The capsule surrounds an articulation containing the articular cavity and the bones. Adhesive capsulitis of the shoulder, also known as “frozen shoulder”, can be described as a thickening and retraction of the capsule, which begins to adhere to the humeral head. This pathology is characterized by pain, stiffness and a limited functioning of the articulation. The pathophysiology of capsulitis remains little-known, even though two types have been studied. First, there is idiopathic adhesive capsulitis (primary) which occurs spontaneously without predisposing factors and originates from a chronic inflammatory response with fibroblastic proliferation. There is also secondary adhesive capsulitis which occurs after a shoulder injury or surgery and which can be associated with certain risk factors such as diabetes, a rotator cuff injury, CVA or other cardiovascular diseases that can delay healing.
Pathology development and symptoms
Capsulitis involves three stages of development and evolves on average over a 30-month period.1
1- Painful phase
2- Retraction phase
3- Recovery phase
Gradual reduction of pain
Progressive stiffening of the shoulder
Marked stiffening of the shoulder
Progressive disappearance of symptoms
How can the physiotherapist intervene?
Physiotherapy offers several interventions to accelerate the healing process. The most effective interventions are exercises.2 When performing mobilization techniques, the physiotherapist can execute passive movements of the upper limb and use specific mobilizations to stretch the joint capsule and allow for a better quality of movement. The therapist can also prescribe different exercises meant to increase shoulder movement, stretch the capsule, increase the strength of scapular stabilizers and improve posture. Other methods can be employed, such as the use of TENS or interferential current for pain management and neuro-proprioceptive taping to improve movement quality and reduce pain. In many cases, physiotherapy treatments are also combined with one or more corticosteroid injection(s) to help stretch capsule fibers and relieve pain. Combining these two methods increases the patient’s chances of having a speedy recovery.
Your physiotherapist at Kinatex will support you during the developmental stages of capsulitis and provide you with a comprehensive treatment plan adapted to your needs to ensure a speedy recovery and quick return to your activities.
1. Phil Page and Andre Labbe, CLINICAL SUGGESTION ADHESIVE CAPSULITIS: USE THE EVIDENCE TO INTEGRATE YOUR INTERVENTIONS, North American Journal of Sports Physical Therapy, Volume 5, Number 4, December 2010: 266-273
2. E Maund, D Craig, S Suekarran et al., Management of frozen shoulder: a systematic review and cost-effectiveness analysis, Health Technology Assessment 2012; Vol. 16: No. 11: 1-9
3. Bruce Arroll and Felicity Goodyear-Smith, Corticosteroid injections for painful shoulder: a meta-analysis, British Journal of General Practice, March 2005: 224-228