Schultersteife

Synonym: adhäsive Kapsulitis der Schulter

Was ist eine Schultersteife?

Die Frozen Shoulder ist eine der häufigsten Ursachen für intrinsische Schulterschmerzen. Es handelt sich um eine glenohumerale Störung und kann in einer Schulter oder in beiden Schultern gleichzeitig auftreten. Verdickung und Kontraktion der glenohumeralen Gelenkkapsel sowie die Bildung von Verwachsungen verursachen Schmerzen und Bewegungseinschränkungen.¹

Eine Schultersteife kann auftreten:

• Spontan.

• Nach Rotatorenmanschettenläsionen/-verletzungen.

• In conditions causing immobility - eg, after a cerebrovascular accident or plaster immobilisation.

See the separate Schulterschmerzen und Schulteruntersuchung articles.

• Adhäsive Kapsulitis tritt bei etwa 2-5% der Bevölkerung auf, mit einer Häufigkeitsspitze zwischen 40 und 70 Jahren.

• It is more common in females and bilateral in 20-30% of cases. When unilateral, the non-dominant hand is more commonly affected.

• The incidence of adhesive capsulitis is more common in those with diabetes and thyroid disorders - outcomes are worse in those with a longer duration of diabetes.

Die Hauptsymptome sind Schmerzen und Steifheit, verursacht durch die Bildung von Adhäsions- oder Narbengewebe im Glenohumeralgelenk.

• There is usually a gradual onset of severe pain in the shoulder, which is then followed by stiffness.

• Einschränkung aller Schulterbewegungen, sowohl aktiv als auch passiv.

• Unfähigkeit, auf der betroffenen Seite zu schlafen.

• Restriction of activities of daily living due to impaired external rotation - eg, driving and dressing.

• Es gibt in der Regel drei Phasen:

  • Phase 1 - severe generalised pain associated with stiffness. Daily activities are limited (eg, putting on a jacket). It can last up to nine months.

  • Phase 2 - pain usually gradually subsides but the shoulder is stiff. Movement can become more limited. External rotation is usually very limited. This phase lasts between 4-12 months.

  • Phase 3 - the shoulder becomes less stiff. There is an increase in the range of movement. This phase usually lasts 1-3 years.

Steifheit, Schmerzen und Bewegungsverlust mit schleichendem Beginn sind normalerweise die Hauptsymptome.

• Die Diagnose ist klinisch:

  • Das gesamte Schultergelenk kann bei Palpation empfindlich sein.

  • Der Hauptdiagnosetest ist die Unfähigkeit, eine passive Außenrotation durchzuführen.

• X-rays are usually only necessary if the presentation is atypical or the patient is not responding to treatment - they are often normal.

• Berücksichtigen Sie andere Ursachen für Schulterschmerzen.

• Blood tests and radiography should only be performed if red flag symptoms are present. For a list of these, refer to the separate Schulterschmerzen article.

Consider referral to secondary care if pain and significant disability are present for more than six months despite appropriate conservative management and always refer if there is diagnostic doubt.

Despite over a hundred years of treating this condition the most efficacious treatments are still largely unclear. A holistic approach to treatment should be used, considering psychological and psychosocial factors.

• Die erste Stufe ist die Analgesie - Paracetamol als Erstlinientherapie, gefolgt von nichtsteroidalen Antirheumatika (NSAR) als Zweitlinientherapie, sofern keine Kontraindikationen vorliegen. Der Einsatz eines transkutanen elektrischen Nervenstimulationsgeräts (TENS) kann ebenfalls hilfreich sein.

• Frühe Aktivität fördern.

• Physiotherapy with joint mobilisation combined with stretching exercises have been shown to be better than stretching exercise alone in terms of external rotation, abduction range of motion and function score, although a 2023 systematic review was limited by lack of consistency in study designs and found that most of the benefits did not reach statistical significance. The 2025 British Elbow and Shoulder Society patient care pathway rates physiotherapy as 'likely to be beneficial'.⁶⁷

• Passive Mobilisation und Kapseldehnung sind zwei der am häufigsten verwendeten Techniken in der Physiotherapie.

• Injection with corticosteroids:

  • This can reduce pain and duration of symptoms in the early stages and the 2025 British Elbow and Shoulder Society patient care pathway rates injection as 'likely to be beneficial'.⁶

  • It should not be done if a previous such injection has shown no or minimal benefit, or if the patient has passed the pain stage and entered the stiffness stage.

  • Care must be taken to monitor blood sugar after the injection in patients with diabetes (they may be raised for 1-2 days) and the balance of risks and benefits should be carefully considered in those with poorly controlled diabetes.⁸

• A 2012 Cochrane review found no benefit to an ultrasound guided injection versus one without such guidance. More recent smaller studies are divided, with some finding more pain reduction with ultrasound guidance and others finding no difference - the 2025 British Elbow and Shoulder Society patient care pathway also found that this made no difference. An injection should therefore not be delayed to wait for ultrasound guidance to be available.⁹¹⁰¹¹

• Oral steroids are not recommended, although they may reduce pain in the very short term.⁸

• Surgical options include manipulation under anaesthesia and arthroscopic capsulotomy but are generally reserved for cases where non-surgical options have failed.²

Long-term pain and shoulder stiffness are possible complications.

• 80 - 90% of patients with spontaneous frozen shoulder have been shown to recover to normal levels of function and movement by two years without any treatment, with the remaining 10-20% having some residual stiffness or discomfort.^{12 2}

• Rückfälle in derselben Schulter sind selten.