Adhesive capsulitis of the shoulder: symptoms, origin & treatment

Adhesive capsulitis of the shoulder is a condition affecting nearly 10% of the world's population. It is one of the shoulder stiffness disorders and corresponds to complex regional pain syndrome type I (CRPS I). Although its origins are sometimes quite difficult to determine, there are solutions to treat the bothersome symptoms. A closer look at adhesive capsulitis of the shoulder and... shoulder care available to relieve patients suffering from this condition.

What is adhesive capsulitis of the shoulder?

To fully understand adhesive capsulitis, it is essential to understand the function of the shoulder joint, and more specifically the glenohumeral joint (one of the five joints of the shoulder complex). This joint is surrounded by a set of organic tissues: the capsule, which forms a fibrous sleeve around the joint (1). The folds of this capsule can contract and stick together, thus hindering arm movement and making it painful. In other words, adhesive capsulitis can be defined as an inflammation of the synovial fluid (the fluid present in the joint and contained within the capsule). The altered lubricating properties of this synovial fluid cause the folds of the shoulder capsule to stick together, which can progress to the "frozen shoulder" syndrome, where shoulder movement becomes impossible in all planes of motion (2).

Symptoms and progression of adhesive capsulitis of the shoulder

At the beginning of the condition, the deep layer of the shoulder capsule (synovial membrane) appears red (due to inflammation), then contracts and turns white as the capsulitis progresses. In advanced stages, this disorder can lead to the loss of the biceps brachii sheath, resulting in a significant decrease in the patient's muscle strength.

Other symptoms of adhesive capsulitis can vary depending on the different stages of this shoulder condition:

During its first phase (also known as the “hot phase”), which can last between 1 and 4 months, adhesive capsulitis causes diffuse pain in the shoulder, which can even extend to the elbow or even the hand. It is an inflammatory pain, present day and night, or when the patient attempts to make a sudden movement;

During the second phase, which lasts between 3 and 12 months, adhesive capsulitis of the shoulder is characterized by stiffness of the shoulder joint and a decrease in the range of motion. It is in this phase that the “frozen shoulder symptom” may appear;

During the third phase (also known as the “cold phase”), the pathology is generally less painful and the patient can gradually regain the range of motion.

What are the causes of adhesive capsulitis of the shoulder?

This retraction of the capsule can be traumatic in origin, caused by tendon damage (tendinopathy, for example), a direct or indirect impact, rotator cuff pathology, or even surgery. It should be noted that it can also be of primary origin, meaning without any significant prior history.

The epidemiology of this condition primarily affects patients aged 40 to 60, and particularly women. It is exacerbated by diabetes (20% of diabetics are affected), hypothyroidism, breast cancer, and heart problems.

What treatment is available for adhesive capsulitis of the shoulder?

The management of adhesive capsulitis of the shoulder revolves around medical treatment and a rehabilitation phase to allow the patient to regain the initial range of motion in their shoulder movements.

Depending on the stage of the disease and the opinion of a healthcare professional, the patient may be directed towards oral anti-inflammatory medication, a corticosteroid injection, a saline injection in the shoulder, etc. Subsequently, a combination of exercises to be performed at home and so-called "manual" therapy may also be implemented, including tissue massage, joint mobilization exercises, passive stretching, etc. It should be noted that surgical intervention is not the first-line treatment.

In general, it is important to note that prompt treatment of adhesive capsulitis of the shoulder can significantly reduce the potential negative consequences of this condition. We therefore recommend that you consult a physiotherapist as soon as you begin to experience any concerning pain in your shoulder, with or without a loss of range of motion.

What exercises should be performed as part of the management of capsulitis of the shoulder?

As we saw earlier, treatment initially consists of cortisone injections to reduce pain, as well as an investigation of the underlying causes, if any. Treatment is then based on intensive and prolonged rehabilitation, aided by the use of painkillers (3).

Some exercises can be performed directly at the patient's home, allowing them to rehabilitate their shoulder independently, alongside their specialized care. Here is an example of a rehabilitation exercise from the Hauteville protocol, recommended for adhesive capsulitis of the shoulder: it is performed lying on the back with knees bent. The patient joins their hands on their stomach, places them at eye level or on their forehead, lets their elbows move apart (as in a napping position), then extends both hands together as far as possible towards the back of their head. The goal is for them to maintain this position for a few seconds before bringing their hands back to their stomach while exhaling. (4)

It should be noted, however, that in rare cases, adhesive capsulitis can leave lasting motor impairments. These include a reduction in active range of motion in rotation, anterior or lateral elevation, with a reduced effective passive range of motion.

The Allyane Method in the treatment of adhesive capsulitis of the shoulder

Allyane neuromotor reprogramming complements rehabilitation sessions with a physiotherapist in the management of the consequences of adhesive capsulitis of the shoulder. It allows for addressing motor inhibitions that may have developed during the phase of limited range of motion. These motor inhibitions prevent muscles from functioning correctly, affecting both their strength and the quality of the movement. They can also lead to compensation in other muscles, often antagonistic to the intended action.

The Allyane method therefore makes it possible to reactivate a motor automatism "forgotten" by prolonged immobilization induced by pain in the patient suffering from adhesive capsulitis of the shoulder (5).

Would you like to learn more about the Allyane method for shoulder capsulitis rehabilitation? Don't hesitate to contact a certified practitioner near you.

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