In other words, the term “frozen shoulder” is also used to describe shoulder stiffness, which already says a great deal about the condition. The shoulder joint gradually becomes “frozen,” meaning that it becomes increasingly stiff and less mobile. Frozen shoulder is often accompanied by pain. It is caused by changes, inflammation, and thickening of the joint capsule tissue, which can lead to contraction of the capsule.

The joint capsule surrounding the shoulder joint normally allows for a very wide range of motion. It can be compared to a bellows.

When the joint is stretched, the tissue is stretched as well. When it is compressed again, folds form. The same applies to the joint capsule during movement.

In cases of frozen shoulder, these folds can become adhered and contract, making it difficult to move the arm normally. It is important to note that the underlying causes are often unknown. In most cases, these adhesions gradually resolve over time, and the shoulder regains mobility on its own.

Frozen shoulder generally progresses through three stages. The duration of each stage can vary considerably from person to person and may last anywhere from 6 to 24 months.

In the first stage (acute/inflammatory phase), shoulder and joint capsule mobility is still largely preserved, although unexplained and often severe pain may occur. Over time, however, patients often begin to experience a restriction in range of motion.

A typical symptom in the second stage of frozen shoulder is a significant loss of mobility, often described as the shoulder “freezing.” The range of motion is markedly reduced. In some cases, pain may decrease significantly during this stage.

In the third stage, known as the “thawing phase,” the shoulder gradually regains its mobility.

Many people affected by frozen shoulder experience sudden pain without any apparent cause. Frozen shoulder is also associated with restricted movement. Simple everyday activities can become difficult, such as pulling up trousers or reaching for a wallet in the back pocket.

An X-ray can be performed to assess the bony structures, particularly if the frozen shoulder is associated with trauma, such as a fracture or tendon tear. In cases of primary frozen shoulder, no abnormalities of the bony structures would be expected.

To assess shoulder stiffness, other possible causes must first be ruled out.

Ultrasound allows dynamic assessment of the shoulder to evaluate its range of motion. It can reveal thickening of the joint capsule as well as other associated findings, such as injuries.

An MR arthrogram uses contrast medium to assess the size of the joint capsule. If the axillary recess is no longer visible, contrast medium cannot flow into it, which is often indicative of frozen shoulder.

In the acute phase, pain relief can be attempted with NSAIDs. If this does not provide sufficient relief, corticosteroids may be administered intra-articularly, directly into the main shoulder joint. During the injection, it is important to ensure that the medication is delivered into the joint. Ultrasound or X-ray guidance can be used to accurately identify the injection site.

Another treatment option is a short course of oral corticosteroids. This involves taking corticosteroid tablets at regular intervals over a specific period of time. The dose is reduced by half with each step. Treatment begins with a high dose, which is then gradually tapered off.

Physiotherapy and movement therapy in warm water can have a positive effect on mobility. Normal movements and stretching exercises are permitted up to the point of pain.

Surgical treatment (arthroscopy) may be considered once there are no longer any signs of inflammation and conservative treatments have not been successful.

In the early stages of frozen shoulder, surgery should generally be avoided, as it may increase the risk of recurrence.

During the procedure, the joint capsule is released arthroscopically using a minimally invasive technique. The aim is to completely release the capsule (360°) and mobilize the shoulder under anesthesia to restore its range of motion.