Capsulitis

Synonyms for capsulitis

• Frozen shoulder syndrome
• Frozen shoulder

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What is capsulitis?

It is an inflammation of the shoulder's envelope (the capsule), which causes significant stiffness in the shoulder (shoulder fibrosis).

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What is the shoulder capsule?

It is a tissue that surrounds the shoulder and allows the shoulder bone to stay in place within the joint. The capsule helps to stabilize the joint.

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What are the causes of capsulitis?

The exact cause of capsulitis remains unknown. In most cases, capsulitis develops without any triggering event.

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In other cases, capsulitis may develop:

• After a shoulder injury
• After surgery to the shoulder or arm
• After having your shoulder immobilized

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What are the symptoms of frozen shoulder?

Frozen shoulder generally progresses in two stages:

• In the first stage, the main symptom is pain localized in the shoulder, often in the front, which starts gradually for no apparent reason. Pain is often present at night. Gradually, stiffness develops in the shoulder, and the arm moves less and less. This is the 'pain' stage.
• In the second stage, the pain decreases, and the arm moves even less. This is the 'stiffness' stage.

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In general, several movements will become very difficult or even impossible to perform due to stiffness and pain, such as:

• Removing or putting on a sweater or coat
• Fastening or unfastening your bra
• Washing your back or hair
• Putting your hair up; styling your hair
• Reaching for the seatbelt in the car

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You may also experience neck pain or even pain that radiates down the arm.

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How is frozen shoulder diagnosed?

The diagnosis is made based on the history of symptoms and a clinical examination. Sometimes, an X-ray of the shoulder will be necessary to rule out another, more serious cause of the pain. Frozen shoulder cannot be seen on an X-ray.

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When to consult a physiotherapist for frozen shoulder?

You should consult a physiotherapist if you have symptoms as described above or if your doctor has already ruled out any other cause that may be responsible for your pain.

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You do not need to see a doctor before consulting a physiotherapist. If your condition requires you to see a doctor, your physiotherapist will be able to tell you.

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What are the physiotherapy treatments for frozen shoulder?

Your physiotherapist will conduct an assessment to determine the cause of the pain and limitations. To do this, they will evaluate the following:

• Your joint mobility
• The gliding of your nerves
• The quality of your movements
• Your strength and stability

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Based on the assessment results, your physiotherapist will:

• Mobilize your shoulder to reduce pain and improve your range of motion.
• Provide you with specific exercises to increase shoulder mobility, reduce pain, and improve muscle stabilization of your shoulder.
• Teach you how to properly manage your daily activities and hobbies to optimize healing
• Give you advice for your posture and movements.

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In general, physiotherapy should be combined with cortisone injections or distension arthrography in the shoulder for the best possible recovery. These injections help reduce pain and allow for more effective physiotherapy exercises. Injections are especially important in the first stage of frozen shoulder when there is inflammation.

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Your physiotherapist can coordinate with your doctor to ensure a good combination of treatments with injections.

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How long does it take to recover from frozen shoulder?

Frozen shoulder is a condition that heals more slowly than other shoulder injuries, such as tendinitis. The average duration for a full recovery is 30 months. However, significant improvement in pain and mobility is usually noticed between three and six months.

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What to do at home for frozen shoulder?

During the pain phase, it is important to continue moving your arm, but without making the movements too painful. If you start stretching exercises that are too aggressive during the pain phase, you risk hindering your recovery.

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During the stiffness phase, you can do stretching exercises in the direction where your arm moves the least. Slight pain is acceptable during exercises at this time.

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Here are some other tips to help you:

• Try to keep your shoulder blade and shoulder slightly elevated at all times. For example, support your arm with a cushion under your armpit, an armrest, or by putting your hand in your pants pocket to raise your shoulder.
• If you have pain at night or morning stiffness, make sure your neck is well supported while sleeping with a pillow that fills the hollow of your neck.
• Avoid sleeping with your arm behind your head or under the pillow. Keep your arm along your body or supported with a pillow.
• Avoid sleeping on the painful shoulder.
• If you can't find a comfortable position for the night, use one or two pillows to support your arm.

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If you don't see any improvement after 10 days, you should consult a physiotherapist.

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Did you know?

• Women are four times more likely to develop frozen shoulder than men.
• The non-dominant side is most often affected.
• Approximately 15% of people who experience a frozen shoulder will develop another one in the opposite shoulder within the next five years.

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Sources

SHOULDER, W. I. F. (2015). Frozen Shoulder.

Uppal HS, Evans JP, Smith C. Frozen shoulder: A systematic review of therapeutic options. World journal of orthopedics. 2015 Mar 18;6(2):263.

Rangan A, Gibson J, Brownson P, Thomas M, Rees J, Kulkarni R. Frozen shoulder. Shoulder & elbow. 2015 Oct;7(4):299-307.

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