23 November 2020 Author : Pedro Lourenço Adhesive capsulitis is one of the most common causes of shoulder pain and its origin is unknown. It affects 3% of the population, mainly women between 40 and 60 years of age. Most often, it affects the shoulder on the non-dominant side, but it can also affect both shoulders (14% of cases). It is estimated to reach 10% -35% of diabetics. Adhesive capsulitis is characterized by progressive pain in the shoulder joint, associated with an increasingly severe limitation of its passive and active motion , assessed by the physician and by each one of us, respectively. In other circumstances, shoulder stiffness may also occur, secondary to another pathology: From the same anatomical region, for example, tendonitis or osteoarthritis; Related to heart, lung or cervical disease; Associated with systemic diseases, for example diabetes mellitus, hypothyroidism, hyperthyroidism, Parkinson disease, among others. Symptoms and diagnosis of adhesive capsulitis Three stages are described in the evolution of adhesive capsulitis : 1 st - Painful phase, in which there is severe or generalized shoulder pain and progressive stiffness. It can last up to 9 months; 2 nd - Stiffness or ice phase, in which the pain resolves, but the stiffness remains. Lasts 4 to 12 months; 3 rd - Defrost phase, in which the shoulder becomes less rigid, lasts 1 to 3 years. The cause of adhesive capsulitis remains unknown, histological findings reveal an inflammation of the synovial capsule (membrane that lines the joints), its fibrous thickening and progressive functional impotence of the joint. The diagnosis of frozen shoulder is clinical, based on the history of the symptoms and signs presented. Some diagnostic tests, such as magnetic resonance (MRI), can reveal typical findings, such as the “tight” joint, and also help to exclude other injuries that may be the cause of pain. Treatment Adhesive capsulitis has usually a benign and self-limited evolution, that is, it often resolves spontaneously. However, this spontaneous resolution can take 18 months to 3 years and not all cases have this outcome. In cases where the care of an orthopedist is sought and treatment is proposed, the primary objective is to control pain, using oral, intramuscular, or intra-articular medication (infiltration). Oral corticosteroid therapy seems to provide clinical improvement, but only in the short term, so its use must be judicious; Corticosteroid infiltration contributes to improvement in pain and more sustained mobility over time, so it may be a proposal to consider. Joint mobilization plays a key role in recovery. The movements must be smooth, that is, the pain they induce must be bearable. Motion schemes that are simple, repeated several times a day, performed at home under medical guidance have beneficial results. The association with physiotherapy sessions with mobilization, thermotherapy, electrotherapy, and ultrasound also has good results. When there is no improvement in pain and stiffness with medication and / or physiotherapy within 3 to 6 months, surgery may be proposed to free the tissues that hinder (trap) the joint and hinder its normal movements. To optimize the results, the surgery combines: Manipulation under anesthesi a, in which the orthopedist forces the shoulder to move, causing the capsule and scar tissue to rupture and release, increasing the range of motion. Arthroscopy , a minimally invasive technique that uses small instruments and incisions, in which the orthopedist, under direct visualization and using lenses and chambers, cuts tight portions of the joint capsule and introduces serum under pressure to distend the joint capsule. Most patients (around 87%) report good to excellent results with these technically complex procedures, which require early postoperative rehabilitation to prevent recurrent stiffness. On average, recovery is complete within 6 weeks to 3 months, but it can be longer. In some cases, even after several years, the range of motion is not fully recovered, and some rigidity may remain. Prevention of recurrence of shoulder stiffness Regardless of its cause, prolonged immobilization should be kept to a minimum as it contributes to stiffness. Meet the orthopedics team from Hospital da Luz network and book your consultation . The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item.
