How to treat shoulder capsulitis?

physiotherapy-CMI-Clinic-Capsulitis of the shoulder

Adhesive capsulitis is a condition that is characterized by pain and progressive restriction of shoulder movement. The diagnostic criteria are a loss of mobility of 25% to 50% in at least two planes of motion. Abduction and external rotation are often the most restricted movements. Women between the ages of 40 and 65 seem to be the most affected by this pathology. Capsulitis starts with an inflammation of the synovial joint. This is followed by capsular fibrosis, which contributes to a reduction in shoulder mobility.

The factors that can trigger capsulitis vary:

  • Idiopathic: No known cause
  • Health Issue: Diabetes, Parkinson’s, hormone disorder
  • Trauma: Fall, fracture, cervical hernia, surgery
  • Shoulder pathology: Tendonitis, calcifications, arthritis/osteoarthritis, bursitis

Capsulitis is a condition that tends to resorb naturally in 6 months to 2 years. However, the condition can persist for several years and it may result in some sequelae including loss of mobility in the shoulder. Physiotherapy has been shown to help reduce the pain associated with this condition, and improve mobility and function.

Clinical presentation

Capsulitis usually presents itself as a progressive reduction in shoulder mobility that sets in over a few months. At first, the pain is felt at the end of the movement, but can then extend over most of the movement. The pain may also be felt at night and affect sleep quality. Patients who visit our clinic often report having difficulty with tasks that are performed over the head or behind the back, such as fastening a bra, dressing up, combing their hair, etc.

Capsulitis has three phases

1. Freezing stage

Inflammatory reaction and formation of adhesions. Beginning of pain and progressive loss of mobility. Significant irritability and disturbed sleep.

2. Frozen stage

Inflammation and pain slowly diminish, leading to fibrosis and a significant decrease in mobility. Moderate irritability.

3. Thawing stage

Gradual increase in mobility with minimal pain. Low irritability.

Physiotherapy treatment

An assessment in physiotherapy is important in cases of shoulder pain to identify the structure involved. During the session, the physiotherapist will observe your posture, evaluate your joint range of motion, your muscle strength and the specific mobility of the shoulder joints. If you have capsulitis, it will be important to determine at which stage it is. Your physiotherapist will then be able to explain the rest of the treatment plan to you.

If you are in the first two phases of capsulitis, the treatment goals will be to relieve pain, mobilize joints to gain mobility, to maintain muscle strength and to optimize function. To do this, we will use active assisted and passive mobilizations, electrotherapy, manual therapy and education.

The thawing phase will require more aggressive treatment to regain mobility. Since this phase is less painful, the treatments will be better tolerated. The physiotherapist may use passive mobilizations to stretch the soft tissues, manual therapy with higher grades and strengthening with elastics.

No matter what stage you are at, your physiotherapist will teach you a daily exercise program at home.

Medical treatments

Treatment of capsulitis usually begins with a conservative approach consisting of physiotherapy and medication to control the pain. However, when capsulitis persists, different medical treatments can be considered. Cortisone infiltration helps reduce pain and inflammation. It will be used after 3 to 6 weeks of conservative treatments. Distensive arthrography is another approach that aims to infiltrate a saline solution into the shoulder, thus putting pressure on the capsule and stretching it. It is important to seek physiotherapy immediately after the arthrography (less than 24-48 hours) to mobilize the shoulder and benefit from the effects of the infiltration.

So, if you feel pain in your shoulder and experience a loss of mobility, do not wait to consult your physiotherapist. He or she will take care of you to heal this condition as quickly as possible.

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