Frozen shoulder, Capsulitis

What is frozen shoulder?

Frozen shoulder, also known and named as adhesive capsulitis or retractile capsulitis, is a pathology that affects the shoulder joint. shoulder.

It could be defined as“freezing of the joint capsule “. Its main characteristic is pain and limitation of movement.

To understand this process we must know what the capsule is and what its function is.

What is the joint capsule?

It is a fibrous structure that gives congruence to the glenohumeral joint (humerus-scapula/ shoulder blade). It has a very important role in the joint, if it were not for it, the humeral head (the ball of the shoulder, as many people know it) would come out of the joint very easily.

Another of its main functions, together with that of giving stability and firmness to the joint, is to send information to our Central Nervous System about the position of our arm.

It also helps to cushion possible trauma to the joint. It protects the bone components, thanks to its lubrication by means of synovial fluid (“jelly-like substance”).

 

How is the capsule affected and why?

It is an idiopathic disease, the reason is not known for sure, especially in the case of“Primary Capsulitis“.

These usually appear spontaneously. We can find some predisposing factors such as systemic diseases, hyperthyroidism or hypothyroidism, diabetes and cardiovascular diseases. The age range is usually between 40 and 55-60 years and more frequently affects the female sex.

Secondary capsulitis” usually appears after shoulder surgery, trauma or long periods of immobilization.

In frozen shoulder, what happens to the capsule is that it becomes inflamed and hardens. As a result, it becomes denser and consequently loses its capabilities.

 

How is it diagnosed?

The diagnosis we can say that it is by discard, since there is no test that diagnoses it. What helps the traumatologist to name this pathology is usually the absence of other pathologies that may cause pain and/or loss of mobility.

The diagnosis is composed of:

• The patient’s anamnesis is based on the patient’s experience, where he/she tells us how the pain started, how long it has been hurting, if he/she has any factors, if he/she has suffered any trauma, etc.
• Physical examination, in which active and passive stiffness and decreased joint range are observed, apart from pain on forcing the joint.
• Imaging tests will help to rule out other pathologies. An X-ray to rule out osteoarthritis, fractures, dislocations and/or calcifications. The ultrasound will show us if the capsule is vascularized and thickened and the possible presence of bursitis, tendinosis, calcifications. Also it helps for the diagnosis, the magnetic resonance in which the thickening of the capsule and the state of the tendons that compose the rotator cuff would be seen. This last one in initial stages of the frozen shoulder, is not useful in many cases.

The absence of other pathology (visible by any imaging test) together with the symptomatology (pain, lack of mobility and stiffness) will make the physician or physiotherapist suspect a possible Adhesive Capsulitis.

 

Evolution of Frozen Shoulder and Physiotherapeutic Treatment

Adhesive capsulitis is a long-term pathology. In the “worst” case, it can last up to three years. It usually subsides on its own after this time, with the help of PHYSIOTHERAPY the duration time is shortened and the symptomatology is reduced, providing quality of life to our patients.

We can distinguish three phases in this process:

 

Inflammatory Phase

It is the initial and most painful phase. The patient suffers pain mainly at night, in the anterior and lateral aspect of the shoulder, being able to radiate towards the arm. The duration of this phase is variable, usually around 2 months.

In this phase physiotherapy is very important. Aiming to reduce inflammation and avoid stiffness.

In some cases, it is necessary to work with our physicians to perform an echo-guided infiltration (corticosteroids). This will reduce inflammation and decrease pain. This will allow the physiotherapist to work better.

If it does not improve with this infiltration, a hydrodilatation (introduction of anesthesia and physiological saline at intra-articular pressure) will be assessed (by the doctor), to achieve a dilatation and increase of the space inside the joint, increasing significantly the mobility of the joint. Physiotherapy will always be necessary after this intervention.

 

Freezing Phase; Stiffening Phase

In this phase the pain decreases and joint stiffness gains prominence, causing limitation in the activities of daily living. The patient describes the impossibility to lift the arm, to perform external rotations, and will even be very limited in daily gestures. The difficulty or impossibility of separating the arm from the body is the symptom that makes many patients seek help and put themselves in the hands of their physiotherapist or traumatologist of trust.

Unfortunately, until the pathology reaches this stage, many patients endure the pain with oral medication and with the “hope” that it will disappear by itself, just as it appeared spontaneously. For this reason, we advise not to wait or endure pain for such a long time simply because you have not made any overexertion or have not suffered a fall, blow or trauma.

 

Thawing” phase; Recovery phase.

In this phase the stiffness begins to disappear, the arm gradually begins to gain mobility and the situation normalizes.

Treatments

The physiotherapeutic treatment is often complemented by the medical treatment.

We can differentiate between two types of physiotherapeutic treatments.

Conventional physiotherapeutic treatment

It focuses on restoring the functionality of the shoulder with different techniques and machines. These techniques are based on the application of local thermotherapy to relax the muscles, electroanalgesia to reduce pain, joint mobilization to prevent loss of mobility and progressively gain joint degrees, muscle and joint stretching to gain “elasticity” of the tissues, postural education and supervised home exercises , so that the patient can perform them at home.

 

Advanced physiotherapeutic treatment

It focuses on the realization of a series of invasive techniques (EPI and neuromodulation). These techniques are performed through the use of acupuncture needles with the support of an ultrasound, we introduce a current in the tissue or area that we want to treat. We perform a much more selective and specific approach and treatment of the affected tissue, both on the nerves that innervate the shoulder joint and its musculature. With the use of these techniques, we will be able to relieve pain, reduce inflammation and improve the quality of the tissue that makes up the joint capsule. We also help to strengthen the affected musculature. With Advanced Physiotherapy we improve both the structure and functionality of the joint.

 

Medical treatment

It will consist of infiltrations, already mentioned above, in the initial stages. Only in a small percentage of the population affected by this pathology would medical intervention in the operating room be necessary. The two most commonly performed techniques are forced mobilization under anesthesia and arthroscopic arthrolysis, in which small cuts are made in the capsule to release the fibrosis. After both, physiotherapy is required to maintain the degrees of mobility gained in the operating room and to prevent “scarring” of the capsule.

 

In our MIVI center, we will be happy to answer any questions about this pathology. We will suggest the most appropriate treatment, according to the stage you are in.