What is adhesive capsulitis?
Adhesive capsulitis is a painful limitation of shoulder mobility in all areas of movement, both active (the patient tries to move his shoulder himself) and passive (the practitioner or physiotherapist tries to move the shoulder).
Why do we have adhesive capsulitis?
1°) Some causes are known
These are pathologies that are more frequently found associated with adhesive capsulitis.
The mechanism of capsulitis and the reason for the link with these pathologies are still poorly understood.
a) Medicines
– Gardenal, anti-epileptic drug
– Isoniazid, anticancer drug
b) Diseases
-Diabetes
-Dyslipidemia (fat abnormalities)
-Dysthyroidism (thyroid diseases)
-Myocardial infarction
c) Surgery
– from the shoulder
– breast
– from the heart
– of the thorax
d) Shoulder injuries
-Rotator cuff (rupture or tendinitis)
-Calcific tendinitis
-Fractures (of and around the shoulder)
2°) In certain cases, no cause is found:
This is then idiopathic adhesive capsulitis.
How does adhesive capsulitis develop?
1°) The first sign to appear is PAIN: this is phase I (isolated pain)
It is often quite intense, poorly calmed by usual analgesics (paracetamol).
This phase I is of very variable duration, from a few weeks to 9 months.
The pain can spread to the entire upper limb or neck.
It may be accompanied by edema, paleness or, on the contrary, redness or a moist appearance of the skin.
The distribution of clinical signs throughout the upper limb represents shoulder-hand syndrome, more common after a heart attack, for example.
The presence of other signs (notably cutaneous) and their distribution can suggest the picture of algodystrophy (or algoneurodystrophy) which is a little different from capsulitis which only affects the shoulder.
2°) The appearance of STIFFNESS, associated with PAIN, signals the entry into Phase II (pain and stiffness)
This phase is also of variable duration: 4 to 9 months.
This is often the most trying phase for the patient, who has the impression of literally “sinking” into the spiral of illness, despite treatments and who may then doubt the progress of their illness and the effectiveness of treatments.
3°) The progressive DISAPPEARANCE of the PAIN with persistence then also attenuation of the stiffness brings to mind Phase III (isolated stiffness)
This is the longest phase: it can last from 5 to 26 months.
The progression then occurs, particularly in idiopathic adhesive capsulitis, towards healing and a return to a normal shoulder in the vast majority of cases (90% of cases)
The after-effects, mainly persistent stiffness, are rare but possible (10% of cases), particularly in the case of traumatic or surgical causes.
What are the principles of treatment?
They are based on several elements that can be combined:
1°) Rehabilitation
The principle of rehabilitation is to be gentle, non-painful, that is to say not trying to “force” the shoulder.
It is present in all phases of the disease.
Balneotherapy is an essential asset in the treatment (cold-hot alternation, lukewarm showers, etc.)
2°) Pain medications
They also remain essential at all phases of the disease.
They can be more or less strong depending on the severity of the pain, which is often evaluated by the patient himself on a small scale graduated from 0 to 10 (Visual Analogue Scale).
3°) Infiltration
They are either subacromial or intra-articular, with an attempt to “distract” the joint.
They are not always used, and not in all phases of the disease.
They sometimes make it possible to overcome a particularly acute painful situation.
4°) Reserpine blocks
This involves an injection of Reserpine, a product that inhibits certain nerve transmissions, in contact with certain central (spinal and cerebral) pain receptors which are believed to be affected by the disease.
These blocks are carried out under local anesthesia, in the operating room, by anesthesiologists, on an outpatient basis.
Effectiveness, when it appears, is always delayed by a few days or even a few weeks.
They are also not offered in all phases of capsulitis.
5°) Surgery
It remains a rare event, but always possible, particularly in cases of persistent stiffness, when the pain has disappeared or has significantly reduced.
It consists of introducing a camera into the shoulder (it is therefore an arthroscopy with very small scars) and using another approach, to cut the retractile flanges in the joint and the retracted areas of the capsule.
It requires daily care in the suites, medical then medical and rehabilitation.
The intensive rehabilitation required post-operatively often requires a rehabilitation center which is better able to maintain the results acquired intraoperatively.
It is offered at variable times during the progression of the disease, most often in phase III.
What is the most suitable treatment?
The first element to understand is that each patient is different and therefore each treatment is different and will combine several of the therapies mentioned above, at a variable pace adapted to each patient.
Many questions still arise about the usefulness or “optimal timing” of certain treatments.
These questions are still commonly debated within the medical community and are the subject of in-depth scientific studies.
Your doctor or surgeon may ask you to participate in the development and evaluation of your treatment.
This is personalized and can involve several doctors:
– The family doctor.
– The anesthetist.
– The neurologist.
– The pain specialist.
– The surgeon.
– The psychiatrist or psychotherapist.
The IRCOS team of shoulder surgeons, in collaboration with anesthesiologists and teams of rehabilitation physiotherapists, is committed to the rigorous and scientific management of adhesive capsulitis.
She is therefore also committed to your personal treatment and all means will be implemented to help you understand the evolution of this disease and to obtain therapy adapted to your case.