Frozen shoulder syndrome: causes, manifestations, treatment? What helps with pain

Musculoskeletalpain and limitations are relatively common health problems.

The occurrence of disorders of this complex system of bones, muscles and tendons occurs due to various types of stress.

This causes its overload and wear and tear with pathological consequences.

To a certain extent, this wear and tear can be prevented by proper care and minimizing the excessive load on specific parts of the body.

The rest of the disease is due to genetics and age, which we cannot stop.

Musculoskeletal wear and tear happens every day!

The musculoskeletal system performs two basic functions:

1. The static function of the musculoskeletal system - it helps to keep our body upright.
2. the dynamic function of the musculoskeletal system - it allows us to move

These functions themselves cause some strain. However, this is a natural process that we cannot do without. Another physiological process of wear and tear is the aging of the musculoskeletal system.

Pathological causes include obesity, injuries, incorrect posture, unilateral loading, extreme sports or, on the contrary, lack of exercise, among others.

The shoulders are particularly susceptible to overloading

The shoulders and shoulder joints are extremely susceptible to strain. However, this is not due to their fragility or instability, but to our "everyday high demands".

Quite the opposite!

The shoulder joint is a huge, strong and flexible ball and socket joint.
It allows us the greatest range of motion in virtually all directions.
It provides us with stability when lifting heavy loads.

It is the uniqueness, strength and wide range of motion in the shoulder joint that causes its frequent use.

It is of great importance in everyday life and routine activities. That is why it is susceptible not only to overloading, but also to stiffening, stretching, tearing, micro-trauma and even serious shoulder injuries.

Table with the most common shoulder injuries:

When the shoulder freezes...

Frozen shoulder syndrome (lat. adhesive capsulitis) is a disease of the shoulder joint characterized by stiffness, restricted movement and pain.

In general, frozen shoulder syndrome can be classified as an inflammatory disease, but inflammation is not the only cause. Very often it also occurs due to microtrauma or after surgery.

Primarily, the tendons and tendon tendons are affected. Calcium deposits, called calcium deposits, are deposited in their surroundings.
When calcium salts penetrate the affected tissue, so-called calcification occurs.

Basically, the capsule starts to tighten and the shoulder joint thickens. This leads to a limited range of motion.

Interesting:
Frozen shoulder syndrome affects women more often than men, and it affects the non-dominant limb. Its incidence increases with age.

How does frozen shoulder manifest itself?

The clinical basis of frozen shoulder is stiffness. It results in a progressive limitation of active and passive movement in the shoulder joint, often without apparent cause.

In more severe cases, the patient has difficulty performing even the simplest movements, which limits him or her in normal activities.

Minimal movement causes intense pain of a dull or sharp nature. The pain worsens during activity, especially at the end of the range of motion and during sleep.

Table with stages of adhesive capsulitis:

Causes of frozen shoulder syndrome

Doctors do not know the exact cause of the disease with certainty. However, we do know the negative factors in which it occurs. These are therefore considered to be risk factors.

Several factors are involved in the development of frozen shoulder at the same time. The more of these influences are present, the greater the risk of developing the disease.

• Some factors are based on the direct nature of the shoulder joint, which is movement (improper movement, extension, overload)
• other physiological factors such as genetics or age
• others can be considered pathological (fracture, surgery, obesity, cancer)

Risk factors based on the nature of the shoulder joint

Certain factors that cannot be considered inherently pathological may also increase the risk of developing frozen shoulder syndrome.

This is due to the excessive range of movements we are able to perform with the shoulder joint and, conversely, the prolonged inactivity of the joint.

Basic aspects of frozen shoulder syndrome based on activity/inactivity:

1. overloading the shoulder through excessive use (sport, physically demanding work)
2. overloading of the shoulder in obese patients, when the joints are loaded with extra weight (more frequent and faster cartilage wear)
3. incorrect involvement of the different muscle groups and their incorrect synchronisation cause overload, pain and wear and tear
4. immobilisation of the shoulder or prolonged inactivity (lack of physical activity, sedentary work, laziness)

Natural factors contributing to frozen shoulder

Genetic predisposition cannot be clearly included in the risk factors for the development of capsulitis, nor can it be excluded.

Another natural risk factor not only for frozen shoulder but for most diseases is age.

Frozen shoulder syndrome is predominantly suffered by people over the age of forty. The risk increases with advancing years.

Based on statistics and observation, it is known that women are much more likely to suffer from frozen shoulder syndrome.

Pathological factors causing frozen shoulder syndrome

The pathological factors of frozen shoulder syndrome include all those that are not natural.

These include various diseases, injuries or surgical procedures. These are a wide variety of different influences.

The most common pathological processes causing frozen shoulder syndrome are:

• muscle and tendon strain in the shoulder joint
• sprains and dislocations of the shoulder joint
• fractures of the shoulder joint
• rotator cuff injuries
• microtrauma and bleeding
• inflammatory diseases of the tendons of the shoulder
• bursitis and arthritis
• tendinitis
• impingement syndrome
• vertebrogenic diseases
• sympathetic reflex dystrophy
• spinal cord disease
• dystonia
• Parkinson's disease
• stroke with paralysis of a limb
• diabetes mellitus
• increased thyroid function
• reduced thyroid function
• cardiovascular and vascular diseases
• tuberculosis
• cancer

What are the treatment options?

As already mentioned, in some patients the symptoms disappear spontaneously. However, even these may trouble for several weeks to months.

More often than not, however, the difficulties persist, do not subside and do not respond to medical treatment. This is when shoulder surgery is the only solution.

Medical (drug) therapy

The treatment for frozen shoulder syndrome is to control pain and maintain as much range of motion as possible.

Patients first try to treat themselves with over-the-counter pain medications (paracetamol, novalgin, ibalgin). They usually do not know the diagnosis at first. However, if symptoms persist, they seek professional help.

After confirming the diagnosis of adhesive capsulitis, the doctor continues to control the pain with drugs that act not only analgesically but also antiphlogistic. Of the above-mentioned over-the-counter drugs, for example, ibalgin.

Non-steroidal antiphlogistics not only relieve pain, but also reduce inflammation. In more severe cases, the doctor prescribes the patient stronger preparations from this group of drugs.

Also suitable are injectable steroids, which are injected directly into the shoulder. They not only help to relieve pain, but also improve mobility in the shoulder joint, especially if the disease is caught in the early stages of the process.

Interesting:
Sometimes the doctor will inject plain sterile water into the shoulder (directly into the joint capsule), which leads to stretching of the tissue in the shoulder joint, helping to facilitate mobility. This is called joint distension.

Physiotherapy (rehabilitation)

Physiotherapy is not a medical discipline. However, the procedures and exercises that physiotherapists carry out with patients have been helping with health problems and painful conditions, particularly those involving the musculoskeletal system, for many years.

This non-medical science is now an integral part of medicine and recovery. It is also used in the diagnosis and prevention of certain diseases.

Its aim is to restore lost functions and abilities of the human organism as a whole by assessing the functional disorders of the musculoskeletal system of a particular person and then reassessing the condition after physiotherapeutic care.

A trained physiotherapist uses special manual techniques, exercises and proven procedures in the treatment.

The aim of physiotherapy exercises for adhesive capsulitis is to increase the range of motion in the shoulder. To achieve optimal results, the most important thing is the regularity of these exercises and, of course, the strong will and perseverance of the patient.

The so-called shoulder manipulation is also suitable, but this technique should be performed by a doctor, not a physiotherapist.

The reason for this is the administration of general anaesthesia, which only a doctor is competent to do. After anaesthesia, when the patient does not feel pain, the doctor moves the arm in different directions. This achieves relaxation of the shortened tissues.

Alternative medicine

Alternative treatments have been around since time immemorial and exist for virtually all conditions.
Two basic techniques are used for frozen shoulder syndrome, namely acupuncture and transcutaneous electrical nerve stimulation (TENS).

Clinical studies have shown that acupuncture is much more effective than TENS for frozen shoulder syndrome.

Acupuncture uses the insertion of extremely thin needles into the patient's skin.
The needles are inserted in specific locations, depending on the patient's problem.
They remain in a specific location for an individually long period of time, usually 20 to 40 minutes. During this time they can be moved in various ways.
This procedure is completely painless for the patient (the needles are the thickness of a human hair and are inserted superficially).

Transcutaneous Electrical Nerve Stimulation (TENS) is in some ways very similar to acupuncture.
However, instead of needles, electrodes are used which are glued to specific points on the patient's body.
A small dose of (harmless) electric current enters the patient through the electrodes.
The electric current stimulates the nerve. Subsequently, pain-relieving molecules (endorphins) are released.
It is thought that the nerve fibres transmitting the pain impulses are also blocked at the same time.

Shock wave treatment

Shockwave treatment is a newer method of treating frozen shoulder.
It is performed using the Swiss Dolor Clast, which is revolutionizing the treatment of shoulder joint disorders, not only adhesive capsulitis, but also tendinopathies, trigger points and other calcifications.

The advantages of this therapy are speed, painlessness and, above all, effectiveness.
No local anaesthesia is required. The procedure is completely painless and effective in up to 95% of cases. Moreover, the effect is long-lasting.

The disadvantage of shock wave treatment is 100% financial reimbursement by the patient.

Surgical and other procedures

As is usually the case, where non-invasive treatments fail, invasive solutions to the disease step in.
Most patients with frozen shoulder achieve improvement within a year.
However, if problems persist, it is time to consider surgical solutions.

Surgery for frozen shoulder syndrome is very rare. It is only performed when the problems last longer than usual and previous treatments have failed.

Using small incisions, adhesive and scar tissue is surgically removed from inside the shoulder joint. The principle of the operation is to release the subacromial space, thus achieving manual release of movement, called redress.