Stiffness - Adhesive Capsulitis - Frozen Shoulder
Stages of Adhesive Capsulitis
Stages of Adhesive Capsulitis
- Acute/hot phase: very painful mobility, even at night (3-9 months).
- Freezing: decreased pain but stiffness (4-12 months).
- Thawing phase: 12-48 months
Signs and Symptoms of Adhesive Capsulitis
Signs and Symptoms of Adhesive Capsulitis
Patients complain of pain, which may be more intense at night, and loss of mobility. They generally do not remember any event that precipitated this condition.
Adhesive Capsulitis Diagnosis
Adhesive Capsulitis Diagnosis
Physical examination
Physical examination
The diagnosis is essentially clinical. Loss of passive mobility is observed. It becomes impossible to raise the shoulder above a certain level due to stiffness, and not so much due to the pain felt by the patient.
The neurological examination is usually normal.
X-ray
X-ray
It does not diagnose adhesive capsulitis but allows the identification of lesions that can lead to adhesive capsulitis, such as shoulder osteoarthritis, fracture or tumor lesion.
Magnetic Resonance Imaging
Magnetic Resonance Imaging
It allows the identification of thickening of the joint capsule and ligaments as well as the reduction of joint space.
Adhesive Capsulitis Treatment
Adhesive Capsulitis Treatment
Analgesia and rest
Analgesia and rest
In the first phase, when the pain is very intense and predominantly nocturnal, it is important and essential to achieve pain control through the use of anti-inflammatories and analgesics.
Rest should be taken initially just to control the pain. If you do not start mobilizing your shoulder quickly, the stiffness will be even greater.
Physiotherapy and Rehabilitation
Physiotherapy and Rehabilitation
After pain control, it is possible to begin exercises that will allow for increased joint range of motion in the first phase and muscle strengthening in the next phase. Rehabilitation can last for several months or even up to a year.
Shoulder Infiltration
Shoulder Infiltration
The use of corticosteroid infiltration can be used in cases of difficult-to-control pain as an adjunct to oral medication and to allow an earlier start of shoulder rehabilitation.
Hydrodistension
Hydrodistension
Hydrodistension is a minimally invasive ultrasound-guided procedure in which saline solution (with or without corticosteroids) is injected into the joint to overcome the resistance of the thickened capsule and ligaments and increase the joint space. This procedure should not be used in isolation, but should always be used in conjunction with rehabilitation and as part of a multidisciplinary team.
Surgical
Surgical
When to perform? In rare cases, none of the measures described above are successful and, despite several months of treatment, the shoulder remains incapable of elevating above 90°. In these cases, surgery is indicated.
Procedure/technique: 360° capsulotomy by arthroscopy, in which the thickened ligaments and capsule are released along their entire length.
Postoperative
Postoperative
- The patient can be discharged on the same day or the day after surgery.
- Remove the stitches 2 weeks after surgery.
- You should start physical rehabilitation the day immediately following surgery and no immobilization should be used.
When to seek an Orthopedic Specialist?
When to seek an Orthopedic Specialist?
Whenever there is a decrease in mobility even if there is no precipitating event.