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Frozen Shoulder

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Posted by on Wednesday, September 8, 2010, 4:00
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“Frozen shoulder” causes pain and loss of motion in the shoulder joint. Though rather a condition than a well defined disease, it is often associated with Dupuytren’s disease. Patients with a frozen shoulder have about an eight times higher risk of developing Morbus Dupuytren, i.e. Dupuytren’s contracture (association_frozenshoulder). Vice versa patients with Dupuytren’s disease have a high probability to also develop a frozen shoulder: a survey of female Dupuytren patients exhibited 45% with confirmed frozen shoulder syndrom I. Degreef et al. “A survey of clinical manifestations and risk factors in women with Dupuytren’s disease” Acta Orthop Belg. 74 (2008) p 456-460 abstract.

Frozen Shoulder

Frozen Shoulder

The similarities and connection between Frozen Shoulder and Dupuytren’s diesease are still being debated. The collagen accumulation associated with Frozen Shoulder seems to be similar to Dupuytren’s disease (TD Bunker and PP Antony “The pathology of frozen shoulder. A Dupuytren-like disease.” J Bone Joint Surg Br. 77 (1995) p 677-83. Abstract frozen_shoulder_Dupuytren) but there seem to be also significant differences between “Frozen Shoulder” tissue and “Dupuytren” tissue: M. Bains, S. Lambert, V. Mudera “Primary Frozen Shoulder – the untold story” abstract_from_BESS . The authors conclude “These data suggest intrinsic differences in cellular activity and mechanisms between Dupuytren’s and Primary Frozen Shoulder even though clinically they both manifest with a contracted extracellular matrix affecting function and requiring surgical intervention.” O. Kilian et al. “Enhanced alpha 1(I) mRNA expression in frozen shoulder and dupuytren tissue” Eur J Med Res 12 (2007) p 585-90 again find similarities in the fibrosing stage of both diseases abstract.

A cancer treatment with a matrix metalloproteinase inhibitor has been reported to induce frozen shoulder as well as Dupuytren, again indicating a similarity between both diseases (metalloproteinase). A survey of “primary frozen shoulders” revealed “a notably contracted biceps tendon” in 7 out of 11 cases. “… exclusive fibrosis of the joint capsule was found. Electronmicroscopic twists of collagen fibrills were marked” (O. Kilian et al. “The frozen shoulder. Arthroscopy, histological findings and transmission electron microscopy imaging” Der Chirurg 72 (2001) p 1303 – 1308).

Physiotherapy is applied to release the shoulder but is often painful. Some patients report very good results with the Niel-Asher physio therapy. Cortisone injection can dissolve chalky deposits in the shoulder joint. Combined with a local anaesthetic and careful manual release of the blocked shoulder it provides another, often successful and less painful therapy.

In the future collagenase injection might become an option to treat Frozen Shoulder. This enzyme is currently in phase 3 trials for Morbus Dupuytren and in early Phase 2 clinical trials for Frozen Shoulder.  Further trials regarding Frozen Shoulder may begin in the future.

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