PDF herunterladen
OP-Journal 2013; 29(1): 16-22
DOI: 10.1055/s-0032-1328313
Georg Thieme Verlag KG Stuttgart · New York

Frozen Shoulder – Ätiologie, Diagnostik und Therapie

Franziska M. Loos
,
Maik Zitzmann
,
Frank Gohlke
Weitere Informationen

Publikationsverlauf

Publikationsdatum:
08. Mai 2013 (online)

   Lizenzen und Reprints

Zusammenfassung

Hinter dem Begriff der Frozen Shoulder oder auch Schultersteife verbirgt sich eine Erkrankung des Schulter?gelenks, die v. a. durch eine schmerzhafte Einschränkung der Beweglichkeit gekennzeichnet ist. Die Ursachen können eine längere Ruhigstellung des Schultergelenks sein, Unfälle oder auch genetische Veranlagung. Diabetiker sind gehäuft betroffen. Der Krankheitsverlauf gliedert sich typischerweise in 3 Phasen und kann sich über mehrere Jahre ausdehnen, wobei es fast immer zu einer Ausheilung kommt. Die Behandlungsme?thoden sind vielfältig und setzen sich idealerweise zusammen aus einer suffizienten medikamentösen Schmerztherapie und intensiver phasenabhängiger Krankengymnastik sowie mög?lichen operativen Maßnahmen zur Verbesserung der Beweglichkeit. Dabei steht die arthroskopische Lösung der verdickten Gelenkkapsel im Vordergrund. Dies sollte möglichst schonend unter Verwendung spezieller Instrumentarien erfolgen ([Abb. 6]). Aufgrund der meist sehr beengten Verhältnisse im Gelenkraum handelt es sich dabei um einen technisch schwierigen Eingriff, der das Risiko von Knorpelschäden und einer Verletzung des N. axillaris birgt, wenn kein standardisiertes Vorgehen eingehalten wird.

Frozen Shoulder – Aetiology, Diagnostics and Therapy

The “frozen shoulder” is a shoulder joint disorder, which is mainly characterised by pain and stiffness. The aetiology includes periods of immobilisation, following injuries and is probably related to a genetic predisposition. Diabetics are more frequently affected. Within the course of the disease three phases are differentiated. Prolonged duration can span over several years, but results mostly in partial or complete recovery of mobility. Treatment options comprise different conservative and operative measures representing a multimodal approach: from sufficient medication to reduce pain, intensive, stage-dependent physical therapy as well as surgical release to improve pain and range of motion. Amongst all surgical measures arthroscopic release of the joint capsule is currently regarded as the most effective one. This procedure should be performed as gently as possible, using special equipment. Due to the limited joint space, arthroscopic release is technically difficult and carries the risk of cartilage damage and injury to the axillary nerve when a standardised procedure is not followed.

 

  • Literatur

  • 1 Binder AI, Bulgen DY, Hazleman BL et al. Frozen shoulder: an arthrographic and radionuclear scan assessment. Ann Rheum Dis 1984; 43: 365-369
    CrossrefPubMedGoogle Scholar
  • 2 Binder AI, Hazleman BL, Parr G et al. A controlled study of oral prednisolone in frozen shoulder. Br J Rheumatol 1986; 25: 288-292
    CrossrefPubMedGoogle Scholar
  • 3 Bridgeman JF. Periarthritis of the shoulder and diabetes mellitus. Ann Rheum Dis 1972; 31: 69-71
    CrossrefPubMedGoogle Scholar
  • 4 Bruckner FE, Nye CJS. A prospective study of adhesive capsulitis of the shoulder in a high risk population. Q J Med 1981; 198: 191-204
    PubMedGoogle Scholar
  • 5 Bunker TD, Anthony PP. The pathology of frozen shoulder: a Dupuytren-like disease. J Bone Joint Surg [Br] 1995; 77: 677-683
    PubMedGoogle Scholar
  • 6 Bunker TD, Esler CAN. Frozen shoulder and lipids. J Bone Joint Surg [Br] 1995; 77: 684-686
    PubMedGoogle Scholar
  • 7 Codman EA. The Shoulder. The Author; 1934
    Google Scholar
  • 8 Corbeil V, Dussault RG, Leduce B et al. Adhesive capsulitis of the shoulder: a comparative study of arthrography with intra-articular corticotherapy and with or without capsular distension. Can Assoc Radiol J 1992; 43: 127-130
    PubMedGoogle Scholar
  • 9 De Seze S. Les epaules doloureuses et les epaules bloquees. Concours Medical 1974; 96: 5329-5357
    PubMedGoogle Scholar
  • 10 Duplay S. De la periarthrite scapulo-humerale. Rev. frat. d. trav. de med 1896; 53: 226
    PubMedGoogle Scholar
  • 11 Fett H, Hedtmann A. Frozen Shoulder. In: Gohlke F, Hedtmann A, eds. Orthopädie und Orthopädische Chirurgie – Schulter. Stuttgart: Thieme; 2002: 340-341
    Google Scholar
  • 12 Fisher L, Kurtz A, Shipley M. Association between cheiroarthropathy and frozen shoulder in patients with insulin-dependent diabetes mellitus. Br J Rheumatol 1986; 25: 141-146
    CrossrefPubMedGoogle Scholar
  • 13 Fleming A, Dodman S, Beer TC et al. Personality in frozen shoulder. Ann Rheum Dis 1976; 35: 456-457
    CrossrefPubMedGoogle Scholar
  • 14 Hartig A, Huth F. Schultersteife: aktuelle morphologische Definition. Arthroskopie 1996; 9: 236-240
    PubMedGoogle Scholar
  • 15 Hedtmann A, Fett H. Atlas und Lehrbuch der Schultersonographie. Stuttgart: Enke; 1991
    Google Scholar
  • 16 Hsu SYC, Chan KM. Arthroscopic distension in the management of frozen shoulder. Int Orthop 1991; 15: 79-83
    PubMedGoogle Scholar
  • 17 Kay N. The clinical diagnosis and management of frozen shoulders. Practitioner 1981; 25: 164-172
    PubMedGoogle Scholar
  • 18 Kieras DM, Matsen FA. Open release in the management of refractory frozen shoulder. Orthop Trans 1991; 15: 801-802
    PubMedGoogle Scholar
  • 19 Kozin F. Two unique shoulder disorders: adhesive capsulitis and reflex sympathetic dystrophy syndrome. Postgrad Med 1983; 73: 207-216
    PubMedGoogle Scholar
  • 20 Lundberg BJ. The frozen shoulder. Acta Orthop Scand 1969; 119: 1-59
    PubMedGoogle Scholar
  • 21 Mclaughlin HL. On the frozen shoulder. Bull Hosp Jt Dis 1951; 12: 383-393
    PubMedGoogle Scholar
  • 22 Moren-Hybbinette I, Moritz U, Schersten B. The clinical picture of the painful diabetic shoulder: natural history, social consequences and analysis of concomitant hand syndrome. Acta Med Scand 1987; 221: 73-82
    PubMedGoogle Scholar
  • 23 Murnaghan JP. Frozen Shoulder. In: Rockwood jr CA, Matsen FA, eds. The Shoulder. Philadelphia: WB Saunders; 1990: 837-862
    Google Scholar
  • 24 Neviaser JS. Adhesive capsulitis of the shoulder: study of pathological findings in peri-arthritis of the shoulder. J Bone Joint Surg [Am] 1945; 27: 211-222
    PubMedGoogle Scholar
  • 25 Neviaser RJ. Painful conditions affecting the shoulder. Clin Orthop Relat Res 1983; 173: 63-69
    PubMedGoogle Scholar
  • 26 Neviaser TJ. Adhesive capsulitis. Orthop Clin N Am 1987; 18: 439-443
    PubMedGoogle Scholar
  • 27 Ozaki J, Nakagawa Y, Sakurai G et al. Recalcitrant chronic adhesive capsulitis of the shoulder: role of contracture of the coracohumeral ligament and rotator interval in pathogenesis and treatment. J Bone Joint Surg [Am] 1989; 71: 1511-1515
    PubMedGoogle Scholar
  • 28 Pasteur F. La teno-bursite bicipitale. J de radial et dʼelectrol 1932; 16: 419
    PubMedGoogle Scholar
  • 29 Reeves B. Arthrographic changes in frozen and post traumatic stiff shoulders. Proc R Soc Med 1966; 59: 27-30
    PubMedGoogle Scholar
  • 30 Reeves B. The natural history of the frozen shoulder syndrome. Scand J Rheumat 1975; 4: 193-196
    CrossrefPubMedGoogle Scholar
  • 31 Saha NC. Painful shoulder in patients with chronic bronchitis and emphysema. Am Rev Respir Dis 1966; 94: 455-456
    PubMedGoogle Scholar
  • 32 Sattar MA, Luqman WA. Periarthritis: another duration-related complication of diabetes mellitus. Diabetes Care 1985; 8: 507-510
    CrossrefPubMedGoogle Scholar
  • 33 Segmüller HE, Taylor DE, Hogan CS et al. Arthroscopic treatment of adhesive capsulitis. J Shoulder Elbow Surg 1995; 4: 403-408
    CrossrefPubMedGoogle Scholar
  • 34 Wiley AM. Arthroscopic Examination of the Shoulder. In: Bayley JIL, Kessel L, eds. Shoulder Surgery. Berlin, Heidelberg, New York: Springer; 1982: 113-118
    CrossrefGoogle Scholar
  • 35 Withers RJW. The painful shoulder: review of one hundred personal cases with remarks on the pathology. J Bone Joint Surg [Am] 1949; 31: 414-417
    PubMedGoogle Scholar