Adhesive capsulitis (frozen shoulder): duration, MRI, treatment

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Adhesive capsulitis (or frozen shoulder) is an inflammation of the membrane surrounding the shoulder joint. Pain and loss of movement are the main symptoms. How do we treat it? Answers from Pr Patrick Boyer, Orthopedic Surgeon, Shoulder Specialist at Bichat Hospital.

The capsulitis retractable (or Shoulder capsulitis) he is Mild injury to the shoulder joint, which is more common in women between the ages of 40 and 60. It is also called “frozen shoulder“Because the affected person increasingly reduces the movements of his shoulder (in all directions: reduction, rotation, abduction, adduction, elevation, tilt, flexion). This makes him chronic form ofarthritis from the shoulder. According to the American Hospital in Paris, this can affect 10% of the population. What are the symptoms? How do you open the shoulder? How do we treat it? All the answers.

Definition: What is adhesive capsulitis or “frozen shoulder”?

The capsule is a membrane that surrounds the shoulder joint. Sometimes this tissue becomes inflamed and hardened: this is called a adhesive capsulitis also called Frozen shoulder. This affection is actually a Chronic form of shoulder arthritis At the joint between the scapula and the humerus. It causes gradual stiffness of the shoulder with increased pain with movement.

What are the symptoms of adhesive capsulitis?

Adhesive capsulitis manifests itself in three stages:

  • level 1 : subordinate Constant pain in the shoulder that can spread to the elbow, intensively during the night to the point of disturbing the quality of sleep. This stage usually lasts from 1 to 4 months.
  • The second phase: a stiffness or stiffness of the joint (hence the name frozen shoulder) which prevents many movements. As the stiffness intensifies, the pain decreases. The The pain becomes intermittent It is less severe than during stage 1. This stage continues 3 to 12 months.
  • Stage 3: The The disappearance of stiffness Then the re-emergence of the shoulder movement. This stage lasts approx 6 months to 2 years.
Diagram of adhesive capsulitis (frozen shoulder) © Normals – 123RF

How long does adhesive capsulitis last?

Spontaneous healing occurs within 18 months, with very mild stiffness sometimes persisting.

At what age is there a greater risk of developing adhesive capsulitis?

If everyone could be concerned, women in perimenopause or compound menopause would be most affected. Men can also be affected. Usually, this shoulder condition occurs in 40-60 years old.

What causes adhesive capsulitis?

Capsulitis is associated with shrinkage of the capsule that surrounds the shoulder joint. Often there is an enlargement of the blood vessels (we are talking about vasodilation) leading to inflammation, The origin of the retraction mechanism. The exact cause of adhesive capsulitis is unknown. This inflammation can occur if:

  • extreme tiredness;
  • stress time.
  • Local trauma such as a fall.
  • Neurological damage (for example, a stroke)
  • Immobilization of the shoulder with a cast or splint (after a fracture, mastectomy, or thoracic surgery)
  • Another shoulder case, such as a tendinitisbursitis, or rotator cuff.
  • Taking certain medications (antivirals, anti-AIDS, tuberculosis treatment, iodine, etc.).
  • Adhesive capsulitis is often associated with certain pre-existing medical conditions, including Diabetes, heart disease and thyroid disorders and diseases of the cervix.

Who do you consult?

If you notice unexplained shoulder pain, especially if it is accompanied by loss of movement, see your doctor General Doctor or one Physiotherapist.

Interview and clinical examination. “The painful stage that swells at night and the loss of shoulder mobility makes it possible to diagnose adhesive capsulitis, Prof. Patrick Boyer, orthopedic surgeon, shoulder specialist at Bichat Hospital explains. But sometimes the symptoms can be misleading.

X ray It is usually performed with the aim of eliminating other causes of shoulder pain and/or stiffness (calcification, in the spinearthritis, etc.). They are often normal or occasionally reveal a heterogeneous bony hyperlordosis of the humeral head, often subchondral.

MRI : Examination that confirms the diagnosis of capsulitis, but also removes other differential diagnoses such as a rotator cuff tear.

blood test

What do we see on an MRI in case of capsulitis?

When ordering an MRI, one might note (Source: MRI Shoulder Capsulitis, a. Cotten, S.; Joss Julien):

  • Capsule thickness in the axillary cavity (> 3 or 4 mm)
  • A moderate T2 hyper-signal of the same recess, so that it is counteracted by another structure (bilateral chord, labrum, etc.)
  • The presence of abnormal lipid signal abnormalities
  • Thickening of the coracohumeral ligament ‘highly visible’ and partial or complete obliteration of the subbursal fatty triangle
  • Unspecified signal distortions from bone marrow from the head of the humerus
  • Pleasantly enhancing intense glenohumeral synovial capsules after gadolinium injection

What is the treatment for capsulitis?

In the first intention, treatment depends on:

Take creams for topical use, such as topical creams.

Oral anti-inflammatory drugs (NSAIDs).

► Sometimes offside or corticosteroid injections.

► from re-education at the clinic

in contrast, Surgery is not recommended as it exacerbates adhesive capsulitis. Professor Boyer says. But sometimes it can be suggested if other treatments fail, such as embolization, which is an interventional radiotherapy consisting of inserting a catheter through the carpal artery (under local anaesthesia).

When is rehabilitation?

Physiotherapy and hot water diving make it possible to obtain good results during the progressive stage of the disease but also during the rehabilitation period “, Professor Boyer says. The gentle lure of the joint during sessions avoids muscle atrophy due to immobilization of the shoulder which the patient tends to impose spontaneously.

What are the natural remedies to relieve capsulitis?

  • a hot shower On the affected area can relieve pain. Such asPut a hot water bottle.
  • Aside from the painful period, little exercise gymnastic movements Like stretching, it can help improve movement. Stop in case of pain.
  • in phytotherapy takingharpagophytum It can soothe inflammation and joint pain
  • subordinate Arnica oil massage.
  • orthotics : With gentle manipulation, compression, and stretching, a few sessions of orthotics can help restore movement and capacity in the shoulder. Go to your X-ray specialist. Some exchanges cover sessions.

What are the possible consequences after capsulitis?

Although this disease is always cured, it can leave some consequences such as stiffness.

What prevention to avoid it?

There is no medically recommended precautionary rule at present, and no external cause has been identified as responsible for the recurrent retractile capsule.

Warning: What is the recovery time for capsulitis?

The prognosis is favorable for most people. Full recovery takes about two years.

Can you work with adhesive capsulitis?

It all depends on the extent of the capsulitis. Capsulitis sometimes requires a downtime that can last from a few days to several months, in order to put the joint at full rest. Your doctor will determine this. In general, the downtime is:

  • A few days to two weeks for stable office work
  • A few months to lead a difficult task
  • Six months for heavy manual work

Thanks to Pr Patrick Boyer, Orthopedic Surgeon, Shoulder Specialist at Bichat Hospital.

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