Adhesive capsulitis is a still poorly understood condition that often occurs unexpectedly, more common between the ages of 40 and 60 and in women. Although invalid, the evolution is favorable in the great majority of cases after two years.

Adhesive capsulitis is inflammation of the shoulder that develops in several phases.

The first phase

It is characterized by pain, often very debilitating, radiating to the arm and forearm. This pain appears gradually until it becomes permanent, including at night (insomnia pain) and at rest. It usually lasts less than 6 months. It is linked to a retraction of the joint capsule, that is to say the thickest layer of the envelope which surrounds the joint.

The second phase

A progression towards the second phase occurs gradually with decrease in pain associated with a decrease in the mobility of the shoulder joint in all directions. This is the “frozen shoulder” stage.

The third phase

Finally, after one year of evolution in total, we move on to a third phase of progressive recovery of joint amplitudes and pain. This phase can last up to a year. Recovery is complete from 2 years in the vast majority of cases.

An x-ray of the shoulder is necessary for the diagnosis to make sure it is not arthritis of the shoulder.

In its classic form, capsulitis appears in women around the age of 50 without any particular cause. We call this shape Idiopathic capsulitis.

Adhesive capsulitis can be observed after prolonged immobilization of the shoulder, postoperatively after thoracic surgery, following a fracture, a mastectomy for example.

However, capsulitis can develop without a known cause. She may be :

• following a painful event of the joint (direct or indirect trauma to the shoulder, tendonitis, bursitis, rupture of the rotator cuff, surgery, etc.);
• favored by certain general diseases (diabetes, following infarction, epilepsy, neurological impairment, hyperthyroidism, etc.);
• or by taking certain medications (barbiturates, iodine, antiretrovirals, etc.). 

It is more common in people with diabetes, people with heart disease or those with thyroid disorders and cervical pathologies.

The problem rarely resolves without any treatment or exercise. In the absence of treatment, a handicap sets in, first due to the debilitating pain, then to the “frozen shoulder” stage.

However, the outcome is favorable after intensive and prolonged rehabilitation.

Adhesive capsulitis is a disease whose course is unpredictable and very different from person to person. In this context, evaluating the effectiveness of treatments by scientific studies is very complex.

During the first phase

This is the most painful phase, the pain can be relieved with the help of painkillers and / or anti-inflammatory drugs. The doctor may also suggest injections (injection of medicine into the joint), increasing the effectiveness of pain medication. In order to offer a suitable treatment, we will carefully look for the initial cause of the capsulitis.

During the second phase

When the movements become very limited, we can adapt a rehabilitation. Performing exercises at home is beneficial, helping to unblock painful limbs. A study shows that intensive physiotherapy, especially in the early and painful phase, is associated with poorer recovery. It follows that at present, we insist on exercises to be performed without ever forcing. Always respect the pain and stop exercising as soon as it becomes painful.

Finally, recent studies suggest that combining manual therapy, home exercises (passive stretching, postural corrections, etc.) and infiltration (either corticosteroids or distensive arthrography) can considerably increase the effectiveness of the treatment and speed up healing. by regaining mobility.

The laser is finally an effective option to limit the pain during the first painful stage of capsulitis.

In the case of the debilitating condition of adhesive capsulitis, surgery is only likely to make the situation worse.

The doctor may offer capsular dilation under local anesthesia, allowing mobility to be gained and the rehabilitation work to be speeded up. But this intervention, consisting in the injection of products softening the capsule, depends on the cases and the people.

The cure of this disease can thus be ensured only during long rehabilitations (between 12 and 18 months).

We know that the earlier we treat this condition, the less chance the handicap has to set in. As its course is rather long, it is important that the patient consult a professional quickly in the event of unexplained pain in the shoulder, whether or not associated with loss of movement. The symptoms could thus be limited in severity and the shoulder will be able to recover more quickly.