Florence Charbonneau-Dufresne
Osteopathy
THE CAPSULITE
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What is capsulitis?
Often known as "Frozen shoulder", capsulitis is a pathology of the shoulder characterized by pain and decreased mobility, generally in all shoulder movements.
It has no known confirmed cause, but several etiologies have been suggested: post-surgical, idiopathic, post-traumatic, diabetic, stiffness caused by rotator cuff pinch.
It can therefore develop following a period of immobilization of the arm, for example during a wrist fracture. It can also occur as a result of another soft tissue disease of the shoulder, such as rotator cuff tendonitis. Sometimes it occurs for no reason at all.
Capsulitis is more likely to occur in women around the age of 50.
The phases of capsulitis
The pathology develops gradually over a period of up to 2 years. This process can be separated into 3 phases.
Phase 1: Pain
This phase can last from 1 to 4 months. The main characteristic is pain. This pain is present in the shoulder area, at rest and during movement. It is worse in the evening and at night. It is impossible to lie on the affected shoulder.
During this phase, there is no loss of mobility and diagnosis is more difficult. Physiotherapy treatment during this phase consists mainly of mobility exercises to be done at home to limit the possible loss of mobility.
During this period, physiotherapists may use analgesic modalities. For example, heat can be applied to reduce pain. A cortisone injection by a physician may be necessary if the pain is too intense.
Phase 2: Stiffening
This phase can last from 3 to 12 months. It is characterized by a decrease in mobility of the affected shoulder, with all movements generally being reduced. Patients may complain of not being able to fasten their bra (putting their hand behind their back) or not being able to wash their hair. The pain gradually decreases: it becomes intermittent.
Physiotherapy treatments during this phase include mobility exercises to be done at home to regain mobility. Manual therapy treatments performed by a physiotherapist can also help increase shoulder mobility.
An injection called a distensive arthrography performed by a radiologist can be helpful to speed up the process. This injection distends the shoulder joint with a mixture of cortisone and saline.
For chronic and resistant cases, distensive arthrographic injection combined with manual therapy by a physical therapist is the treatment of choice. Up to 3 injections can be given each month, with manual therapy sessions in physiotherapy between injections.
Phase 3: Recovery
The third phase is when mobility gradually returns and pain diminishes. It can last from 6 months to 2 years. The prognosis for recovery of mobility is favorable, but the process can be very long, which is why it is important to be patient.
What to do in case of shoulder pain?
In case of shoulder pain, it is best to consult a health professional, such as a physiotherapist. A physiotherapist will be able to diagnose capsulitis because the diagnosis is clinical. This means that the patient's history and a physical examination are used to make the diagnosis.
Sometimes, a medical visit may be necessary to do imaging tests to eliminate other possible damage to the shoulder, such as rotator cuff tendinopathy.
Also, it is very important to consult a physiotherapist when experiencing shoulder pain, as some mobility exercises indicated for capsulitis may not be indicated for other shoulder problems.
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Florence Charbonneau-Dufresne, Physiotherapist Pht.
florence.charbonneau-dufresne@cliniquealtermed.com