Skip to main content
SpringerLink
Log in

Konservative Therapie der „frozen shoulder“

Conservative treatment of frozen shoulder

  • Leitthema
  • Published:
Der Unfallchirurg Aims and scope Submit manuscript

Zusammenfassung

Die idiopathische Schultersteifigkeit (Frozen shoulder, FS) ist eine häufige Pathologie des Glenohumeralgelenks, die durch ein plötzlich einsetzendes Schmerzsyndrom und eine progressive Einschränkung der Beweglichkeit charakterisiert ist. Während die histologischen Veränderungen der FS neben einer synovialen Entzündung eine zunehmende Kapselfibrosierung zeigen, ist die zugrunde liegende Ursache der FS ist noch unbekannt. Die Behandlungsmöglichkeiten der FS sind vielfältig und beinhalten u. a. Medikamente, lokale Steroidinjektion, Physiotherapie, Hydrodistension, Manipulation unter Narkose sowie die arthroskopische und die offene Kapselfreilegung. Da die Erkrankung meist nach 2 bis 3 Jahren selbstlimitierend abklingt, kommen speziell konservative Therapiemaßnahmen klinisch häufig zum Einsatz. Allerdings gibt es in diesem Zusammenhang noch keinen wissenschaftlich basierten Konsens darüber, welche Therapiemaßnahmen in welcher Phase der Erkrankung am ehesten zur Symptomlinderung beitragen. Aus diesem Grund fokussiert der vorliegende Beitrag die Beschreibung der wissenschaftlich untersuchten konservativen Therapiemaßnahmen bei FS und deren zeitliche Einteilung in den klassisch-dreiphasigen Verlauf der Erkrankung.

Abstract

Idiopathic shoulder stiffness (i.e. frozen shoulder, FS) is a common pathology of the glenohumeral joint characterized by a sudden onset of pain syndrome and progressive restriction of the range of motion. While the histological changes of FS are accompanied by synovial inflammation and increasing capsular fibrosis, the underlying cause of FS is still unknown. The treatment options for FS are multifarious and include medication, local steroid injection, physiotherapy, hydrodistension, manipulation under anesthesia, arthroscopic and open capsular release. As the disease is usually self-limiting and the symptoms resolve after 2–3 years, especially conservative treatment measures are often clinically applied; however, in this context there is still no scientifically based consensus on which treatment measures are most likely to contribute to symptom relief in which phase of the disease. For this reason, this article focuses on the description of the scientifically investigated conservative treatment methods in FS and their temporal classification into the classical three-phase course of the disease.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5
Abb. 6
Abb. 7

Literatur

  1. Binder AI, Bulgen DY, Hazleman BL et al (1984) Frozen shoulder: a long-term prospective study. Ann Rheum Dis 43:361–364

    Article  CAS  Google Scholar 

  2. Bryant M, Gough A, Selfe J et al (2017) The effectiveness of ultrasound guided hydrodistension and physiotherapy in the treatment of frozen shoulder/adhesive capsulitis in primary care: a single centre service evaluation. Shoulder Elbow 9:292–298

    Article  Google Scholar 

  3. Buchbinder R, Green S, Forbes A et al (2004) Arthrographic joint distension with saline and steroid improves function and reduces pain in patients with painful stiff shoulder: results of a randomised, double blind, placebo controlled trial. Ann Rheum Dis 63:302–309

    Article  CAS  Google Scholar 

  4. Buchbinder R, Hoving JL, Green S et al (2004) Short course prednisolone for adhesive capsulitis (frozen shoulder or stiff painful shoulder): a randomised, double blind, placebo controlled trial. Ann Rheum Dis 63:1460–1469

    Article  CAS  Google Scholar 

  5. Buchbinder R, Youd JM, Green S et al (2007) Efficacy and cost-effectiveness of physiotherapy following glenohumeral joint distension for adhesive capsulitis: a randomized trial. Arthritis Rheum 57:1027–1037

    Article  Google Scholar 

  6. Buchbinder R, Green S, Youd JM (2003) Corticosteroid injections for shoulder pain. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD004016

    Article  PubMed  PubMed Central  Google Scholar 

  7. Burt MG, Roberts GW, Aguilar-Loza NR et al (2011) Continuous monitoring of circadian glycemic patterns in patients receiving prednisolone for COPD. J Clin Endocrinol Metab 96:1789–1796

    Article  CAS  Google Scholar 

  8. Carette S, Moffet H, Tardif J et al (2003) Intraarticular corticosteroids, supervised physiotherapy, or a combination of the two in the treatment of adhesive capsulitis of the shoulder: a placebo-controlled trial. Arthritis Rheum 48:829–838

    Article  CAS  Google Scholar 

  9. Codman EA (1934) The Shoulder. G. Miller & Company, Boston

    Google Scholar 

  10. Donatelli R, Ruivo RM, Thurner M et al (2014) New concepts in restoring shoulder elevation in a stiff and painful shoulder patient. Phys Ther Sport 15:3–14

    Article  Google Scholar 

  11. Dudkiewicz I, Oran A, Salai M et al (2004) Idiopathic adhesive capsulitis: long-term results of conservative treatment. Isr Med Assoc J 6:524–526

    PubMed  Google Scholar 

  12. Famaey JP, Ginsberg F (1984) Treatment of periarthritis of the shoulder: a comparison of ibuprofen and diclofenac. J Int Med Res 12:238–243

    Article  CAS  Google Scholar 

  13. Favejee MM, Huisstede BM, Koes BW (2011) Frozen shoulder: the effectiveness of conservative and surgical interventions—systematic review. Br J Sports Med 45:49–56

    Article  CAS  Google Scholar 

  14. Guyver PM, Bruce DJ, Rees JL (2014) Frozen shoulder—a stiff problem that requires a flexible approach. Maturitas 78:11–16

    Article  CAS  Google Scholar 

  15. Itoi E, Arce G, Bain GI et al (2016) Shoulder stiffness: current concepts and concerns. Arthroscopy 32:1402–1414

    Article  Google Scholar 

  16. De Jong BA, Dahmen R, Hogeweg JA et al (1998) Intra-articular triamcinolone acetonide injection in patients with capsulitis of the shoulder: a comparative study of two dose regimens. Clin Rehabil 12:211–215

    Article  Google Scholar 

  17. Jurgel J, Rannama L, Gapeyeva H et al (2005) Shoulder function in patients with frozen shoulder before and after 4‑week rehabilitation. Medicina (Kaunas) 41:30–38

    Google Scholar 

  18. Khan AA, Mowla A, Shakoor MA et al (2005) Arthrographic distension of the shoulder joint in the management of frozen shoulder. Mymensingh Med J 14:67–70

    CAS  PubMed  Google Scholar 

  19. Kraal T, Visser C, Sierevelt I et al (2016) How to treat a frozen shoulder? A survey among shoulder specialists in the Netherlands and Belgium. Acta Orthop Belg 82:78–84

    PubMed  Google Scholar 

  20. Kraal T, Sierevelt I, Van Deurzen D et al (2018) Corticosteroid injection alone vs additional physiotherapy treatment in early stage frozen shoulders. World J Orthop 9:165–172

    Article  Google Scholar 

  21. Lin HC, Li JS, Lo SF et al (2009) Isokinetic characteristics of shoulder rotators in patients with adhesive capsulitis. J Rehabil Med 41:563–568

    Article  Google Scholar 

  22. Lin JJ, Wu YT, Wang SF et al (2005) Trapezius muscle imbalance in individuals suffering from frozen shoulder syndrome. Clin Rheumatol 24:569–575

    Article  Google Scholar 

  23. Longo UG, Ciuffreda M, Locher J et al (2018) The effectiveness of conservative and surgical treatment for shoulder stiffness: a systematic review of current literature. Br Med Bull 127:111–143

    Article  Google Scholar 

  24. Lorbach O, Anagnostakos K, Scherf C et al (2010) Nonoperative management of adhesive capsulitis of the shoulder: oral cortisone application versus intra-articular cortisone injections. J Shoulder Elbow Surg 19:172–179

    Article  Google Scholar 

  25. Maitland GD (1993) Treatment of the glenohumeral joint by passive movement. Physiotherapy 1983:6836050

    Google Scholar 

  26. Ohta S, Komai O, Hanakawa H (2014) Comparative study of the clinical efficacy of the selective cyclooxygenase‑2 inhibitor celecoxib compared with loxoprofen in patients with frozen shoulder. Mod Rheumatol 24:144–149

    Article  CAS  Google Scholar 

  27. Page MJ, Green S, Kramer S et al (2014) Manual therapy and exercise for adhesive capsulitis (frozen shoulder). Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD011275

    Article  PubMed  Google Scholar 

  28. Van Raalte DH, Brands M, Van Der Zijl NJ et al (2011) Low-dose glucocorticoid treatment affects multiple aspects of intermediary metabolism in healthy humans: a randomised controlled trial. Diabetologia 54:2103–2112

    Article  CAS  Google Scholar 

  29. Reeves B (1975) The natural history of the frozen shoulder syndrome. Scand J Rheumatol 4:193–196

    Article  CAS  Google Scholar 

  30. Robinson PM, Norris J, Roberts CP (2017) Randomized controlled trial of supervised physiotherapy versus a home exercise program after hydrodilatation for the management of primary frozen shoulder. J Shoulder Elbow Surg 26:757–765

    Article  Google Scholar 

  31. Ryans I, Montgomery A, Galway R et al (2005) A randomized controlled trial of intra-articular triamcinolone and/or physiotherapy in shoulder capsulitis. Rheumatology (Oxford) 44:529–535

    Article  CAS  Google Scholar 

  32. Sharma SP, Baerheim A, Moe-Nilssen R et al (2016) Adhesive capsulitis of the shoulder, treatment with corticosteroid, corticosteroid with distension or treatment-as-usual; a randomised controlled trial in primary care. BMC Musculoskelet Disord 17:232

    Article  Google Scholar 

  33. Sun Y, Lu S, Zhang P et al (2016) Steroid Injection Versus Physiotherapy for Patients With Adhesive Capsulitis of the Shoulder: A PRIMSA Systematic Review and Meta-Analysis of Randomized Controlled Trials. Med (baltimore) 95:e3469

    Article  CAS  Google Scholar 

  34. Tamai K, Akutsu M, Yano Y (2014) Primary frozen shoulder: brief review of pathology and imaging abnormalities. J Orthop Sci 19:1–5

    Article  Google Scholar 

  35. Tveita EK, Tariq R, Sesseng S et al (2008) Hydrodilatation, corticosteroids and adhesive capsulitis: a randomized controlled trial. BMC Musculoskelet Disord 9:53

    Article  Google Scholar 

  36. Vermeulen HM, Rozing PM, Obermann WR et al (2006) Comparison of high-grade and low-grade mobilization techniques in the management of adhesive capsulitis of the shoulder: randomized controlled trial. Phys Ther 86:355–368

    PubMed  Google Scholar 

  37. Widiastuti-Samekto M, Sianturi GP (2004) Frozen shoulder syndrome: comparison of oral route corticosteroid and intra-articular corticosteroid injection. Med J Malaysia 59:312–316

    CAS  PubMed  Google Scholar 

  38. World Health Organisation (WHO) (1996) Cancer Pain Relief (2nd edn). WHO: Geneva

  39. Wu WT, Chang KV, Han DS et al (2017) Effectiveness of glenohumeral joint dilatation for treatment of frozen shoulder: a systematic review and meta-analysis of randomized controlled trials. Sci Rep 7:10507

    Article  Google Scholar 

  40. Yang JL, Chang CW, Chen SY et al (2007) Mobilization techniques in subjects with frozen shoulder syndrome: randomized multiple-treatment trial. Phys Ther 87:1307–1315

    Article  Google Scholar 

  41. Yoon JP, Chung SW, Kim JE et al (2016) Intra-articular injection, subacromial injection, and hydrodilatation for primary frozen shoulder: a randomized clinical trial. J Shoulder Elbow Surg 25:376–383

    Article  Google Scholar 

  42. Zheng XQ, Li K, Wei YD et al. (2014) Nonsteroidal anti-inflammatory drugs versus corticosteroid for treatment of shoulder pain: a systematic review and meta-analysis. Arch Phys Med Rehabil 95:1824-1831

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. ATOS Orthoparc Klinik, Aachener Str. 1021B, 50858, Köln, Deutschland

    A. Franz B.Sc. &  K. Beitzel

  2. Abteilung für Sportorthopädie, Technische Universität München, München, Deutschland

    M. Klose &  K. Beitzel

Authors
  1. A. Franz B.Sc.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. Klose
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. K. Beitzel
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to K. Beitzel.

Ethics declarations

Interessenkonflikt

A. Franz, M. Klose und K. Beitzel geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

Additional information

Redaktion

A. B. Imhoff, München

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Franz, A., Klose, M. & Beitzel, K. Konservative Therapie der „frozen shoulder“. Unfallchirurg 122, 934–940 (2019). https://doi.org/10.1007/s00113-019-00731-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00113-019-00731-3

Schlüsselwörter

Keywords

Search

Navigation