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Primäre (idiopathische) Schultersteife

Definition, Krankheitsverlauf, Epidemiologie und Ätiologie

Primary (idiopathic) shoulder stiffness

Definition, disease progression, epidemiology and etiology

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Zusammenfassung

Das charakteristische Merkmal der Schultersteife ist die Einschränkung der aktiven und passiven Beweglichkeit des Glenohumeralgelenks. Ursächlich sind letztendlich eine Fibrosierung und die daraus resultierende Kontraktur der glenohumeralen Gelenkkapselstrukturen. Der Begriff „Schultersteife“ ist jedoch nur ein beschreibender Überbegriff, der zwingend weiterführend definiert werden muss, da sowohl der Krankheitsverlauf als auch die zu empfehlende Therapie entscheidend von der Ursache der Schultersteife beeinflusst werden. Die primäre Schultersteife, auch idiopathische Schultersteife oder „frozen shoulder“ genannt, muss von verschiedenen Formen der sekundären Schultersteifen unterschieden werden und verläuft häufig in 3 Stadien: der initialen „freezing phase“, der darauf folgenden „frozen phase“ und letztendlich der „thawing phase“, die alle jeweils mehrere Monate bis hin zu Jahre andauern können. Obwohl die primäre Schultersteife mit einer Prävalenz von 2–5 % in der Normalbevölkerung eine häufige pathologische Veränderung darstellt, ist die genaue Ätiologie bisher weitgehend unbekannt. Es besteht jedoch Konsensus in der Literatur, dass gewisse systemische Erkrankungen wie beispielsweise ein Diabetes mellitus mit dem vermehrten Auftreten einer primären Schultersteife assoziiert sind.

Abstract

Shoulder stiffness is characterized by restriction of the active and passive movement of the glenohumeral joint. The stiffness is ultimately caused by fibrosis and the resulting contracture of the glenohumeral joint capsule and its ligaments; however, the term stiff shoulder is only a descriptive umbrella term that must be further defined as the course of the disease and the recommended treatment are decisively influenced by the cause of the shoulder stiffness. Primary shoulder stiffness, also known as idiopathic shoulder stiffness or “frozen shoulder”, must be distinguished from various forms of secondary shoulder stiffness and often occurs in three stages, which can all last for several months to years: the initial “freezing phase”, followed by a “frozen phase” and finally a “thawing phase”. Although primary shoulder stiffness is a frequent pathological alteration with an prevalence of 2–5% in the general population, the exact etiology remains largely unknown; however, there is consensus throughout the literature that certain systemic pathologies, such as diabetes mellitus are associated with a higher incidence of primary shoulder stiffness.

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Literatur

  1. Akbar M, Mclean M, Garcia-Melchor E et al (2019) Fibroblast activation and inflammation in frozen shoulder. PLoS ONE 14:e215301

    CAS  PubMed  PubMed Central  Google Scholar 

  2. Arpaci D, Karakece E, Tocoglu AG et al (2016) Endocan, TGF-beta, and ADMA as risk factors for endothelial dysfunction and possible vascular disease in patients with subclinical hypothyroidism. Ann Clin Lab Sci 46:601–607

    CAS  PubMed  Google Scholar 

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

    CAS  PubMed  PubMed Central  Google Scholar 

  4. Binder AI, Bulgen DY, Hazleman BL et al (1984) Frozen shoulder: an arthrographic and radionuclear scan assessment. Ann Rheum Dis 43:365–369

    CAS  PubMed  PubMed Central  Google Scholar 

  5. Blonna D, Fissore F, Bellato E et al (2017) Subclinical hypothyroidism and diabetes as risk factors for postoperative stiff shoulder. Knee Surg Sports Traumatol Arthrosc 25:2208–2216

    PubMed  Google Scholar 

  6. Braga M, Bhasin S, Jasuja R et al (2012) Testosterone inhibits transforming growth factor-beta signaling during myogenic differentiation and proliferation of mouse satellite cells: potential role of follistatin in mediating testosterone action. Mol Cell Endocrinol 350:39–52

    CAS  PubMed  Google Scholar 

  7. Bridgman JF (1972) Periarthritis of the shoulder and diabetes mellitus. Ann Rheum Dis 31:69–71

    CAS  PubMed  PubMed Central  Google Scholar 

  8. Bulgen DY, Hazleman BL, Voak D (1976) HLA-B27 and frozen shoulder. Lancet 1:1042–1044

    CAS  PubMed  Google Scholar 

  9. Bunker TD, Anthony PP (1995) The pathology of frozen shoulder. A Dupuytren-like disease. J Bone Joint Surg 77:677–683

    CAS  Google Scholar 

  10. Bunker TD, Esler CN (1995) Frozen shoulder and lipids. J Bone Joint Surg Br 77:684–686

    CAS  PubMed  Google Scholar 

  11. Bunker TD, Reilly J, Baird KS et al (2000) Expression of growth factors, cytokines and matrix metalloproteinases in frozen shoulder. J Bone Joint Surg Br 82:768–773

    CAS  PubMed  Google Scholar 

  12. Cakir M, Samanci N, Balci N et al (2003) Musculoskeletal manifestations in patients with thyroid disease. Clin Endocrinol (Oxf) 59:162–167

    Google Scholar 

  13. Cao J, Sato H, Takino T et al (1995) The C‑terminal region of membrane type matrix metalloproteinase is a functional transmembrane domain required for pro-gelatinase A activation. J Biol Chem 270:801–805

    CAS  PubMed  Google Scholar 

  14. Chen L, Deng H, Cui H et al (2017) Inflammatory responses and inflammation-associated diseases in organs. Oncotarget 9:7204–7218

    PubMed  PubMed Central  Google Scholar 

  15. Codman EA (1934) The shoulder; rupture of the supraspinatus tendon and other lesions in or about the subacromial bursa. T. Todd Company, Boston

    Google Scholar 

  16. De Ponti A, Vigano MG, Taverna E et al (2006) Adhesive capsulitis of the shoulder in human immunodeficiency virus-positive patients during highly active antiretroviral therapy. J Shoulder Elbow Surg 15:188–190

    PubMed  Google Scholar 

  17. De Witte S, Bonnet F, Bonarek M et al (2002) Adhesive capsulitis of the shoulder in an HIV patient treated with nelfinavir. AIDS 16:1307–1308

    PubMed  Google Scholar 

  18. Duplay ES (1872) De la periarthritis scapulohumerale et des radieurs de l’epaule quien son la consequence. Arch Gen Med 20:513–542

    Google Scholar 

  19. Glass CK, Olefsky JM (2012) Inflammation and lipid signaling in the etiology of insulin resistance. Cell Metab 15:635–645

    CAS  PubMed  PubMed Central  Google Scholar 

  20. Grasland A, Ziza JM, Raguin G et al (2000) Adhesive capsulitis of shoulder and treatment with protease inhibitors in patients with human immunodeficiency virus infection: report of 8 cases. J Rheumatol 27:2642–2646

    CAS  PubMed  Google Scholar 

  21. Hakim AJ, Cherkas LF, Spector TD et al (2003) Genetic associations between frozen shoulder and tennis elbow: a female twin study. Rheumatology (Oxf) 42:739–742

    CAS  Google Scholar 

  22. Hand GCR, Carr AJ (2005) Natural history and genetics of frozen shoulder a 1–20 year follow up of 273 patients. Orthop Proc 87-B:161–161

    Google Scholar 

  23. Hand GC, Athanasou NA, Matthews T et al (2007) The pathology of frozen shoulder. J Bone Joint Surg Br 89:928–932

    CAS  PubMed  Google Scholar 

  24. Huang SW, Lin JW, Wang WT et al (2014) Hyperthyroidism is a risk factor for developing adhesive capsulitis of the shoulder: a nationwide longitudinal population-based study. Sci Rep 4:4183

    PubMed  PubMed Central  Google Scholar 

  25. Hutchinson JW, Tierney GM, Parsons SL et al (1998) Dupuytren’s disease and frozen shoulder induced by treatment with a matrix metalloproteinase inhibitor. J Bone Joint Surg Br 80:907–908

    CAS  PubMed  Google Scholar 

  26. Iams WT, Hames ML, Tsai JP et al (2015) Increased serum tumor necrosis factor alpha levels in patients with lenalidomide-induced hypothyroidism. Exp Hematol 43:74–78

    CAS  PubMed  Google Scholar 

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

    Google Scholar 

  28. Kabbabe B, Ramkumar S, Richardson M (2010) Cytogenetic analysis of the pathology of frozen shoulder. Int J Shoulder Surg 4:75–78

    PubMed  PubMed Central  Google Scholar 

  29. Kanbe K, Inoue K, Inoue Y et al (2009) Inducement of mitogen-activated protein kinases in frozen shoulders. J Orthop Sci 14:56–61

    CAS  PubMed  PubMed Central  Google Scholar 

  30. Kanter JE, Kramer F, Barnhart S et al (2012) Diabetes promotes an inflammatory macrophage phenotype and atherosclerosis through acyl-CoA synthetase 1. Proceedings of the National Academy of Sciences of the United States of America 109:E715–724

    CAS  Google Scholar 

  31. Kaviratne M, Hesse M, Leusink M et al (2004) IL-13 activates a mechanism of tissue fibrosis that is completely TGF-beta independent. J Immunol 173(0):4020–4029

    CAS  PubMed  Google Scholar 

  32. Kendrick JI (1940) The treatment of periarthritis of the shoulder. Med Clin North Am 24:525–532

    Google Scholar 

  33. Kilian O, Kriegsmann J, Berghauser K et al (2001) The frozen shoulder. Arthroscopy, histological findings and transmission electron microscopy imaging. Chirurg 72:1303–1308

    CAS  PubMed  Google Scholar 

  34. Kingston K, Curry EJ, Galvin JW et al (2018) Shoulder adhesive capsulitis: epidemiology and predictors of surgery. J Shoulder Elbow Surg 27:1437–1443

    PubMed  Google Scholar 

  35. Klapp R (1916) Die operative Erweiterung der Schultergelenkkapsel. Eine Methode zur blutigen Mobilisiemng von Schultersteifigkeiten. Zbl Chir 43:137–140

    Google Scholar 

  36. Kobayashi T, Karasuno H, Sano H et al (2019) Representative survey of frozen shoulder questionnaire responses from the Japan Shoulder Society: What are the appropriate diagnostic terms for primary idiopathic frozen shoulder, stiff shoulder or frozen shoulder? J Orthop Sci. https://doi.org/10.1016/j.jos.2018.12.012

    Article  PubMed  Google Scholar 

  37. Li W, Lu N, Xu H et al (2015) Case control study of risk factors for frozen shoulder in China. Int J Rheum Dis 18:508–513

    PubMed  Google Scholar 

  38. Lundberg BJ (1969) The frozen shoulder. Clinical and radiographical observations. The effect of manipulation under general anesthesia. Structure and glycosaminoglycan content of the joint capsule. Local bone metabolism. Acta Orthop Scand Supplementum 119:1–59

    Google Scholar 

  39. Macnab I (1973) Rotator cuff tendinitis. Ann R Coll Surg Engl 53:271–287

    CAS  PubMed  PubMed Central  Google Scholar 

  40. Marx RG, Malizia RW, Kenter K et al (2007) Intra-articular corticosteroid injection for the treatment of idiopathic adhesive capsulitis of the shoulder. Hss J 3:202–207

    PubMed  PubMed Central  Google Scholar 

  41. Milgrom C, Novack V, Weil Y et al (2008) Risk factors for idiopathic frozen shoulder. Isr Med Assoc J 10:361–364

    PubMed  Google Scholar 

  42. Nago M, Mitsui Y, Gotoh M et al (2010) Hyaluronan modulates cell proliferation and mRNA expression of adhesion-related procollagens and cytokines in glenohumeral synovial/capsular fibroblasts in adhesive capsulitis. J Orthop Res 28:726–731

    CAS  PubMed  Google Scholar 

  43. Neviaser AS, Hannafin JA (2010) Adhesive capsulitis: a review of current treatment. Am J Sports Med 38:2346–2356

    Google Scholar 

  44. Neviaser JS (1945) Adhesive capsulitis of the shoulder: a study of the pathological findings in periarthritis of the shoulder. JBJS 27:211–222

    Google Scholar 

  45. Neviaser JS (1962) Arthrography of the shoulder joint: study of the findings in adhesive capsulitis of the shoulder. Study of the findings in adhesive capsulitis of the shoulder. J Bone Joint Surg 44-a:1321–1359

    CAS  PubMed  Google Scholar 

  46. Neviaser TJ (1987) Adhesive capsulitis. Orthop Clin North Am 18:439–443

    CAS  PubMed  Google Scholar 

  47. Nguyen MT, Favelyukis S, Nguyen AK et al (2007) A subpopulation of macrophages infiltrates hypertrophic adipose tissue and is activated by free fatty acids via Toll-like receptors 2 and 4 and JNK-dependent pathways. J Biol Chem 282:35279–35292

    CAS  PubMed  Google Scholar 

  48. Noy S, Dekel S, Orgad S et al (1981) HLA-B27 and frozen shoulder. Tissue Antigens 17:251

    CAS  PubMed  Google Scholar 

  49. Pasteur F (1932) La teno-bursite bicipitale. J Deradial et d’Electrol 16:419

    Google Scholar 

  50. Patel K, Patel N, Curtis M (2012) Bilateral simultaneous frozen shoulder: a possible adverse event of the FOLFOX chemotherapy regime? Shoulder Elbow 4:193–195

    Google Scholar 

  51. Peyriere H, Mauboussin JM, Rouanet I et al (1999) Frozen shoulder in HIV patients treated with indinavir: report of three cases. AIDS 13:2305–2306

    CAS  PubMed  Google Scholar 

  52. Prodromidis AD, Charalambous CP (2016) Is there a genetic predisposition to frozen shoulder? A systematic review and meta-analysis. JBJS Rev. https://doi.org/10.2106/jbjs.Rvw.O.00007

    Article  PubMed  Google Scholar 

  53. Qiao YC, Chen YL, Pan YH et al (2017) Changes of transforming growth factor beta 1 in patients with type 2 diabetes and diabetic nephropathy: a PRISMA-compliant systematic review and meta-analysis. Medicine 96:e6583

    CAS  PubMed  PubMed Central  Google Scholar 

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

    CAS  PubMed  Google Scholar 

  55. Rizk TE, Pinals RS (1984) Histocompatibility type and racial incidence in frozen shoulder. Arch Phys Med Rehabil 65:33–34

    CAS  PubMed  Google Scholar 

  56. Rodeo SA, Hannafin JA, Tom J et al (1997) Immunolocalization of cytokines and their receptors in adhesive capsulitis of the shoulder. J Orthop Res 15:427–436

    CAS  PubMed  Google Scholar 

  57. Sattar MA, Luqman WA (1985) Periarthritis: another duration-related complication of diabetes mellitus. Diabetes Care 8:507–510

    CAS  PubMed  Google Scholar 

  58. Schiefer M, Teixeira PFS, Fontenelle C et al (2017) Prevalence of hypothyroidism in patients with frozen shoulder. J Shoulder Elbow Surg 26:49–55

    PubMed  Google Scholar 

  59. Schultheis A, Reichwein F, Nebelung W (2008) Frozen shoulder. Diagnosis and therapy. Orthopäde 37:1065–1066 (1068–1072)

    CAS  Google Scholar 

  60. Seignalet J, Sany J, Caillens JP et al (1981) Lack of association between HLA-B27 and frozen shoulder. Tissue Antigens 18:364

    CAS  PubMed  Google Scholar 

  61. Smith SP, Devaraj VS, Bunker TD (2001) The association between frozen shoulder and Dupuytren’s disease. J Shoulder Elbow Surg 10:149–151

    CAS  PubMed  Google Scholar 

  62. Spite M, Claria J, Serhan CN (2014) Resolvins, specialized proresolving lipid mediators, and their potential roles in metabolic diseases. Cell Metab 19:21–36

    CAS  PubMed  Google Scholar 

  63. Sugimoto R, Enjoji M, Nakamuta M et al (2005) Effect of IL-4 and IL-13 on collagen production in cultured LI90 human hepatic stellate cells. Liver Int 25:420–428

    CAS  PubMed  Google Scholar 

  64. Sung CM, Jung TS, Park HB (2014) Are serum lipids involved in primary frozen shoulder? A case-control study. J Bone Joint Surg 96:1828–1833

    PubMed  Google Scholar 

  65. Tighe CB, Oakley WS Jr. (2008) The prevalence of a diabetic condition and adhesive capsulitis of the shoulder. South Med J 101:591–595

    PubMed  Google Scholar 

  66. Uhthoff HK, Boileau P (2007) Primary frozen shoulder: global capsular stiffness versus localized contracture. Clin Orthop Relat Res 456:79–84

    PubMed  Google Scholar 

  67. Uitvlugt G, Detrisac DA, Johnson LL et al (1993) Arthroscopic observations before and after manipulation of frozen shoulder. Arthroscopy 9:181–185

    CAS  PubMed  Google Scholar 

  68. Vicenti G, Moretti L, De Giorgi S et al (2016) Thyroid and shoulder diseases: the bases of a linked channel. J Biol Regul Homeost Agents 30:867–870

    CAS  PubMed  Google Scholar 

  69. Wang K, Ho V, Hunter-Smith DJ et al (2013) Risk factors in idiopathic adhesive capsulitis: a case control study. J Shoulder Elbow Surg 22:e24–e29

    PubMed  Google Scholar 

  70. Welty FK, Alfaddagh A, Elajami TK (2016) Targeting inflammation in metabolic syndrome. Transl Res 167:257–280

    CAS  PubMed  Google Scholar 

  71. White D, Choi H, Peloquin C et al (2011) Secular trend of adhesive capsulitis. Arthritis Care Res 63:1571–1575

    CAS  Google Scholar 

  72. Wiley AM (1991) Arthroscopic appearance of frozen shoulder. Arthroscopy 7:138–143

    CAS  PubMed  Google Scholar 

  73. Wohlgethan JR (1987) Frozen shoulder in hyperthyroidism. Arthritis Rheum 30:936–939

    CAS  PubMed  Google Scholar 

  74. Zabraniecki L, Doub A, Mularczyk M et al (1998) Frozen shoulder: a new delayed complication of protease inhibitor therapy? Rev Rhum Engl Ed 65:72–74

    CAS  PubMed  Google Scholar 

  75. Zreik NH, Malik RA, Charalambous CP (2016) Adhesive capsulitis of the shoulder and diabetes: a meta-analysis of prevalence. Muscles Ligaments Tendons J 6(1):26–34

    PubMed  PubMed Central  Google Scholar 

  76. Zuckerman JD, Rokito A (2011) Frozen shoulder: a consensus definition. J Shoulder Elbow Surg 20:322–325

    PubMed  Google Scholar 

  77. Zwaal P, Van De Laar S (2014) Management of the frozen shoulder. Orthop Res Rev 6:81

    Google Scholar 

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  1. Abteilung und Poliklinik für Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland

    Jonas Pogorzelski MHBA, Andreas B. Imhoff, Hannes Degenhardt & Sebastian Siebenlist

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Pogorzelski, J., Imhoff, A.B., Degenhardt, H. et al. Primäre (idiopathische) Schultersteife. Unfallchirurg 122, 917–924 (2019). https://doi.org/10.1007/s00113-019-0703-z

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