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Die eingesteifte Schulter

Diagnose und Therapie

Frozen shoulder

Diagnosis and therapy

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Zusammenfassung

Das Krankheitsbild der „Schultersteife“ wird durch Synonyme wie „adhäsive Kapsulitis“ [1] oder „frozen shoulder“ beschrieben. Es ist eine benigne, eigenständige Erkrankung mit regelmäßigem Ablauf. Der führende klinische Befund ist die Reduktion der aktiven und passiven Beweglichkeit, welche stadienabhängig von starken Schmerzen begleitet ist. Die Diagnose kann klinisch gestellt werden. Unterschieden werden primäre und sekundäre Formen. Bei der primären Schultersteife ist die Ätiologie unbekannt, Häufungen in Verbindung mit Stoffwechselerkrankungen sind beschrieben. Bei den sekundären Formen sind Verletzungen oder Operationen der Schultersteife vorausgegangen.

Der klinische Verlauf bei primären und sekundären Schultersteifen zeigt 3 Stadien, wobei jedes Stadium durchschnittlich 4–6 Monate dauert. Der gesamt Ablauf wird als selbstlimitierend beschrieben, unvollständige Restitutionen treten auf. Das Stadium I („freezing phase“) ist gekennzeichnet durch eine zunehmende Einschränkung der passiven Beweglichkeit, welche von Schmerzen begleitet ist. In Phase II („frozen phase“) lassen Entzündung und Schmerzen nach, die Bewegungseinschränkung steht im Vordergrund. Im III. Stadium der Auflösung („thawing shoulder“) geht die Einschränkung zurück und die Mobilität der Schulter nimmt zu. Therapeutisch wird ein phasenabhängiges Vorgehen empfohlen. Im Stadium I werden Analgetika und Gelenkinjektionen angeraten. Ab dem Stadium II werden Physiotherapie, kombiniert mit manueller Therapie empfohlen. Bei Versagen können eine intensive passive Übungstherapie bei liegendem Interskalenuskatheter, eine Narkosemobilisation oder eine arthroskopische Arthrolyse angeraten werden.

Abstract

The condition of shoulder stiffness is often called adhesive capsulitis or frozen shoulder. It is regarded as a distinct clinical entity showing a benign and regular course. The major clinical feature is significant reduction in both active and passive range of motion (ROM) accompanied by stage-dependent pain, allowing for a clinical diagnosis. There are primary and secondary forms, the former having an unknown etiology and increased occurrence in patients with metabolic disorders and the latter being seen with prior injury or operation.

Three stages, each lasting 4–6 months, mark the clinical course. The progression of the disease is self-limiting and may occasionally resolve in partial restitution. In the first stage (“freezing”), the shoulder continuously loses passive motion and causes worsening pain. Continuing stiffness and improvements in pain and inflammation are characteristic of the second stage (“frozen”). In the third stage (“thawing”), restriction of shoulder motion decreases, and ROM increases. Treatment should be adjusted to these stages. Recommendations include analgesics and joint injections in the first stage and physiotherapy in combination with manual therapy in the second and third stages. In cases of failure, passive exercise under interscalene block, manipulation under general anesthesia, or arthroscopic arthrolysis should be considered.

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  1. Abteilung Arthroskopie - Sportorthopädie, Marienkrankenhaus Kaiserswerth, An St. Swidbert 17, 40489, Düsseldorf, Deutschland

    A. Schultheis, F. Reichwein &  W. Nebelung

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  1. A. Schultheis
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  2. F. Reichwein
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  3. W. Nebelung
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Correspondence to W. Nebelung.

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Schultheis, A., Reichwein, F. & Nebelung, W. Die eingesteifte Schulter. Orthopäde 37, 1065–1072 (2008). https://doi.org/10.1007/s00132-008-1305-6

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