Frozen shoulder in Vienna
First the shoulder hurts at rest and at night, then it stiffens: putting on a jacket or reaching behind your neck no longer works. Behind this there is often a frozen shoulder, an inflammation of the joint capsule with subsequent shrinkage. I establish which phase your shoulder is in.
In short
The frozen shoulder (adhesive capsulitis, in German Schultersteife) is an inflammation of the shoulder joint capsule; the tissue shrinks and constricts the joint from within. Typically there is a gradual onset with pain at rest and at night, followed by a marked restriction of movement, above all when turning the arm outwards. It arises without any recognisable trigger (primary) or after injury, surgery and a longer period of immobilisation (secondary). Treatment is conservative first: pain relief, ultrasound-guided injection and adapted physiotherapy. If the shoulder stays stiff, the capsule can be released arthroscopically.
What is a frozen shoulder?
A wide capsule encloses the shoulder joint; it is what makes the large range of movement of the arm possible in the first place. In a frozen shoulder this capsule becomes inflamed: the tissue thickens, scars and contracts, particularly in the upper front section between the tendons (the rotator interval). The arm is not blocked from outside but held back from within.
The primary form begins without a recognisable trigger, most often in middle age, and is connected with metabolic disorders, above all with diabetes mellitus and disorders of the thyroid gland. The secondary form follows a fall, an operation, a longer period of immobilisation or a tendon disorder such as calcific tendinitis. Sparing the arm out of pain leads easily into a cycle of sparing and stiffness.
Typical symptoms
- Pain at rest and at night — lying on the affected side becomes impossible
- Loss of external rotation — with the elbow held at the side the forearm barely turns outwards any more
- Loss of movement in every direction — lifting, moving the arm out to the side and reaching behind the back
- No movement even under guidance — the arm stops even when I move it passively
- Signs in daily life — dressing, washing your hair or reaching to a high shelf become hard
The three phases
The course is divided into three sections: a painful phase with inflammatory pain at rest and decreasing movement, a stiff phase in which the pain recedes and the restriction remains, and a thawing phase with a gradual return of movement. The transitions are fluid; the classification still counts for treatment, because what helps in the inflammatory phase differs from what helps in the stiff one.
How I make the diagnosis
It begins with a thorough conversation: when did the symptoms start, was there a fall, an operation or a period of immobilisation? I then test movement actively and passively, comparing both sides — the loss of passively guided movement, external rotation above all, is the most important sign. Ultrasound in the practice shows me tendons, bursa and calcium deposits and separates the frozen shoulder from other causes of shoulder pain. Where needed I arrange an X-ray or an MRI.
Treatment: conservative first
The frozen shoulder is as a rule treated conservatively. The approach follows the phase — at the wrong moment, the same measure can irritate more than it helps.
- Dampening the pain — while the inflammation leads, so that the nights become restful again
- Ultrasound-guided injection — under visual control I place an anti-inflammatory medication at the irritated capsule and open a window for physiotherapy
- Physiotherapy in a fitting dose — first guided movement with little pain, later consistent work on the range of movement; physiotherapy and exercise therapy are available in-house at the Orthozentrum Döbling
- Home exercises — practising briefly several times a day achieves more than infrequent, vigorous stretching
- Magnetic field therapy — as an adjunct in the practice, where it fits the symptoms
I recommend forced stretching in the inflammatory stage no more than complete rest: the shoulder needs movement at a tolerable intensity. I adapt the plan at follow-up appointments.
When an operation is necessary
If the shoulder stays stiff despite consistent conservative treatment and daily life remains markedly restricted, a procedure comes into consideration. In an arthroscopic capsular release (arthrolysis, the release of the scarring) I divide the shrunken capsule through small incisions and remove scarred tissue; the principles of arthroscopic keyhole surgery apply. A calcium deposit can be dealt with in the same procedure.
The aftercare is decisive: the range of movement gained has to be maintained with physiotherapy from the outset. I carry out necessary procedures at the ATOMOS Klinik Währing, the Privatklinik Döbling or the Rudolfinerhaus, and I accompany you from planning through the procedure to aftercare.
My practice is a private practice, in Austria a Wahlarztordination. I do not settle directly with any public health insurer; you receive an invoice and submit it to your insurer — on request I take care of the submission for you. For operations, direct settlement with a supplementary private insurance is possible; I explain how a private practice works on a page of its own.
Whether a procedure makes sense depends on the findings and on the course. I take that decision together with you once all the findings are in — my page on shoulder surgery in Vienna gives an overview.
Frequently asked
Frequently asked questions about frozen shoulder
The hallmark is a progressive loss of movement without a matching accident. First the shoulder hurts at rest and at night, then it stiffens. What stands out is that the arm stops even when I guide it myself with the muscles relaxed. External rotation with the elbow held at the side is affected early.
The primary frozen shoulder tends to settle again over time. You should not rely on it: the way there is often protracted, and in some of those affected a residual stiffness remains. Treatment therefore pursues two aims — to dampen the pain early and to preserve movement.
Yes, when it fits the phase. While the inflammation dominates, the point is movement with little pain and good positioning; vigorous stretching against the pain can increase the irritation. Only once the pain eases is the range of movement worked on more firmly. Physiotherapy and exercise therapy are available in-house at the Orthozentrum Döbling.
A connection is known: in people with diabetes mellitus the frozen shoulder occurs more often and frequently runs a more stubborn course; disorders of the thyroid gland are also associated with it. That is why I ask about metabolism and previous illnesses at the first consultation, and where there is a suspicion I advise an assessment in internal medicine.
Only once conservative treatment has been consistently exhausted and the shoulder remains markedly restricted in daily life. The shrunken capsule can then be divided arthroscopically and scarred tissue released. With a secondary stiffness after injury or previous surgery, a procedure is advised sooner. We decide together, based on the findings.
With a tear of the rotator cuff it is above all active strength that suffers: lifting is hard, while under guidance the shoulder usually still moves well. With a frozen shoulder the passively guided movement is restricted as well, because the capsule itself holds it back. Ultrasound and, if needed, an MRI secure the distinction.
Dr. med. Martin Eigenschink
Specialist in Orthopaedics and Traumatology · Specialist in elbow, shoulder and hand surgery
Surgical and conservative treatment of the elbow, shoulder and hand, preferably minimally invasive. Practice at the Orthozentrum Döbling, 1190 Vienna. More about my background
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Medical notice: The contents of this page serve as general information. They do not replace a medical examination, diagnosis or individual advice. Medicine is a constantly evolving field — despite careful research, no guarantee can be given that the content is fully up to date.