ADHESIVE CAPSULITIS OR FROZEN SHOULDER
Frozen shoulder is the most important cause of reduced mobility of the shoulder. Typically, it affects women around the age of 50. It comes with severe pain, especially at night. Continuous evolution of this pathology points towards self-healing after a period of 12-24 months.
ANATOMY AND PHYSIOLOGY
Adhesive capsulitis is a contraction phenomenon of all the ligaments located around the shoulder joint, called "capsule". The mechanism of this decrease is unknown but it seems to be favored by trauma or by stress. or diabetes.
The reduction of the capsule volume leads to a reduction in shoulder motion forward, outwards or backwards (no longer being able to fasten your bra).
It is linked to significant inflammation of the capsule.
SYMPTOMS
The symptoms evolution occurs typically in three main phases:
– first gradual phase of onset pain that can last a few days to a few weeks.
– second phase, or stiffening phase during which a limitation of movement gradually sets in, while pain, especially at night, tends to decrease.
– third phase, where stiffness is most often painless, and gradually decreases, progressing to a complete recovery, in 12 to 24 months. This development, which is considered to be always favourable, rarely involves a permanent limitation of mobility
DIAGNOSIS
It is only the natural history of the symptoms, the age of the patient and the context in which this pathology evolves, that characterizes adhesive capsulitis: limitation of mobility in anterior elevation, in external rotation elbow to the body, or the arm backwards.
Simple shoulder X-rays usually show few signs.
MRI scan will confirm the integrity of the cuff tendons.
TREATMENT
Conservative treatment is the therapeutic solution of choice with patience. To reduce the intensity of the pain, one or two injections can be made in the shoulder joint itself .
Self-rehabilitation is recommended to maintain mobility especially in the water (hydrotherapy)
Rehabilitation with a physiotherapist in the acute phase is of little interest.
Aggressive treatments have few indications. It involves mobilizing the shoulder, under anesthesia, or proposing a section of the capsule, under endoscopy. These treatments have not shown that they can significantly reduce the length of the capsulitis progression cycle.
OTHER TYPES OF SHOULDER STIFFNESS
The following will be noted:
Stiffness secondary to very intense pain: calcification of the shoulder.
Stiffness following trauma: such as a fracture of the humeral head, or a fracture of the upper extremity of the humerus.
Stiffness following surgery in the shoulder area, which is often complex to analyze.
SUMMARY
Adhesive capsulitis is probably the most common cause of shoulder pain and stiffness, especially in women over the age of 50. It most often evolves in a context of anxiety. This pathology heals on its own, and most often without sequelae, over a period of evolution varying from 12 to 24 months. One or two intra-articular injections can improve the patient's comfort during the cycle.
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