Adhesive capsulitis of shoulder

As a Frozen Shoulder ( Syn: humeroscapularis periarthritis, frozen shoulder and Duplay syndrome) refers to a broad, pain-related cancellation of the mobility of the shoulder joint. One of " painful frozen shoulder ", the various causes underlie the term only describes the clinical fact of pain-related cancellation of the mobility. In contrast to the blocking is this possible in all three planes of motion.

• 6.1 Differential Diagnosis

Classification

If the cause is known, then one speaks of a "secondary" frozen shoulder, otherwise a " primary" or " idiopathic ". The latter shape is also referred to as " adhesive capsulitis".

Anatomical peculiarities of the shoulder joint

The socket of the shoulder blade is very small relative to the humeral head and the leadership of the joint performed primarily by the muscles and the joint capsule. Therefore, the range of motion in the shoulder joint very large and the capsule is very wide. In any position, this capsule raises accordingly on one side or the other folds. If certain movements of the shoulder joint due to painful changes permanently avoided, may result in adhesions of these folds and forms from a so-called capsule Patterns: In the passive joint investigation shows a joint- specific restriction of movement of the shoulder joint.

Another possible cause of restraint is a shortening of muscles that need to move the joint and give in movements in the opposite direction.

Occurrence

The peak age of the primary painful frozen shoulder is 40 to 60 years, men and women are equally affected. Up to 30% of cases, it occurs on either side. Heaped she can be seen with diabetes mellitus, thyroid dysfunction and lipid disorders in patients.

Causes

The cause of primary form is unknown, the secondary can besides surgeries and injuries and diseases of the Subakromialraumes, prolonged immobilization, especially changes in the rotator cuff, such as a crack, is based.

Disease

Primary form

It runs chakteristischerweise in 3 steps. Initially, arthroscopic synovitis seen, the increases in the course (in addition at this stage occurrence of a joint capsule irritation - " capsulitis " ) until the final stage then atrophy of the joint capsule ( shrinkage and adhesion lead to a reduction of the joint internal space ) occurs. The disease can go on for 1 to 4 years, the prognosis is good, but a minor inconvenience may remain.

• Stage 1 (initial phase): In the foreground is a growing movement of pain that can be severe to unbearable and especially at night even worse. A limitation of movement is often first noticed by the people concerned. This stage usually lasts three to nine months.
• Stage 2 ( Einsteifungsphase ): At this stage the pain subsides slowly - there is a significant increase in restriction of movement, especially when the arm is rotated or splayed outward or inward. Towards the end of this phase can be completely restricted in their movement the shoulder. This stage can last up to 15 months.
• Stage 3 (solution phase): The shoulder now stiffened and no longer sore is now slowly moving because regress the inflammatory changes in the joint capsule. The affected shoulder joint is ultimately limited only marginally in his mobility back or even move freely. This stage lasts an average of nine months.

Secondary form

Typical causes are in addition to surgery and injuries and diseases of the Subakromialraumes, prolonged immobilization, and especially changes in the rotator cuff.

The interior of a bursa is not in direct connection with the blood circulation. If there is - in any injuries - is hemorrhaging, the body can not the blood, as in other parts of the body reabsorb. Over time, this blood is to a chalky, a little liquid material that remains lie in the bursa. An unfavorable movement then is often sufficient to clamp these Kalkpfropfen. The surrounding tissue swells, the space in the shoulder joint is functionally reduced ( the anatomical structures have no place ), every movement hurts.

Another explanation for the inflammation of the bursa is the combination of overload caused by too much pressure by the morbidly rising from the abduction humerus ( Humeruskopfhochstand or impaired movement see below - for which the bursae not as well suited as a sliding layer ) with a by the pressure disturbed trophism ( Versorgungssitutation of the tissue). Like lime is deposited there, where the tissue pH is too low ( acidic) is.

Injuries and rotator cuff tears occur as an acute consequence of an accident in younger age as well as multifactorial, mainly degenerative disease in advancing age. The latter, especially when instability of the glenohumeral joint osteoarthritis and increasing the clinical picture of Frozen Shoulder can lead.

When impingement ( pinching ) is probably the most common cause of painful shoulder stiffness. The opinion on the causes of impingement is not uniform, usually several causes are mentioned.

Between the humeral head and the " acromion " the rotator cuff pulls through. This is also the subacromial bursa (see above). It is there, depending on the shape of the bones, relatively little space. As the " acromion " refers to the acromion, including the joint to the clavicle (shoulder - corner hinge ) and the current to the coracoid process of the scapula band ( coracoacromial ligament ). When a tendon is irritated in between, these swells, and the already small space is then more concentrated with pain and disruption of the structure of the tendon / rotator cuff. This occurs mainly in disturbed gait when Abspreizbewegungen of the arm (see below rotator cuff injuries and disturbed Caudalgleiten ).

But chronic overloads with small breaks of tendon or labrum ( Bankart lesion), forced Throwing sports exercise and age-related atrophy of the rotator cuff in question come at the shoulder.

Arthritic changes of the joint, especially of the acromioclavicular ( Acromioclavikulargelenk ) have osteophytes result that grow into the space in which the humeral head and the rotator cuff moves ( Hook). Here is a painful restriction of movement will result.

Injuries, as well as overloading may lead to injury of the shoulder joint. Particularly severe arthritis found in people who had to rely very long time on crutches due to other diseases. The degenerative changes also lead then to a painful restriction of movement. In advanced stages, it can also, as in other joints, come to the state of an activated arthrosis, come in addition to degenerative changes then inflammatory reactions.

Just like any other joint in the body can also be affected shoulder of inflammatory processes ( arthritic irritation ). Depending on the type of the disease may be present here oligoarthritis or polyarthritis.

Rare, but significantly in their therapeutic consequences are metastases of a cancer tumor, which absiedeln in some cases in the humeral head.

Undetected fractures in osteoporosis can cause the same symptoms, but are most often associated with a severe bruising, which can seep into the hand. These fractures are hard to miss.

It must not be forgotten that many of voltage disturbances in the shoulder muscles are caused by inner tension (co-) - too much wear on the shoulders etc.

Diagnostics

From the clinical findings and the sometimes considerable limitation of movement at the shoulder stiffness can be observed easily. But as this does not say anything about the cause of these symptoms was taken to a more detailed investigation needs to connect. This includes fundamentally a conventional X-ray diagnostic and determining appropriate laboratory parameter for the detection of inflammatory causes. In addition, ultrasound, NMR and in rare cases, arthrography or arthroscopy may be useful.

Differential Diagnosis

The cervikobrachiale syndrome is often accompanied by pain, which are limited to the shoulder. Carpal tunnel syndrome often causes pain in the entire arm including the shoulder. In both cases, treatment of the shoulder has no benefit.

Therapy

The " frozen shoulder " is often a slow, over years protracted disease course. The therapy is based on the cause. In some cases, surgical treatment (eg, arthroscopy ) is necessary.