Stiffness of the shoulder («Frozen shoulder»)

Introduction
Because of its complex anatomy with several sensitive layers of soft tissue (see chapters 1 and 2) the shoulder joint is more inclined than other large joints to loss of motion and stiffening. Stiffening can occur after a fall, an operation, or spontaneously. Not infrequently, intensive and persistent shoulder pain with loss of mobility occurs without external cause. The shoulder is said to «freeze», and becomes what we call a «frozen shoulder». After a period of weeks or months the pain recedes, but the shoulder remains stiff, so that the arm cannot be turned outwards or raised above the horizontal. The patients are considerably disabled in everyday life. Months later the shoulder may slowly become more mobile, that is to say it «thaws».

Surgical procedure and follow-up
Up to now, people either put up with a frozen shoulder as fate, or had a forceful shoulder mobilisation under anaesthetic. Today arthroscopy can be successfully used in these cases. During the operation the thickened joint capsule is split in a circle around the glenoid with an electrothermic probe, which restores the lost mobility immediately. We start the physiotherapy in the recovery room to preserve the gained mobility. Further physiotherapy several times a day in the first few days after the operation is of great importance.

Prognosis
The majority of patients are very happy with the gain of motion and reduction in pain after shoulder mobilisation. Sometimes, this has to be followed by a second intervention, namely a sutu-ring of the rotator cuff tendons, so the shoulder may return to it’s normal functioning.