yogabook / pathologie / periarthropathia humeroscapularis

periarthropathy/periarthritis humeroscapularis PHS, painful frozen shoulder, frozen shoulder, adhesive capsulitis

Definition of

Collective term for various pain conditions in the shoulder girdle caused by degenerative processes in the soft tissues (joint capsule, rotator cuff). The shoulder is one of the most complex joints in the body; its design offers extreme flexibility, which is somewhat at the expense of stability. Metabolic derailments, in which lactic acid in the interstitium leads to acidosis, often result in long-lasting restrictions in quality of life and ability to work. Active flexibility is more clearly restricted than passive flexibility. Proactive patients have a clear advantage, as PT exercises carried out at home are of great value. Prevention of the contralateral shoulder is also important. Early intervention is beneficial. Peak age: 40-60 years, W > M. In 25% of cases, the second shoulder is also affected shortly after the first. The disease usually burns out after 6 – 24 months and can be divided into phases:

1. Stage 1: pronounced pain on movement, possibly also pain at rest, no restriction of flexibility yet. Analgesics provide little relief
2. Stage 2: after about 3 months the pain subsides, but flexibility is increasingly restricted; lateral abduction is limited to less than 90°. No more inflammation of the capsule but scarring, it shrinks and thickens
3. Stage 3: decreasing flexibility restrictions, risk of permanent weakening of the shoulder joint

ICD M75.0

Cause

1. Primary form (autoimmune-inflammatory): unknown
2. Secondary form: Trauma, fracture, ruptures within the „rotator cuff„, surgery, degenerative diseases such as osteoarthritis

Predisposing

– Behavior

1. Lack of exercise
2. Repetitive monotonous movements(narrowuse)
3. Acidic (acid-forming) diet

– Bewegungsapparat

1. Kalkschulter
2. Immobilisierung des Schultergelenks

– Other factors

1. Metabolic diseases such as diabetes mellitus, hypercholesterolemia, hyperthyroidism, hypothyroidism, metabolic syndrome

Diagnosis

1. primarily clinical/functional diagnostic and anamnestic
2. can hardly be visualized in imaging
3. arthroscopically detectable

Symptoms

1. Movement-dependent pain, painful restriction of movement in all directions; as a rule, lateral abduction is significantly restricted by pain sensation, passive movement is possible a little further than active movement
2. Highlight: Night-time pain at rest when lying on the affected side
3. Sudden, severe pain, also occurring independently of strain or trauma during everyday activities
4. Stabilization of pain, detachment from certain movements up to permanent pain
5. Finally, the permanently painful and spared shoulder stiffens
6. Significant pressure pain of the inflamed capsule (stage 1)

Complications

1. Psychological stress
2. Temporary incapacity to work, if applicable
3. subacromial impingement

Therapy

1. first immobilize
2. Administration of analgesics, optionally also anti-inflammatory drugs
3. It is good to administer local anesthetics such as lidocaine, procaine,… (which should not contain adrenaline) via wheals, which has an additional effect of stimulating blood circulation (trick: prick briefly (1 s), inject a little, then deeper and more, place the next wheal in the already anaesthetized area).
4. for frozen shoulder: Anesthesia mobilization and consistent active KG, otherwise there is a risk of recurrence
5. Alkaline nutritional therapy, avoidance of supplements containing arachidonic acid
6. Ultrasound therapy
7. Water-filtered infrared-A heat therapy (wIRA lamp)
8. Movement therapy: stretching, strengthening, coordination
9. Surgery (minimally invasive) only if conservative therapy fails: arthrolysis. Post-op: immediate permanent movement training of the shoulder on a motorized splint under analgesia.
10. Temporary switch to shoulder-friendly sports
11. A serious shortening of the course is hardly achievable