Adhesive capsulitis of the shoulder

Introduction

Adhesive capsulitis of the shoulder, popularly known as frozen shoulder, represents a painful and limiting condition affecting the shoulder joint. Its distinctive feature lies in the inflammation and thickening of the joint capsule, a tissue that surrounds the joint and helps hold the head of the humerus in place in the shoulder socket.

The shoulder joint is one of the most mobile joints in the body, allowing for a wide range of motion. The joint capsule is a key component of this joint, acting as a protective covering that supports stability while facilitating mobility. However, when inflammation occurs, the capsule may thicken and contract, leading to adhesive capsulitis.

The symptoms of adhesive capsulitis appear gradually and can be divided into two main characteristics: pain and loss of movement. Individuals with this condition often experience increasing pain, which may be particularly severe during the night. This pain can interfere with sleep and contribute to a decreased quality of life. At the same time, shoulder stiffness becomes apparent, leading to a significant loss of mobility. Normal movements, such as raising your arm or reaching behind your back, become difficult or impossible.

Historically, adhesive capsulitis has been studied through medical literature and clinical observations. The first references to this condition date back decades, with descriptions of patients experiencing progressive loss of movement and persistent shoulder pain. Over the years, the understanding of adhesive capsulitis has deepened through medical research, establishing links between risk factors and the underlying mechanisms of the disease.

Although the exact causes of adhesive capsulitis are not always clear, several risk factors have been identified. Individuals with diabetes, for example, are at increased risk of developing frozen shoulder. Injuries, previous surgeries, or prolonged periods of shoulder immobilization can also contribute to the development of this condition.

Treatment for adhesive capsulitis generally aims to relieve pain and restore mobility. Approaches may include anti-inflammatory medications, osteopathic sessions to improve flexibility, and in some cases, more invasive medical interventions. The course of the disease can vary from individual to individual, but with proper treatment, most people with adhesive capsulitis gradually regain mobility and reduce pain.

Thus, adhesive capsulitis of the shoulder, or frozen shoulder, is a painful condition characterized by inflammation and thickening of the joint capsule. Its history, rich in clinical observations and medical research, has helped to broaden our understanding of this disease. Although adhesive capsulitis can present challenges, treatment options exist to relieve pain and restore mobility, offering hope of recovery for those affected.

The Journey of Adhesive Capsulitis Through History

1. Early Observations:
   • The condition has likely been present throughout history, but its formal recognition and description began to take shape in the early 20th century.
   • Doctors noticed patients with shoulder stiffness and limited range of motion, but the term “adhesive capsulitis” had not yet been coined.
2. Ernest Codman (1934):
   • Ernest Amory Codman, an American orthopedic surgeon, is often credited with one of the first formal descriptions of frozen shoulder.
   • In his 1934 publication “The Shoulder: Rupture of the Supraspinatus Tendon and Other Lesions in or About the Subacromial Bursa,” Codman detailed cases of what is now recognized as adhesive capsulitis.
3. Evolution of Terminology:
   • The term “adhesive capsulitis” has been widely accepted to describe the condition, emphasizing inflammation and adhesions in the shoulder joint capsule.
   • The condition has been differentiated from other shoulder disorders with similar symptoms.
4. Julius Nevasier (1945):
   • Julius Nevasier, an American surgeon, is sometimes associated with the identification and naming of adhesive capsulitis in 1945.
   • His work has focused on recognizing the chronic inflammatory process leading to thickening and contracture of the shoulder capsule.
5. Advances in Understanding (20th Century):
   • Throughout the 20th century, medical professionals continued to refine their understanding of adhesive capsulitis.
   • Research has explored the underlying causes, risk factors and optimal treatment approaches to manage the condition.
6. Contemporary Perspective (21st Century):
   • Adhesive capsulitis remains a difficult condition to manage, and research continues to explore its pathophysiology, contributing factors, and effective interventions.
   • Treatment approaches may include osteopathy, anti-inflammatory medications, corticosteroid injections, and in severe cases, surgery.

Adhesive capsulitis, sometimes referred to as adhesive capsulitis, was initially documented by surgeon Ernest Codman in 1934 in a major article titled “The Shoulder: Rupture of the Supraspinatus Tendon and Other Lesions in or About the Subacromial Bursa.” This was a significant contribution that laid the foundation for the medical understanding of this complex condition.

Adhesive capsulitis is characterized by chronic inflammation of the shoulder capsule, a structure essential for the proper functioning of the shoulder joint. This inflammation leads to progressive thickening and contracture of the capsule, severely limiting shoulder mobility. Ernest Codman was among the first to examine and describe this condition in detail, providing crucial information that has since guided research and medical interventions.

Codman’s initial reference laid the foundation for further study and in-depth research into adhesive capsulitis. Subsequent efforts have led to a better understanding of the underlying mechanisms of the disease, associated risk factors, and the various treatment approaches available.

Early recognition of adhesive capsulitis is crucial, as it can significantly improve treatment outcomes. Symptoms usually include persistent pain, stiffness, and gradual loss of shoulder mobility. Treatment approaches vary, from physical therapy and anti-inflammatory medications to more invasive procedures in some cases.

Thus, thanks to the pioneering contributions of Ernest Codman, adhesive capsulitis was entered into the medical literature, facilitating a better understanding of this condition and paving the way for more effective management strategies for those who suffer from it. Ongoing research in this area aims to refine interventions and improve the quality of life of individuals faced with this painful shoulder condition.

In 1944, Julius Nevasier marked a crucial milestone in the understanding of shoulder disorders by identifying a chronic inflammatory process leading to thickening and specific contracture of the shoulder joint capsule. This phenomenon, which results in adhesion of the capsule to the humeral head, was named “adhesive capsulitis” by Nevasier, thus establishing a distinctive terminology for this condition.

Adhesive capsulitis is characterized by a series of pathological changes in the joint capsule, the tissue surrounding the shoulder joint. This chronic inflammatory process results in progressive thickening of the capsule, limiting its ability to stretch normally. At the same time, adhesions form, leading to contracture of the capsule, which, in turn, significantly restricts shoulder mobility.

The term “adhesive capsulitis” reflects both the nature of the condition and its impact on joint mobility. This is a painful condition that can make shoulder movement difficult or impossible. Individuals with adhesive capsulitis may experience severe pain, particularly at night, and face a significant loss of shoulder flexibility.

Julius Nevasier’s identification of this process laid the foundation for the modern understanding of adhesive capsulitis, or frozen shoulder, guiding medical research and efforts to develop treatment approaches aimed at relieving pain and restoring mobility to people affected by this condition.

Persistent shoulder pain, disrupting sleep and making daily tasks laborious, can have significant implications on quality of life. When it reaches an advanced stage, shoulder problems can persist not only for months, but sometimes even years. This delicate reality was highlighted by Simmons, Travel and Simons in 1999 (604-605), emphasizing the chronic and often debilitating nature of these conditions.

Constant pain can impact emotional well-being, impairing sleep and leading to persistent fatigue. The ability to carry out daily activities, whether simple household tasks or work responsibilities, can be severely compromised, affecting productivity and overall well-being.

It is imperative to understand these shoulder problems not only from a physical pain perspective, but also by recognizing the profound impact they can have on overall quality of life. Appropriate treatments and appropriate management are essential to alleviate pain, restore function and improve the quality of life of individuals facing these chronic shoulder challenges.

In 1992, during a symposium sponsored by the American Academy of Orthopedics and Orthopedic Surgeons, a workshop committee defined frozen shoulder as a condition of uncertain etiology characterized by significant restriction of movement of the shoulder. he active and passive shoulder that occurs in the absence of a known intresic disorder. We have used the term frozen shoulder to describe the idiopathic condition.

To better understand the source of “frozen shoulder” symptoms, two issues are examined: adhesive capsulitis and myofascial trigger points . Simmons, Travel and Simons 1999, 604-605

The subscapularis and supraspinatus muscles are mainly responsible for blocking frozen shoulder. By using the trigger point approach, it is possible to speed up the healing process.

Frozen Shoulder vs Adhesive Capsulitis

1. Frozen Shoulder:
   • Frozen shoulder is a general term that refers to a shoulder that becomes painful and gradually loses mobility.
   • Symptoms of frozen shoulder include pain, stiffness, and decreased shoulder mobility.
   • This problem can be due to a variety of causes, including inflammation, injury, or prolonged immobilization.
2. Adhesive Capsulitis:
   • Adhesive capsulitis is a specific type of frozen shoulder characterized by inflammation of the shoulder joint capsule, leading to a significant decrease in mobility.
   • In adhesive capsulitis, the capsule surrounding the shoulder joint becomes thickened and tightened, limiting shoulder movement.
   • The causes of adhesive capsulitis are not always clear, but factors such as injuries, infections, or underlying medical conditions may be involved.

In summary, frozen shoulder is a more general term, while adhesive capsulitis is a specific form of frozen shoulder characterized by inflammation and contraction of the joint capsule.

Rounded shoulders

Posture plays a vital role in shoulder health, and poor posture can have lasting consequences, including internal rotation of the humerus. This internal rotation, if not corrected from an early age, can become permanent, leading to complications such as impingement syndrome.

When posture is altered, creating internal rotation of the humerus, this can affect the ability to externally rotate the humerus to accommodate its greater tuberosity. The greater tuberosity of the humerus is a prominent bony protrusion on the side of the bone, playing a crucial role in shoulder movements. If internal rotation becomes permanent, it becomes difficult or impossible to perform external rotation, thereby compromising the normal function of the shoulder joint.

A notable consequence of this situation is the increased risk of developing impingement syndrome. This syndrome is characterized by impingement or compression of the tendons, muscles and other structures of the shoulder during movement, causing pain and inflammation. The inability to perform adequate external rotation may contribute to this condition, increasing the likelihood of discomfort and complications.

Additionally, poor posture can also impact the brachial nerve, which lies close to the head of the humerus. Increased compression of the brachial nerve can result from the constant internal rotation of the humerus, increasing the chances of symptoms such as tingling, numbness, or weakness in the arm.

It is therefore imperative to raise awareness about the importance of good posture from a young age, as correcting these problems early can avoid long-term complications. Proper muscle strengthening exercises and stretching can help restore and maintain correct posture, preventing adverse consequences on shoulder health.

Thus, poor posture, particularly internal rotation of the humerus, can have significant implications for shoulder health. It can lead to external rotation difficulties, thus promoting the development of arched humerus syndrome and increasing the risk of brachial nerve compression. Early correction of these postural problems is crucial to avoid long-term complications and maintain optimal function of the shoulder joint.Pathophysiology of Adhesive Capsulitis

Adhesive capsulitis of the shoulder, also known as frozen shoulder, is a painful condition characterized by progressive restriction of movement of the shoulder joint. The pathophysiology of this complex condition involves inflammation and thickening of the joint capsule, a fibrous structure that surrounds the shoulder joint. This inflammation leads to the formation of scar tissue, which significantly limits the mobility of the shoulder.

At the heart of the pathophysiology of adhesive capsulitis is an inflammatory reaction within the joint capsule. Although the specific triggers for this inflammation are not always clear, factors such as injury, overexertion or underlying medical conditions can contribute to its development. The initial inflammation causes an immune system response, leading to proliferation of inflammatory cells and the release of chemical mediators.

As inflammation progresses, the joint capsule undergoes structural changes. The synovial membrane, which lines the inside of the capsule, can thicken and produce excess synovial fluid. At the same time, fibroblasts can be activated, leading to the production of collagen and the formation of scar tissue. It is this fibrosis that restricts movement of the joint, causing the characteristic stiffness of frozen shoulder.

The progression of adhesive capsulitis is generally divided into several phases. The initial inflammatory phase is marked by pain and discomfort, often exacerbated by certain shoulder movements. This phase can last several weeks to a few months. Subsequently, the freezing phase occurs, characterized by a significant limitation of mobility. Finally, the thawing phase begins, during which pain gradually subsides, and mobility slowly improves.

The predisposition to adhesive capsulitis can also be influenced by individual factors such as age, gender and certain medical conditions. Women are more likely to suffer from it, especially between the ages of 40 and 60. Conditions such as diabetes, cardiovascular disease, and thyroiditis can increase the risk of developing this condition.

Diagnosis of adhesive capsulitis relies on a thorough clinical evaluation, often accompanied by medical imaging such as X-rays or MRIs to rule out other possible causes of shoulder pain. Treatment for this condition aims to alleviate pain, preserve mobility, and prevent the progression of adhesive capsulitis. Non-surgical approaches such as physiotherapy, non-steroidal anti-inflammatory drugs and corticosteroid infiltrations are often favored as first intention.

Stage

1. Initial inflammation: Adhesive capsulitis often begins with inflammation of the shoulder joint capsule. This inflammation can be triggered by factors such as injuries, overuse, infections, or underlying medical conditions.
2. Pain and stiffness: The initial inflammation causes shoulder pain, especially with movement. Sufferers may feel widespread pain in the shoulder and arm region. At the same time, the joint capsule begins to contract, leading to progressive stiffness in the shoulder.
3. Scar tissue formation (fibrosis): Over time, persistent inflammation leads to the formation of scar tissue or fibrosis in the joint capsule. This leads to thickening of the capsule and further limits shoulder mobility.
4. Capsule retraction: Fibrosis continues to develop, leading to significant capsule retraction. This retraction severely limits shoulder mobility and can even lead to adhesion of the joint surfaces.
5. Decreased synovial fluid production: Synovial fluid production, which normally lubricates the shoulder joint, may decrease as the retracted capsule compresses the joint structures.
6. Formation of adhesions: Adhesions between joint surfaces can form, worsening stiffness and loss of mobility.

Risk factors

Adhesive shoulder capsulitis, a painful medical condition characterized by progressive limitation of movement of the shoulder joint, has certain risk factors that may predispose individuals to this complex condition. Personal and family medical history plays a crucial role in the development of adhesive capsulitis. Previous injuries or trauma to the shoulder, such as dislocations or fractures, may increase susceptibility to this condition. Additionally, underlying medical conditions such as diabetes, cardiovascular disease, and thyroid disease have been associated with an increased risk of developing adhesive capsulitis. Individuals aged 40 to 60, particularly women, also appear to be more predisposed, although adhesive capsulitis can affect people of all ages.

Lifestyle factors can also contribute to an increased risk of developing adhesive capsulitis. Smoking habits are strongly correlated with this condition, as smoking impairs blood flow to the shoulder tissues, thereby promoting the development of capsulitis. Additionally, a lack of physical activity and sedentary behaviors may increase the likelihood of developing adhesive capsulitis, as inactivity contributes to muscle stiffness and loss of joint mobility.

Adhesive capsulitis may also be linked to psychosocial factors, such as stress and anxiety. Stressful situations can trigger muscle tension and affect the body’s response to inflammation, contributing to the progression of capsulitis. At the same time, unresolved emotional issues may influence pain perception and tolerance to adhesive capsulitis symptoms.

Heredity appears to play a role in the predisposition to adhesive capsulitis. If family members have been affected by this condition, this may increase the risk of other family members developing capsulitis. The genetic component may influence the structure of connective tissues and the response of the immune system, thereby contributing to susceptibility to this condition.

Early diagnosis of adhesive capsulitis and appropriate management of risk factors are essential to minimize the impact of this condition. Treatment approaches may include physiotherapeutic interventions to improve shoulder mobility, anti-inflammatory medications to relieve pain, and in some cases, corticosteroid injections to reduce inflammation. Managing lifestyle risk factors, such as smoking and lack of exercise, is also crucial to optimize treatment results and prevent recurrence of adhesive capsulitis.

List of risk factors

1. Age: Most cases of frozen shoulder occur in people between the ages of 40 and 60.
2. Gender: Women appear to be more likely to develop frozen shoulder than men.
3. Pre-existing medical conditions:
   • Diseases such as diabetes have been linked to increased risk.
   • Cardiovascular disease and thyroid disease can also be risk factors.
4. Prolonged shoulder immobilization: A prolonged period of shoulder immobilization, for example after surgery or due to injury, can increase the risk.
5. Shoulder trauma or surgery: People who have had shoulder trauma or surgery may be more likely to develop frozen shoulder.
6. Physical inactivity: Lack of exercise or physical inactivity can contribute to the development of shoulder problems, including frozen shoulder.
7. Autoimmune diseases: Certain autoimmune diseases, such as rheumatoid arthritis, can increase the risk of developing joint problems, including adhesive capsulitis.
8. Genetic factors: There may be a genetic component in some cases.
9. Other medical conditions: Conditions such as heart disease, stroke, or lung disease have also been linked to increased risk.

Stages and symptoms of Adhesive Capsulitis of the shoulder

There are several stages in the development of shoulder pathology, often associated with adhesive capsulitis. Here is a detailed description of each phase:

1. Pre-freezing:

• Duration: 1 to 3 months
• Shoulder Appearance: No obvious signs of adhesive capsulitis yet
• Symptoms: Increasing pain, especially with shoulder movements
• Limitations: Beginning of limitation of movements, especially in external rotation
• Behavior: Reduction of movements to relieve pain, protection of the shoulder by using it less
• Pain: Present during the day and night

2. Freezing:

• Duration: 3 to 9 months
• Symptoms: Gradual loss of movement, increased pain (especially at night)
• Range of motion: Still present, but limited by pain and stiffness
• Evolution: Slow loss of range of motion over 6 to 9 weeks

3. Frozen:

• Duration: 9 to 14 months
• Symptoms: Significantly reduced range of motion, persistent initial pain
• Pain: Gradual decrease, appearing mainly during extreme movements

4. Defrosting:

• Duration: 12 to 15 months
• Symptoms: Gradual improvement, significant reduction in pain (especially at night)
• Range of motion: Still limited, but improving quickly, returning to normal strength and movement
• Recovery time: Typically 6 months to 2 years

Frozen shoulder is painful with significant restriction of active and passive shoulder range of motion, most often in abduction and external rotation.

Functional limitations

The functional limitations associated with adhesive capsulitis of the shoulder present a significant challenge for affected individuals, affecting their quality of daily life and their ability to perform normal activities. One of the most pronounced aspects of these limitations is the progressive restriction of movement of the shoulder joint. As the joint capsule thickens and becomes less flexible due to inflammation and scar tissue formation, shoulder movements, such as raising the arm and rotating, become more difficult. more and more difficult.

Loss of shoulder mobility can cause difficulty with the simplest daily activities, such as combing your hair, getting dressed, or even reaching items on a shelf. Patients with adhesive capsulitis may also experience limitations in work tasks requiring frequent and varied use of the shoulder, leading to decreased work efficiency. These functional limitations have a significant impact on independence and can lead to increased dependence on outside assistance to complete common tasks.

Pain, often intense, is a major component of the functional limitations of adhesive capsulitis. This pain can be exacerbated by shoulder movements and can become disabling over time. When pain is present, individuals tend to avoid painful movements, which contributes to joint stiffness and worsening mobility. Therefore, adhesive capsulitis can lead to a vicious cycle where pain leads to avoidance of movement, thereby worsening stiffness and loss of function.

Sports and leisure activities are also strongly impacted by the functional limitations of adhesive capsulitis. Movements required in activities such as tennis, swimming or golf often become impossible or extremely painful, leading to decreased participation in these activities and potentially affecting the emotional well-being of affected individuals.

Sleep quality may also be compromised due to the functional limitations of adhesive capsulitis. Finding a comfortable position to sleep becomes a challenge, and persistent pain can disrupt sleep, leading to fatigue and irritability during the day.

Managing daily tasks becomes a major challenge for people suffering from adhesive capsulitis. Simple activities like carrying groceries, opening a door or driving become challenges that may require adaptation of operating procedures or help from other people. These functional limitations can lead to feelings of frustration, helplessness and sometimes depression, thus accentuating the psychological impact of adhesive capsulitis.

Management of the functional limitations of adhesive capsulitis often involves a multidisciplinary approach. Physiotherapy plays a crucial role in restoring mobility and relieving pain. Anti-inflammatory medications and corticosteroid injections can also be used to reduce pain. In certain severe cases, surgery may be considered to release the joint capsule and restore shoulder mobility.

The Vicious Cycle of Adhesive Capsulitis: The Evolution of Persistent Pain

Adhesive capsulitis, commonly known as frozen shoulder, is a painful condition characterized by inflammation and thickening of the capsule surrounding the shoulder joint. This process results in a vicious cycle that evolves over time, exacerbating pain and restriction of movement in affected individuals.

Stage 1: Initial Pain Initially, the initial pain occurs in the shoulder joint. Unpleasant sensations indicate the onset of adhesive capsulitis, often accompanied by stiffness and discomfort.

Stage 2: Immobility To avoid pain, individuals begin to restrict their movements, leading to a decrease in normal use of the shoulder. A progressive immobility sets in, limiting daily activities.

Stage 3: Stiffness of the Joint Lack of regular movement leads to stiffness of the shoulder joint. The capsule surrounding the joint gradually thickens, making movements even more difficult.

Stage 4: Muscle Weakness and Atrophy Limited movement causes muscle weakness around the shoulder. Muscles gradually atrophy due to reduced use, contributing to deterioration of joint strength and stability.

Step 5: Compensatory Movements Faced with shoulder restriction, the body develops compensatory movements. Other parts of the body are overused to compensate for the lack of mobility in the shoulder, leading to biomechanical changes.

Stage 6: Increased Sensitivity to Pain The persistent cycle amplifies sensitivity to pain. The nervous system becomes more reactive, making every movement more painful, even with minimal intensity.

Stage 7: Inflammation and Tissue Changes Persistent inflammation and tissue changes in the shoulder joint become more pronounced. Arrows of inflammation and alterations in tissue structure create an environment conducive to adhesive capsulitis.

Stage 8: Progression of Adhesive Capsulitis The capsule around the joint gradually thickens, reinforcing the diagnosis of adhesive capsulitis. The progression of the condition creates a vicious cycle that is difficult to break without intervention.

Stage 9: Chronic Pain Eventually, the pain becomes chronic, persisting even at rest. The shoulder joint is enveloped in a constant state of discomfort, affecting quality of life and daily activities.

This vicious cycle highlights the need for early intervention to prevent the progression of adhesive capsulitis. Therapeutic approaches, such as physical therapy and pain management, are essential to breaking this cycle and restoring mobility and function to the shoulder joint.

Biomechanics of adhesive capsulitis

Understanding the biomechanics of adhesive capsulitis of the shoulder is essential to understanding the underlying mechanisms of this painful and debilitating condition. Shoulder biomechanics rely on a complex interaction between bones, muscles, tendons and ligaments, contributing to the stability and mobility of this joint. When a person develops adhesive capsulitis, these biomechanical mechanisms are disrupted, leading to significant functional limitations.

At the heart of the biomechanics of adhesive capsulitis is the joint capsule, a cover of connective tissue that surrounds the shoulder joint. This capsule is normally flexible and allows a wide range of movement. However, in cases of adhesive capsulitis, the capsule undergoes pathological changes, becoming stiffer and less extensible due to inflammation and scar tissue formation. This stiffness limits shoulder mobility, hindering rotation, elevation, and other essential movements.

The shoulder ligaments, which provide joint stability, are also affected by adhesive capsulitis. The ligaments lie inside the joint capsule and, if there is stiffness and contraction of the capsule, they can experience excessive stress. This can lead to decreased ligament flexibility, increasing the risk of ligament damage and contributing to limitation of movement.

The muscles surrounding the shoulder are also impacted biomechanically. The rotator cuff muscles, responsible for stabilizing the shoulder joint, can experience imbalances due to capsule stiffness. These muscle imbalances can worsen the limitation of movement and contribute to the pain associated with adhesive capsulitis.

The altered biomechanics of adhesive capsulitis lead to a loss of synchronization in shoulder movements. Adjacent joints, such as the acromioclavicular joint, may also be affected, exacerbating biomechanical problems. Abnormal shoulder biomechanics can lead to compensations in other parts of the body, affecting overall posture and contributing to muscular imbalances.

The biomechanical mechanisms of adhesive capsulitis are not limited to the joint itself, but also influence surrounding tissues, including the bursae. These small pockets of synovial fluid, which facilitate the sliding of tendons and muscles over bone, can become inflamed due to increased biomechanical stress, contributing to the pain and discomfort associated with adhesive capsulitis.

Understanding the altered biomechanics of adhesive capsulitis is crucial to guiding treatment approaches. Interventions generally aim to restore flexibility of the joint capsule, rebalance the rotator cuff muscles and improve coordination of movements. Physiotherapy plays a central role in these interventions, focusing on specific exercises to restore normal shoulder biomechanics.

Compensation that the shoulder must make to raise the arm with adhesive capsulitis of the shoulder

Adhesive capsulitis of the shoulder causes significant functional limitations, forcing the shoulder to implement complex compensation mechanisms to accomplish movements as simple as raising the arm. When the joint capsule, a cover of connective tissue that normally surrounds the shoulder joint, becomes stiff and thick due to inflammation and scar tissue formation, the shoulder’s natural movements are significantly restricted.

When a person with adhesive capsulitis attempts to raise their arm, the shoulder must compensate by changing normal joint mechanics. The rotator cuff muscles, responsible for raising the arm, may encounter increased resistance due to the stiffness of the capsule, requiring additional muscular effort to overcome this resistance. This compensation can lead to rapid muscle fatigue and contribute to the feeling of heaviness or pain during movement.

Another frequently observed compensation mechanism is the modification of overall posture. To overcome joint stiffness, the person may adopt a tilted or leaning posture, which alters the normal mechanics of the shoulder to partially facilitate movement. This postural adaptation, however, can cause additional muscle tension in other parts of the body, worsening biomechanical problems.

Restriction of normal shoulder movement also leads to increased activation of the neck and upper back muscles. When arm elevation is compromised, these muscles attempt to compensate by providing additional support for the movement. This can lead to muscle tension, stiffness and pain in these areas, adding an extra layer of complexity to the compensations put in place by the shoulder.

The use of other adjacent joints may also be involved in the compensation process. Movements of the trunk, spine and even hips can be used to help raise the arm more effectively. However, these adaptations can create muscular imbalances and alter the natural coordination of movements, leading to adverse consequences on posture and overall body biomechanics.

The compensations that the shoulder must make to raise the arm with adhesive capsulitis can also influence activities of daily living. Simple actions like combing your hair, reaching overhead objects or feeding yourself can become significant challenges. These functional limitations can lead to increased reliance on outside assistance to complete these daily tasks, thereby affecting independence and quality of life.

Management of adhesive capsulitis often involves correction of these compensatory mechanisms. Physiotherapy plays a crucial role in targeting the restoration of shoulder mobility, strengthening weakened muscles and restoring muscle balance. Specific exercises aim to minimize inappropriate compensations and restore more natural biomechanics.

A Day in the Life of Someone Suffering from Adhesive Capsulitis

Adhesive capsulitis, or frozen shoulder, is a complex condition that significantly impacts daily life. Here’s a glimpse into what a typical day might look like for someone living with this condition:

Morning

Mornings are often marked by intense stiffness and reduced shoulder mobility, making waking up particularly challenging. Getting out of bed becomes a slow and painful task. To alleviate the stiffness, the person typically starts their day with gentle stretching exercises and the application of warm compresses. These practices are essential for improving circulation and reducing discomfort.

Breakfast is carefully chosen to include anti-inflammatory foods, such as oatmeal topped with berries, nuts, and seeds. These dietary choices help moderate inflammation and provide the nutrients necessary to support joint health.

Work and Daily Activities

Daily tasks require adjustments to avoid straining the shoulder. Whether at work or home, the person needs to adapt their movements. Ergonomic adjustments, such as using supportive chairs or adapted workstations, are often necessary to minimize discomfort.

Regular breaks are crucial to avoid stiffness; reminders may be set to perform gentle stretches or exercises. These breaks help relieve pain and maintain flexibility.

Activities such as dressing, reaching for items on high shelves, or carrying heavy loads sometimes require specialized tools or assistance. Creative solutions are often implemented to facilitate these tasks.

Lunch is usually light but nutritious, with a focus on maintaining energy levels while limiting inflammation. A protein-rich salad with a variety of vegetables is commonly on the menu.

Osteopathy and Exercises

Osteopathy plays a crucial role in managing adhesive capsulitis. Regular consultations with an osteopath help improve shoulder mobility and alleviate pain. The osteopath uses manual techniques to stretch the shoulder capsule, improve blood circulation, and release muscle tension.

In addition to osteopathic treatments, low-impact exercises may be incorporated into the routine to maintain overall fitness without overstraining the shoulder. These exercises, recommended by the osteopath, aim to improve flexibility and strengthen the muscles around the shoulder.

Pain Management

Managing pain is an ongoing task. Non-steroidal anti-inflammatory drugs (NSAIDs) may be used to relieve discomfort, and methods such as ice packs or heating pads provide temporary relief. Relaxation techniques, such as meditation or breathing exercises, can also help manage pain and stress.

Evening and Relaxation

In the evening, the focus shifts to relaxation to reduce the tension accumulated throughout the day. A warm bath with Epsom salts can be soothing for the muscles. Evening activities are often chosen to avoid excessive strain on the shoulder, such as reading or spending time with loved ones.

Dinner typically consists of anti-inflammatory foods, including grilled fish, whole grains, and a variety of vegetables, to provide the necessary nutrients for tissue repair and maintain overall health.

Before bed, relaxation exercises or gentle stretching can help prevent nighttime stiffness. Regular sleep practices, such as using supportive pillows and maintaining a consistent sleep schedule, are important for ensuring good sleep quality.

Nighttime Challenges

Sleeping with adhesive capsulitis presents challenges due to the pain. Finding a comfortable sleeping position often requires specialized pillows to support the shoulder. Many individuals opt for positions that minimize pressure on the affected shoulder.

Despite the difficulties, maintaining a positive attitude and focusing on gradual progress is essential. With appropriate osteopathic treatment and attentive self-care, it is possible to regain functional mobility and effectively manage symptoms.

Differential diagnosis of adhesive capsulitis of the shoulder

Here are some of the conditions that might be considered in the differential diagnosis of frozen shoulder:

1. Rotator cuff tendinopathy:
   • Inflammation or damage to the rotator cuff tendons of the shoulder.
2. Shoulder bursitis:
   • Inflammation of the bursa (fluid-filled bag) around the shoulder.
3. Shoulder arthritis:
   • Inflammation of the shoulder joints, which may be linked to autoimmune diseases.
4. Thoracic outlet syndrome:
   • Compression of the nerves or blood vessels between the collarbone and the first rib.
5. Peripheral nerve damage:
   • Peripheral nerve problems can cause similar symptoms, such as pain and stiffness.
6. Tumors or masses:
   • Tumors or masses in the shoulder area can cause similar symptoms.
7. Heart disease :
   • In some cases, pain in the arm or shoulder may be related to heart problems.
8. Shoulder instability:
   • A structural imbalance that can cause pain and loss of mobility.
9. Fracture of the humerus or clavicle:
   • Fracture of the shoulder bones.
10. Joint infections:
    • Joint infections can cause inflammation and similar symptoms.

Scientific Insights: Osteopathy and Its Role in Managing Adhesive Capsulitis

The Function of Osteopathic Medicine in the Treatment of Adhesive Capsulitis (Tafler et al., 2022)
This paper describes a case study of a 58-year-old woman with adhesive capsulitis. It shows how osteopathic manipulation therapy helped her recover, avoiding shoulder surgery.

Adhesive Capsulitis of the Shoulder: A Review (Ewald, 2011)
This review highlights various non-surgical treatments for adhesive capsulitis, including physical therapy, corticosteroid injections, and the importance of diagnosis and treatment approaches.

Diagnosis and Management of Adhesive Capsulitis (Manske & Prohaska, 2008)
This paper focuses on both non-operative and operative treatments, including medications and rehabilitation strategies for adhesive capsulitis.

Adhesive Capsulitis: Diagnosis and Management (Ramirez, 2019)
It provides insights into the idiopathic nature of adhesive capsulitis and discusses different treatment options such as physical therapy and injections.

Adhesive Capsulitis of the Shoulder: Review of Pathophysiology and Current Clinical Treatments (Le et al., 2017)
This article focuses on the pathophysiology of adhesive capsulitis and explores both non-operative and operative treatments, as well as potential future pharmacological interventions.

Combination treatment for adhesive capsulitis of the shoulder (Ekelund & Rydell, 1992)
This study presents a combination treatment involving distention-arthrography, local anesthetics, and manipulation for treating adhesive capsulitis, showing rapid improvement in patients.

Adhesive Capsulitis: Diagnosis and Management (Ramirez, 2019)
This article discusses diagnosis and treatment methods for adhesive capsulitis, focusing on both non-surgical treatments like physiotherapy and injections, and surgical options.

Treatment of adhesive capsulitis (frozen shoulder) with arthrographic capsular distension and rupture (Rizk et al., 1994)
This paper discusses the use of arthrographic capsular distension and rupture in treating frozen shoulder, resulting in immediate pain relief and increased mobility.

The efficacy of physiotherapy interventions in the treatment of adhesive capsulitis: A systematic review (Nakandala et al., 2020)
A review that evaluates the efficacy of physiotherapy interventions in the treatment of adhesive capsulitis, showing that certain mo

Treatment of adhesive capsulitis of the shoulder

Myofascial release

• Subscapular
• Supraspinous
• Pectoral (small and large)
• Biceps

Handling

• Shoulder mobilization according to patient tolerance – Emphasis on anteroinferior capsular stretching
• Inferior Glide, Anterior Glide and Axial Distraction
• Consideration of thoracic subluxations and the cervical spine
• Handling under anesthesia – If conservative treatment fails, the patient is given local anesthesia and the shoulder is literally “torn” back into its normal ROM – the procedure is painless and ruptures chronic adhesions.

Increased joint movement applied to the hip opposite the affected shoulder while the client actively moves the frozen shoulder may stimulate reflex responses promoting mobility

Exercises and joint mobilization are more effective than modalities, medications and steroid injections.

Stretching and Exercise for Adhesive Capsulitis of the Shoulder

 1.Pendulum

1. Lean forward, supporting the body with one arm and relaxing the muscles of the other arm so that it hangs freely
2. Gently move the arm forward and backward, side to side and in circular motions.
3. Perform 15 repetitions in each direction 3 times a day.
4. Repeat on the other side.

 2. Passive external rotation stretching

1. Stand in a doorway, facing the door jamb.
2. With the affected arm held at your side and the elbow bent 90°, grasp the edge of the door jamb.
3. Keep your hand in place and twist your upper body as shown in the illustration.
4. Hold the stretch for 30 seconds, then return to the starting position for 30 seconds.
5. Perform 5 repetitions, 3 times a day.
6. Repeat on the other side.

3. Passive stretching of internal rotation. Pendulum

1. Behind your back, grasp the stick with one hand and lightly grip the other end of the stick with the other hand.
2. Pull the stick horizontally as shown so that the arm is passively stretched to the point where you feel a painless pull.
3. Hold the position for 30 seconds, then relax for 30 seconds.
4. Repeat 5 times, 3 times a day.
5. Repeat on the other side.

 1.Front bending in supine position

1. Lie on your back with your legs straight.
2. With the unaffected arm, grasp the affected arm at the elbow and lift the affected arm overhead until you feel a slight stretch.
3. Hold the stretch for 15 seconds and slowly lower back to the starting position.
4. Perform 5 repetitions, 3 times a day.

Conclusion

Adhesive capsulitis, also known as frozen shoulder, is a medical condition characterized by inflammation and thickening of the shoulder joint capsule. This leads to a gradual loss of mobility in the shoulder joint, accompanied by significant pain and stiffness. Although the exact cause of adhesive capsulitis is not always clear, factors such as trauma, inactivity, diabetes, and certain medical conditions can contribute to the development of this condition.

Management of adhesive capsulitis often relies on conservative approaches, such as osteopathy, and stretching exercises. In more severe cases, medical interventions such as corticosteroid injection or manipulation under anesthesia may be considered. Recovery of shoulder mobility can take several months, or even more than a year in some cases.

In conclusion, adhesive capsulitis is a debilitating condition of the shoulder that can have a significant impact on the quality of life of those affected. Early and appropriate treatment, in collaboration with health professionals, is essential to alleviate symptoms, restore mobility and promote functional recovery of the shoulder joint.

Quizz

References

1. Allen GM. The diagnosis and management of shoulder pain. J Ultrasound. 2018;18(74):234-239. [ PMC free article ] [ PubMed ]
2. McKean D, Yoong P, Brooks R, Papanikitas J, Hughes R, Pendse A, McElroy BJ. Shoulder manipulation under targeted ultrasound-guided rotator interval block for adhesive capsulitis. Skeletal Radiol. 2019 Aug;48(8):1269-1274. [ PubMed ]
3. Gumina S, Candela V, Castagna A, Carnovale M, Passaretti D, Venditto T, Giannicola G, Villani C. Shoulder adhesion capsulitis and hypercholesterolemia: role of APO A1 lipoprotein polymorphism on etiology and severity. Musculoskelet Surg. 2018 Oct;102(Suppl 1):35-40. [ PubMed ]
4. Expert Panel on Musculoskeletal Imaging: Small KM, Adler RS, Shah SH, Roberts CC, Bencardino JT, Appel M, Gyftopoulos S, Metter DF, Mintz DN, Morrison WB, Subhas N, Thiele R, Towers JD, Tynus KM, Weissman BN , Yu JS, Kransdorf MJ. ACR Appropriateness Criteria ^® Shoulder Pain-Atraumatic. J Am Coll Radiol. 2018 Nov;15(11S):S388-S402. [ PubMed ]
5. Papalia R, Torre G, Papalia G, Baums MH, Narbona P, Di Lazzaro V, Denaro V. Frozen shoulder or shoulder stiffness from Parkinson disease? Musculoskelet Surg. 2019 Aug;103(2):115-119. [ PubMed ]
6. Kingston K, Curry EJ, Galvin JW, Li X. Shoulder adhesive capsulitis: epidemiology and predictors of surgery. J Shoulder Elbow Surg. 2018 Aug;27(8):1437-1443. [ PubMed ]
7. Suh CH, Yun SJ, Jin W, Lee SH, Park SY, Park JS, Ryu KN. Systematic review and meta-analysis of magnetic resonance imaging features for diagnosis of adhesive capsulitis of the shoulder. Eur Radiol. 2019 Feb;29(2):566-577. [ PubMed ]
8. Georgiannos D, Markopoulos G, Devetzi E, Bisbinas I. Adhesive Capsulitis of the Shoulder. Is there Consensus Regarding the Treatment? A Comprehensive Review. Open Orthop J. 2017;11:65-76. [ PMC free article ] [ PubMed ]
9. Koorevaar RCT, Van’t Riet E, Ipskamp M, Bulstra SK. Incidence and prognostic factors for postoperative frozen shoulder after shoulder surgery: a prospective cohort study. Arch Orthop Trauma Surg. 2017 Mar;137(3):293-301. [ PubMed ]

Credit in part: John M. St Angelo; Sarah E. Fabiano.