Shoulder capsulitis

Adhesive capsulitis is a condition characterized by a pain and the gradual onset of restriction of movement to the shoulder. The diagnostic criteria are a loss of mobility of 25% to 50% in at least 2 planes of movement. Abduction and external rotation will often be the most limited. Women aged 40 to 65 seem to be the most affected by this pathology. Capsulitis begins with inflammation of the articular synovia. Then, a capsule fibrosis occurs, which contributes to reduce the mobility of the shoulder.

Factors that can trigger capsulitis can 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 many years and it is possible to maintain certain after-effects of this condition, including a loss of mobility in the shoulder. Physical therapy has been shown to help reduce the pain associated with this condition and improve mobility and function.

Clinical presentation

Capsulitis usually consists of a progressive decrease of shoulder mobility that is established over a few months. Initially, the pain is felt at the end of the movement, but can then extend over most of the movement. The pain can also be felt at night and affect the quality of sleep. Patients coming to the clinic often report having difficulty with tasks that are performed above the head or behind the back such as attaching a bra, dressing, combing, etc.

Capsulitis has 3 stages

1. The “freezing” stage
Inflammatory reaction and appearance of adhesions. Appearance of pain and progressive loss of mobility. Significant irritability and disturbed sleep.

2. The “frozen” stage
Inflammation and pain slowly diminish. Fibrosis appears with a significant decrease in mobility. Moderate irritability.

3. The “thawing” stage
Gradual increase in mobility with minimal pain. Low irritability.

Physiotherapy treatment

A physiotherapy assessment is important in shoulder pain cases to determine the structure involved. During the session, the physiotherapist will observe your posture, check your range of motion, muscle strength and specific mobility of the shoulder joints. If you have a capsulitis, it will be important to determine the stage you are at. Then, the physiotherapist will explain you the rest of the treatment plan.

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

The thawing stage will require a more aggressive treatment to regain mobility. Since this phase is less painful, treatments will be better tolerated. The physiotherapist will be able to use passive mobilizations to stretch the soft tissues, manual therapy with higher grades and reinforcement 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 of physiotherapy and medication to control pain. However, when capsulitis persists, different medical treatments may be considered. The infiltration of cortisone allows to reduce the pain and the inflammation among other things. It will be used after 3 to 6 weeks of conservative treatments. Another approach is distension arthrography, which aims to infiltrate a saline solution into the shoulder, which puts pressure on the capsule and allows it to be stretched. It is important to consult a physiotherapist immediately after the arthrography (less than 24-48h) to mobilize the shoulder and take advantage of the effects of the infiltration.

So, if you have shoulder pain associated with loss of mobility, do not wait to see your physiotherapist. He or she will take care of you in order to heal this condition as quickly as possible.