[In Process Citation]
Painful stiffness of the shoulder is an ill-defined||| clinical entity that is difficult to assess and delicate to treat. The||| nomenclature used is broad and includes terms such as frozen shoulder, adhesive||| capsulitis, focal algodystrophy, stiff shoulder, contracted shoulder, and||| others. Apart from its idiopathic form, the disease can be initiated by trauma,||| infection, tumour, radiation, systemic and local metabolic disturbances.||| Pathoanatomically, the common denominator is an inflammatory vascular||| proliferation followed by thickening, scarring, and retraction of the joint||| capsule. The inflammatory process often starts at the rotator interval and may||| extend to the subacromial space. Clinical diagnosis is based on history and||| physical examination. Generally the onset of pain precedes the perception of a||| reduced range of motion by weeks or months. In early stages of the disease, the||| inflammatory type of pain dominates, i.e., the patient's main complaint ist||| pain at night. In the later stage, range of motion gradually decreases.||| Patients do not often complain about reduced motion, probably because of its||| slow onset. Treatment options are a combination of mobilisation exercises with||| intra-articular steroids, hydraulic distension of the joint capsule,||| manipulation under anaesthesia, arthroscopic and/or open arthrolysis. The||| appropriate choice of protocol is just as important as its correct timing. In||| the inflammatory phase, aggressive treatment protocols are probably||| contraindicated. Complications of invasive protocols are rare but deleterious||| and therefore have to be taken into consideration. New anti-anglogenetic agents||| may enhance functional results and shorten the rehabilitation||| phase.
Hertel
R
Universitatsklinik fur Orthopadische Chirurgie,|| Inselspital, CH-3010 Bern. ralph.hertel@insel.ch