Adhesive Capsulitis or frozen shoulder

Adhesive capsulitis occurs when the shoulder joint capsule (the membrane that surrounds the shoulder joint), “shrinks” and thickens, causing a gradual onset of pain and a progressive loss of movement at the shoulder in all directions. This condition is most prevalent in individuals between 40 and 60 years and is more common in women.

Causes

The exact cause of adhesive capsulitis is unknown : it therefore tends to manifest itself for no apparent reason. However, some medical conditions, which have in common to cause a loss of shoulder, precede sometismes its appearance :

• Immobilization of the shoulder (following a fracture, mastectomy, etc.) or prolonged general immobilization (following thoracic surgery, for example)
• A neurological impairment (a stroke for example)
• The existence of another shoulder condition, such as tendinitis, bursitis or rotator cuff tear..

Note also that adhesive capsulitis is often associated with certain pre-existing medical conditions, including diabetes, heart disease, thyroid disorders and cervical pathologies.

Symptoms and course of retractable capsulitis

The adhesive capsulitis evolves in three main phases and the symptoms vary according to the stage reached:

• Phase 1: lasting from 1 to 4 months, this phase is characterized by significant pain, a diffuse pain in the shoulder area, which can radiate to the elbow. The pain can be present at rest and during movements especially with sudden movements and particularly in the evening and at night. During this phase, sleep is disturbed because it is impossible to lie on the side of the affected shoulder.
• Phase 2: lasting from 3 to 12 months, it is characterized by a stiffening of the affected shoulder (hence the nickname” frozen shoulder “) and a decrease in the range of motion. The pain is now intermittent and is less intense than during phase 1. Note that the range of motion is very limited in all directions.
• Phase 3: The third phase of the condition is the beginning of recovery and can last anywhere from six months to two years and is characterized by a reduction in pain and a gradual increase in movement.

Treatment

Medical component (as appropriate):

• Taking oral anti-inflammatories drugs
• Injection of corticosteroids
• Arthrography distension, which is the injection into the shoulder of saline or air (under local analgesia) to promote the return of the capsule to its normal state.

Physiotherapy component

At the shoulder level, physiotherapy treatments aim to reduce pain, improve mobility and restore function:

• Analgesic modalities: moist heat, ice, laser and TENS
• Manual therapy (soft tissue massage, joint mobilization, contraction and relaxation)
• Passive stretching
• Postural correction
• Exercise program to do at home.

Evidence suggests that early management and early treatment of capsulitis (medical and physiotherapy) can significantly reduce the adverse consequences of this condition and decrease recovery time. In addition, recent studies suggest that the combination of of manual therapy, home exercise and infiltration, either corticosteroids or distal arthrography, is the most effective to reduce pain, regain mobility and recover function during an adhesive capsulitis. The use of the laser is a modality that is effective in reducing pain during the first stage of adhesive capsulitis.

Given the rather long history of this condition, it is important to consult a physiotherapist promptly if you experience unexplained shoulder pain, whether or not accompanied by loss of movement. You could reduce the severity of symptoms and promote faster recovery.

Prognosis

Although the prognosis is favorable for the majority of people affected, the complete recovery can be long, the recovery time can range from one to two years. In addition, some mobility restrictions may persist, particularly with regard to range of motion.

Contact us immediately to get the right diagnosis, promote optimal recovery and avoid long-term complications.

References

• Éric Noël, Thierry Thomas, Thierry Schaeverbeke, Philippe Thomas, Monique Bonjean, Michel Revel, La capsulite rétractile de l’épaule, Revue du Rhumatisme, Volume 67

• Bergeron , Fortin , Leclaire, Capsulite rétractile, Pathologie médicale de l’appareil locomoteur, 2eme Edition

• Jain, T. K., & Sharma, N. K. (2014). The effectiveness of physiotherapeutic interventions in treatment of frozen shoulder/adhesive capsulitis: a systematic review. Journal of back and musculoskeletal rehabilitation

• Page, M. J., Green, S., Kramer, S., Johnston, R. V., McBain, B., & Buchbinder, R. (2014). Electrotherapy modalities for adhesive capsulitis (frozen shoulder). The Cochrane Library.

• Ahn, J. H., Lee, D. H., Kang, H., Lee, M. Y., Kang, D. R., & Yoon, S. H. (2017). Early intra-articular corticosteroid injection improves pain and function in adhesive capsulitis of shoulder: 1-year retrospective longitudinal study.