shoulder examination under anesthesia
Examination of a stiff shoulder under anesthesia














arthrocopic exploration of the axillary nerve in a stiff shoulder

Arthroscopic exposure of the axillary nerve, while dissecting the inferior capsule

















Frozen shoulder / Shoulder stiffness


inflammed frozen shoulder - arthroscopic view inside the joint
Here you can read:
What is a frozen shoulder ?
Signs and symptoms of a shoulder stiffness ?
Development of a frozen shoulder ?
Age and sex of a frozen shoulder
Who is affected by a shoulder stiffness ?
How to treat a shoulder stiffness


What is a frozen shoulder ?
A frozen shoulder or shoulder stiffness is a disease of it´s own, which leads into a stiff shoulder. A typical symptom is a painful reduced movement. Using a microscope an inflammation of the synovia and the shoulder capsule will be recognized and as the disease progresses a thickening of the shoulder joint capsule as well as a shrinking of the capsule can be observed, histologically. These changes of the shoulder joints tissue are comparable to Dupuytrens disease.


Signs and symptoms of a shoulder stiffness ?
A frozen shoulder is a creepingly starting disease. In the beginning slight pain is present, which becomes more and more debilitating. Than the affected shoulder becomes stiff more and more. Shoulder movements decrease and are limited signifantly.
Nearly every day pain at night occurs, which is very annoying for the concerned person. Sleep is nearly impossible because of shoulder pain. Sporting activities nearly get impossible because of pain and increasing shoulder stiffness.


Development of a frozen shoulder ?
In some cases it´s obvious what had happened. In these cases e.g. a fracture occured or soft tissue of the shoulder was damaged. Due to pain the affected shoulder joint isn´t used and the shoulder becomes stiff.
In most of the cases we don´t know the exact mechanism of development. Then, a physician is speaking about an idiopathic or primary frozen shoulder. There are associations of these idiopathic shoulder stiffnesses to diabetes or bigger / long lasting operations ( like heart or lung operative procedures ). A shoulder stiffness can even just occur spontaneously.


Age and sex of a frozen shoulder:
Most people suffering from a stiff shoulder are between 40 and 70 years of age. Men and women are affected equally. Some studies demonstrated slighlty more stiff shoulders in women. It´´ estimated that about 5% of all people between 40 and 70 will suffer from a frozen shoulder.


Who is affected by a shoulder stiffness ?
People having metabolic diseases ( high cholesterol levels, diabetes, thyroid insufficiencies ) will develop a frozen shoulder. About 20% of all diabetic patients experience a stiff shoulder during their life time and 35% of people with insulin dependent diabetes are affected by a frozen shoulder. Several years later, in patients with diabetes, the other shoulder will become stiff, as well.
Patients with heart and lung diseases and after heart and lung operations are more likely to have a shoulder stiffness.
Degenerative diseases like cervical spine arthritis and people with Duyptrens contracture suffer more often from a frozen shoulder.


How to treat of a shoulder stiffness:
A frozen shoulder is a domain of non-operative treatment, in the beginning. Physiotherapy and physical therapy are used to improve the symptoms of a stiff shoulder.
A lot of shoulder stiffnesses are refractory and the patient is suffering from it, a lot. Then a mobiliziation under anesthesia, with or without an arthroscopically assisted capsular release, is performed.
Besides a lot of different therapeutic oppotunities, there are only two evidence based therapies for a frozen shoulder: corticosteroids or a mobilization under anesthesia.
inflammation inside a frozen shoulder
Arthroscopy of the right shoulder: a typical inflammation ( red ) within this right shoulder joint is causing pain
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