The capsulitis is a benign condition of the shoulder consisting of a progressive painful stiffening of this joint.
Its name comes from the fact that the joint capsule (membrane surrounding the joint) retracts and thus prevents the normal functioning of the shoulder. The capsulitis is also called frozen shoulder.
Where does the capsulitis come from?
The capsulitis can occur without cause, it is said idiopathic. In a number of cases, there is a contributing factor such as shoulder trauma or any painful shoulder condition, including surgery follow-ups.
Some diseases favor capsulitis: diabetes (capsulitis can then be bilateral), myocardial infarction, hemiplegia … Finally, certain drugs would promote this disease: barbiturates, isoniazid, antiproteases.
How to diagnose capsulitis?
Capsulitis always begins with a painful phase that is can last from a few weeks to several months. The pain is constant, including night pain often causing the patient to wake up. It is slightly relieved by simple analgesics or anti-inflammatories. At this initial stage, the clinical examination is normal or almost and the patients are usually treated for tendonitis.
After several weeks or months, a progressive stiffness occurs. It becomes more and more difficult to put a jacket, a bra or go looking for an object in height. At this stage, the diagnosis should be made by the doctor.
Generally, when the stiffness settles, the pain disappears or decreases sharply in the following weeks, finally little by little, the stiffness will disappear and the shoulder will return to a normal state. A small persistent stiffness may persist but should not affect function.
Should you do complementary exams?
No specific additional examination is necessary in case of typical capsulitis. Simple examinations are sufficient: shoulder Xrays and blood tests.
How long is a can capsulitis last?
In the vast majority of cases, this healing occurs within 18 to 24 months but may occur earlier, exceptionally, the evolution may be more prolonged requiring specific interventions such as arthrographic distension.
What treatment to propose in retractile capsulitis?
Being a benign condition that heals spontaneously, no specific treatment except for physiotherapy is indicated.
During the initial stage of acute pain, no aggressive treatment should be undertaken as these treatments can lead to serious complications (infections, fractures …) and by the same disabling sequelae. Nevertheless, the pain must be controlled by analgesics adapted according to its intensity. Infiltrations can also be proposed.
What is the place of physiotherapy in retractile capsulitis?
Physiotherapy has a place in the treatment of capsulitis on the one hand during the stiffness phase and on the other hand in the healing phase.
In the initial acute phase, physiotherapy has little effect, the shoulder mobilizations aggravate the pain.
In the phase of stiffening, the physiotherapy will:
• Help fight pain through massage and physiotherapy modalities (heat, electrotherapy, …)
• Maintain the function of the scapula complex, allowing for better shoulder biomechanics
• avoid shoulder muscle atrophy through active work of all shoulder muscles
It is very important to act gently and never trigger pain during or after the physitherapy session.
Work in a hot pool, combining the analgesic effect of heat and the buoncy effect, is particularly indicated throughout the evolution of capsulitis.
In the healing phase, physiotherapy takes its place by allowing a recovery as complete as possible of the shoulder range of motion, strength and function. At this stage, the focus is on the recovery of mobility and active functioning of the shoulder to find a normal shoulder and a return to your normal daily activities and work.
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