder or arthrofibrosis, the joint capsule swells with inflammation and the shoulder joint becomes increasingly immobile. The disease passes through 3 stages:

1. During "freezing", the joint is initially very painful. However, mobility is still preserved. Nocturnal and constant pain is very troublesome, and there is also pain on exertion, typically during involuntary movements.
2. The joint is "frozen" when it can no longer move. The degree of stiffness varies, but can be considerable. Sometimes it goes so far that you can hardly eat with your arm, let alone comb your hair. Fortunately, the pain subsides.
3. When "thawing", the pain continues to ease and mobility slowly returns. This phase can last for several months. Courses of a year or more are not uncommon.

Causes

Although the condition is very common, the actual cause is not known. Possible triggers include previous accidents involving injury to the shoulder, operations and immobilisation of the joint. However, there is also an increased incidence in various diseases such as diabetes, neurological diseases, thyroid disorders and arteriosclerosis. It is also possible for both sides to be affected.

Conservative treatment methods

Fortunately, frozen shoulder (adhesive capsulitis) passes on its own. The question is how long it lasts and how much you suffer from it. There is no standard treatment. A large study from France with 235 patients examined six different forms of treatment for their effectiveness and came to the conclusion that physiotherapy with a daily exercise programme at home and painkillers is the most effective treatment.

Cortisone can also be used. It inhibits the inflammation of the joint capsule and thus leads to rapid pain relief. It has less effect on mobility. Administered as a tablet, it should not be given for too long because of the side effects. Injected into the joint, it works locally and has hardly any side effects.

Surgical treatment methods

Surgery is also an option. The joint capsule can be cut open to restore mobility to the joint. Today, this operation is performed arthroscopically, i.e. using keyhole surgery. The important tendons of the rotator cuff can be spared. A very good and intensive rehabilitation programme is important after the operation so that the capsule does not scar again and the shoulder becomes stiff again. In the past, the shoulder was moved under anaesthetic and the capsule torn open. This method should no longer be used because it sometimes resulted in bone fractures.

Prospects of success

In all cases, it is important that you have the right care. This is because the disease is protracted, severely restrictive and rehabilitation is often frustrating in its slowness. Your doctor and therapist must be aware of this, respond to you and have the necessary patience and perseverance during therapy.

Book a consultation appointment

Dr Andreas L. Oberholzer is an experienced FMH specialist in orthopaedics and trauma surgery.

We guarantee rapid, expert clarification and advice as well as treatment using the most modern methods.

Book your appointment directly online here or call us on +41 44 388 16 16. You are also welcome to come to us for a second opinion.