Capsulitis. Adhesive capsulitis of the shoulder - a reason for immediate treatment Adhesive capsulitis of the shoulder

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One of the main components of the human skeleton is the shoulder joint. It consists of three bones: the humerus, clavicle and scapula, each part of the bone is covered with a sheath containing fluid.

The joint capsule is a shell that prevents the bones of the joint from rubbing against each other. Adhesive capsulitis of the shoulder (ICD 10) is an injury to the capsule that is manifested by severe pain and limited mobility in the shoulder area. This disease is also called "frozen shoulder". Because if you do not take measures to treat it, then it can completely lose mobility, and the person will become disabled.

Several factors contributing to the development of the disease have been identified. Most often, adhesive capsulitis appears after injuries and injuries of the shoulder joint. Various metabolic disorders in the body, such as diabetes, also contribute to the development of this disease.

It is important to treat diseases of the spine in a timely manner, because adhesive capsulitis of the shoulder can develop due to cervical or thoracic osteochondrosis. Even the hormonal disruptions that occur in a woman's body during menopause, leading to changes in metabolism, can give impetus to the development of this disease called adhesive capsulitis of the shoulder. The reasons may be different.

Work in which the arms are constantly raised up puts a lot of stress on the shoulder joint, which leads to the development of the disease. Especially at risk are people who have had a heart attack, stroke and other heart diseases, as well as surgery. Also, adhesive capsulitis is promoted by inflammatory processes in cartilage and articular tissues. It can be provoked by diseases of the respiratory system.

Stages of the disease

Adhesive capsulitis of the shoulder occurs in three stages:

• The first is pain in the shoulder area. She can be very strong. The pains are not constant, they appear often. Get stronger from exercise or manual work. There is also an increase in pain at night. For some time the pain progresses. The patient tries to make less movements with the diseased limb, looking for a comfortable position for her. This period is quite long, about 6-8 months.
• In the second stage, the mobility of the shoulder joint is limited. A person suffering from this disease cannot raise his hand high. At the same time, the mobility of the hand and elbow is not impaired. The duration of this stage depends on the therapy used. If the treatment was effective, then the next stage will follow.
• The last stage is recovery. The joint becomes fully mobile. The disease can last for a long time - 1.5-4 years. Some patients cannot move their arm normally for the rest of their lives.

Diagnostics

However, if adhesive capsulitis of the shoulder is not treated or the wrong method of therapy is chosen, then the disease will end in disability.

In order to begin treatment of the disease, it must first be correctly diagnosed, and this can be done by a rheumatologist. Diagnosis begins with listening to the patient's complaints and a simple examination. Palpation reveals pain in some points of the shoulder. The patient is asked to take hold of his head with both hands, put his hands on his belt, and take his hands away from the body as much as possible. After that, the patient is assigned a more detailed examination: X-ray of the shoulder joint, blood for analysis. But the most reliable way to identify adhesive capsulitis of the shoulder is to conduct an examination of the joint itself, called arthrography. This method allows you to see how much the volume of the joint capsule has actually decreased.

When it is normal, its volume is 12 ml. With articular pathology, the fluid decreases to 2-3 ml.

It is worth noting the fact that an experienced doctor will reveal pathology even without expensive diagnostic methods. He will examine the contour of the shoulder and joint, find thinning and retraction of the muscle.

What is the treatment for the diagnosis of "adhesive capsulitis of the shoulder"?

Based on the results of the examination, the doctor chooses the optimal treatment for the affected joint. There are several areas of it:

• At the first stage of the disease, symptoms consisting in severe pain are stopped. This is achieved by the use of drugs to relieve pain.
• It is necessary to stop the inflammatory process, because it is the cause of all troubles. To do this, non-steroidal anti-inflammatory drugs are most often used, for example, Diclofenac, Indomethacin, and the like. A chiropractor for adhesive capsulitis of the shoulder can also help.
• It is not necessary to immobilize the joint. This can even harm him, because the forced restriction of the joint makes it difficult for him to regain mobility. The recovery phase is slowing down. But hand movements must be careful. They shouldn't be painful.
• In the case of very severe pain, the doctor may prescribe intra-articular injections of glucocorticosteroids. Injections can be replaced by taking pills, but they cause more adverse reactions. To eliminate severe pain, a blockade of the suprascapular nerve can be prescribed.

Adhesive capsulitis of the shoulder: therapeutic exercises

At the stage of recovery, a set of exercises is prescribed that will help restore lost mobility to the damaged joint. In order for the healing process to bring the expected effect, it is necessary to perform special exercises several times every day.

Raising the arms as much as possible, they make rotational movements, raise and lower. You can try to take your hand behind your back and grab it with your other hand, and then pull it a little towards your buttocks. A set of exercises will also be effective, helping to maintain muscle tone, as well as preventing the onset of pain. This complex contains the following exercises:

• the head is alternately tilted to the side;
• turn the head in different directions;
• shoulders are raised and lowered;

Neck muscles need to be trained. To do this, in the supine position, raise and lower the head, while holding it when lifting.

Simple exercises for the neck and shoulder will help stretch the muscles. When the neck is numb, it is not recommended to make active movements of the head in a circle.

1. The exercises performed should not bring pain. Proceed to their implementation only after consulting a doctor, so as not to harm your health and not nullify the result achieved by drug treatment. Don't overwork the joint. Excessive loading may damage it. Increase it gradually. They also make appointments for therapeutic massage, laser, magnetic or sound therapy. Unfortunately, these treatments do not always bring the desired effect. Its productivity depends on the extent to which the joint is affected.
2. In the event that a significant area was affected and as a result of treatment the mobility of the joint was not restored or restored, but not completely, then surgical intervention is necessary. Arthroscopy is required. This is an operation aimed at restoring the motor function of the shoulder joint.

The shoulder is pierced in several places. An arthroscope with a camera, which is inserted into the joint cavity, searches for a sore spot. The other puncture area is used to insert a special instrument. It acts with cold plasma on the joint, as a result of which fusion and wrinkling is eliminated.

After such a surgical intervention, you can move the limb freely and painlessly.

Adhesive capsulitis of the shoulder: treatment with folk remedies

Before starting therapy with folk methods, it is necessary to consult a doctor.

In compresses, "Dimexide" is often used. Cold blue clay, wax or paraffin is also effective. An alcohol mixture of camphor can be rubbed into a sore shoulder. Mustard and egg white, ointment from burdock roots and butter are also used in folk medicine.

You need to drink this for at least 4 weeks for a visible result.

Complications

As with any operation, arthroscopy can lead to complications. This can happen due to the following negative factors:

• chronic diseases that have been transferred recently;
• bad habits (alcohol, nicotine);
• taking medications that cause bleeding;
• previous shoulder surgeries.

Possible complications are bleeding, infection, damage to soft tissue or nerve endings, negative reaction to anesthesia, joint immobility, fracture.

You need to see a doctor urgently if:

• an anesthetic has been taken, but the pain does not subside;
• a person is shivering and feverish, which means that an infection has begun to develop;
• numbness, tingling in the arm and shoulder is felt;
• swelling, inflammation, bleeding in the puncture area;
• vomiting, nausea appeared.

After arthroscopy, pain can last for several weeks, and a complete cure occurs after six months.

In order for the recovery after the operation to go smoothly, you must adhere to the following points:

• in the first two postoperative days, ice should be applied to the swollen area and kept for 20-30 minutes;
• take painkillers;
• constantly change bandages;
• after the operation, the first time to sleep with a pillow under the elbow, it is better not in bed, but in an armchair, for example;
• do physical exercises recommended by the doctor.

How can adhesive capsulitis of the shoulder be prevented? We examined the causes and treatment.

Prevention

There are a number of preventive measures that can help prevent the development of adhesive capsulitis. It is important to remain emotionally calm. Avoid stressful situations, they provoke muscle spasms, contribute to the appearance of seizures. In addition, anxiety, stress lead to rapid muscle fatigue. Breathe properly.

When working at a computer, it is important to sit correctly. The posture should be comfortable. Hold your phone correctly. It is not recommended to clamp it with your shoulder when talking. This can lead to pain in the shoulder joint. Drink enough water. Muscle fatigue will be less developed if the body maintains water balance.

Conclusion

Shoulder capsulitis is a long-term disease. It happens that a person throughout his life cannot completely get rid of discomfort in this joint. Typically, capsulitis affects people over 40 and mostly women.

Adhesive capsulitis can completely immobilize the shoulder. But it is possible to restore joint mobility and overcome this disease. The main thing is to pay attention to the appearance of the slightest discomfort in the shoulder. The occurrence of even minor pain can be a signal of the development of the disease.

The appearance of pain during the natural movement of the shoulder can warn of the development of a disease such as adhesive capsulitis. The disease affects the capsule of the shoulder joint and its inner (synovial) membrane. Inflammation begins with the process of sticking together of certain parts of it, leading to immobilization of the shoulder. In most cases, the treatment of adhesive capsulitis of the shoulder joint is successful.

The development of the disease begins with damage to the capsule of the shoulder joint

The disease is common, more often develops in people aged 40–60 years and patients with diabetes mellitus.

The main causes of the development of the disease

Adhesive capsulitis of the shoulder joint can develop due to such factors:

• any type of joint injury;
• violations of metabolic processes in the body;
• hormonal disruptions;
• osteochondrosis of the thoracic or cervical spine;
• features of professional activity (the need to keep your hands up for a long time).
• diseases of the heart and blood vessels (stroke, heart attack, etc.);
• inflammatory diseases of cartilage and joints.

Stages of the course of capsulitis

There are three stages in the course of adhesive capsulitis of the shoulder.

1. First stage. There is a sharp pain when moving in the shoulder area. The pain is constantly present, only slightly dulling while the hand is at rest. It intensifies in the morning and in the evening. The maximum duration of this period is 8 months.

Note. This disease negatively affects the general mental state of a person. Due to frequent pain, the patient develops nervousness, sleep is disturbed.

The development of adhesive capsulitis is accompanied by severe pain that occurs when the shoulder is moved.

1. Second stage. Hand movements become limited due to pain in the shoulder joint. Raising the arm up is difficult, and then only in the forward direction. It is impossible to raise a hand, directing it backwards because of the pain. The movements in the elbow and hand are free. Under the condition of timely prescribed treatment, this stage gradually passes into the third - final.

1. Third stage- final. Its duration is approximately 1-3 months. During this period, pain is absent, complete immobilization of the shoulder occurs. But after a certain period, the tension in the inflamed area disappears, the movements in the shoulder joint are restored, but at the same time, some of their limitations remain.

The appearance of pain in the shoulder joint is the main symptom indicating the development of inflammation of the joint capsule.

The symptoms of shoulder osteoporosis are very similar to those of adhesive capsulitis. In both cases, the disease is manifested by severe pain in the shoulder.

Significantly reduced motor activity. Taking painkillers doesn't help. With both diseases, pain may at some point intensify or disappear completely. But the causes of pain and subsequent immobilization of the shoulder in these diseases are different.

Differential diagnosis of capsulitis and osteoporosis

Osteoporosis

It develops as a result of a violation of phosphorus-calcium metabolism and leads to a decrease in the strength of all bones of the skeleton.

Due to the absence of symptoms at an early stage, treatment for osteoporosis of the shoulder joint begins only after the onset of pain that prevents the natural movement of the shoulder.

When the disease is advanced, the bones become brittle, there is a risk of fracture. Bones grow together with osteoporosis for a long time. But even after long-term treatment, the risk of re-fracture in the fused site is present for the next two years. Treatment of osteoporosis of the shoulder joint consists of taking hormonal drugs and enriching the body with calcium.

Adhesive capsulitis

In the people, this disease is often called "frozen shoulder". Develops due to the development of inflammatory processes in the joint capsule.

The cause of the inflammatory process can also be a joint injury, which occurred due to increased bone fragility, provoked by the development of osteoporosis.

Important! Thus, the presence of osteoporosis does not preclude the occurrence of adhesive capsulitis. Both diseases can be present in the patient at the same time, which, of course, makes diagnosis difficult.

Any shoulder injury can provoke the development of adhesive capsulitis.

Diagnostics

It is possible to identify the exact cause of the onset of increasing pain during the movement of the shoulder joint only after a complete examination of the body. It includes:

• examination by a specialist;
• delivery of clinical tests;
• certain tasks that help to identify the level of shoulder mobility;
• x-rays, sometimes an MRI may be done instead.

X-ray of the shoulder joint is a mandatory diagnostic method for adhesive capsulitis

Fighting methods

In most cases, the treatment of adhesive capsulitis of the shoulder is successful. But the duration and complexity of treatment directly depend on the stage of the disease. If the treatment was started in the first months of the development of the disease, before the appearance of pronounced symptoms, then its outcome is always good.

Treatment consists in relieving pain and inflammation with the help of NSAIDs (Diclofenac, Nimesulide, Ibuprofen, etc.). In the case of severe pain, intra-articular corticosteroids are used. A suprascapular nerve block may be performed.

In the initial stage of the disease, pain is the main factor limiting the movement of the shoulder.

If the treatment was started at the 2nd stage of the disease, accompanied by severe pain and partial immobilization of the shoulder, then its effectiveness will be minimal. In such cases, resort to surgical intervention - arthroscopic capsulotomy.

Treatment carried out at the third stage of the disease (exercise therapy, massage, physiotherapy) will speed up recovery. Pain sensations will be eliminated faster, and motor functions of the joint will improve.

A large number of adults from 40 to 60 years old, especially women, note pain and a sharp limitation of movement in the shoulder joint. This condition is often referred to in everyday life as frozen shoulder, and in the scientific literature as adhesive capsulitis. Sometimes these concepts are considered as interchangeable, although in fact they are not.

The shoulder joint is made up of three bones: the scapula, the humerus, and the clavicle. The joint is surrounded by a special joint capsule. The capsule is not permeable to fluid, so the intra-articular synovial fluid does not go beyond it and lubricates the articulating surfaces.

Most of the joint capsule is made up of tight ligaments that attach to the bones and hold them together. The joint capsule consists of fibrous structures, which, under certain conditions, become denser or fibrous, thereby becoming stiffer. The capsule shrinks, and the range of motion in the joint decreases.

Another reason for a decrease in the range of motion in the joint can be injuries to the rotator cuff, articular lip, or biceps tendon. Damage to intra-articular structures becomes, as it were, a trigger that triggers pathological inflammatory changes in the joint, causing limitation of movement and pain.

Adhesive capsulitis is based on a change in the joint capsule, which results in a sharp limitation of passive and active movements. Usually this disease occurs against the background of diabetes mellitus or autoimmune diseases, more often in women, as risk factors include previous strokes or myocardial infarction. Occasionally, adhesive capsulitis can develop in people without obvious risk factors. The exact etiology of the disease, scientists can not yet identify. Usually, the causes of adhesive capsulitis in a patient remain largely a mystery.

The cause of stiffness in the shoulder joint can also be injuries. Trauma with damage to intra-articular structures causes chronic inflammation and pain. Pain causes the patient to use the joint less, and stiffness gradually develops. To cure post-traumatic stiffness, it is necessary to establish a damaged structure, it can be a rotator cuff, a biceps tendon or, for example, an articular lip, to perform its reconstruction and thereby create the prerequisites for restoring the previous range of motion.

The reason for the development of stiffness in the joint may also be previous surgery. As a result of operations, the anatomy of the bones that make up the shoulder joint, as well as the ligaments and tendons that hold them, can be disturbed. For example, when the head of the humerus or a large tubercle is fractured, there is a displacement of the attachment points of the main ligaments and tendons, which, if not properly treated, can lead to stiffness in the joint.

Restoration of the rotator cuff can cause a decrease in the length of the tendons, thereby inevitably reducing the range of motion in the joint. Osteoarthritis of the shoulder joint also leads to hardening of the joint capsule as a result of constant inflammation, which also leads to the development of contractures and a decrease in range of motion.

The main symptoms of adhesive capsulitis include progressive limitation of movement in the joint and pain.

Stiffness in the joint can make daily activities such as combing or dressing very difficult. Finding out the exact causes of the development of stiffness in the joint contributes to the development of the correct treatment tactics and the achievement of recovery.

The diagnosis is usually established on the basis of a carefully collected history of the disease and a thorough clinical examination. In its development, adhesive capsulitis goes through several stages. Each of the stages is characterized by certain symptoms and a different duration. Approaches to the treatment of adhesive capsulitis at different stages also differ.

As a rule, simple radiography in these diseases is not informative. The most common study for diseases and injuries of the shoulder joint is MRI.

Magnetic resonance imaging is a special study, based on which, using magnetic waves, an image of the shoulder joint is formed. An MRI can very well visualize damage to the ligaments, tendons, and other soft tissues around the joint.

The final and most accurate diagnosis can be established during arthroscopy. During arthroscopy, most structures within the shoulder joint can be visually assessed and sanitized.

Treatment of adhesive capsulitis begins, as a rule, with conservative therapy. Conservative treatment includes the use of non-steroidal anti-inflammatory drugs, physiotherapy, physiotherapy exercises. Treatment is aimed at reducing pain and developing movements in the joint.

Unfortunately, it may take a long time to achieve satisfactory results. Sometimes it may be necessary to inject steroid drugs into the joint cavity to reduce inflammation. Blockade of the suprascapular nerve is also practiced, as a result of which pain in the shoulder joint is sharply reduced, but the effect of anesthesia is limited in time. Usually conservative treatment takes from 2 to 4 months, the function of the joint may not fully recover.

If the results of conservative treatment do not satisfy the patient, surgery may be considered.

Operations on the shoulder joint at the present stage of development of medicine are performed by the arthroscopic method.

During the operation, it is possible to examine the joint cavity and intra-articular structures, remove scar tissues that impede movement in the joint, and dissect the wrinkled joint capsule, which also allows you to increase the range of motion.

After the operation, under anesthesia, the surgeon carefully redresses the joint. Redressing is a manipulation in which the surgeon forcibly flexes and unbends the shoulder joint. In rare cases, such manipulations can lead to a fracture of the head of the humerus, especially in elderly patients with osteoporosis.

After surgery, a short-term wearing of a special orthotic bandage is usually required. The stitches are removed 12 days after the operation. Good results can be obtained by using a special apparatus for the passive development of movements in the joint in the postoperative period. In the postoperative period, you will need to visit the attending physician several times more, who will control the recovery process after the operation.

In our clinic, we widely use arthroscopy and other minimally invasive methods for treating shoulder joint pathology. Operations are performed on cutting-edge medical equipment using high-quality and proven consumables, fixators and implants from major global manufacturers.

However, the result of the operation depends not only on the equipment and quality of implants, but also on the skill and experience of the surgeon. The specialists of our clinic have extensive experience in the treatment of injuries and diseases of this localization for many years.

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Capsulitis of the shoulder joint is an inflammation of the synovium and capsule of the shoulder. This is not the most common disease, where more often patients are found with tendonitis and tendinosis, but this does not make the pathology less dangerous. The essence of the threat lies in the likelihood of the formation of ankylosis - areas of immobility in the structure of the joint. This is a direct path to disability. What else do you need to know about this difficult disease?

Shoulder capsulitis is an inflammatory and degenerative lesion of the soft tissues of the shoulder joint. Capsulitis is a form of periarthritis (a complex lesion of periarticular structures in which the cartilage itself does not suffer), while its final stage, in which ankylosis is formed. This is an extremely dangerous disease that requires urgent medical care, most often surgical. According to statistics, people living in civilized countries most often suffer from this disease, the more terrible the described pathology: it deprives the state of the able-bodied population, excludes a person from active life.

Reasons for the development of the disease

Capsulitis is characterized by a multifactorial nature of etiology. In practice, this means that a disease can be caused by many reasons, moreover, affecting at once, in a complex. What are the reasons for:

• The first and most significant factor is the age of the patient. There is a direct correlation between age and the risk of capsulitis. The older the patient, the higher the likelihood of morbidity. This form of periarthritis affects people over 40 years old, which is associated with the natural wear and tear of the musculoskeletal system.
• Heredity. It is not the disease that is inherited, but only the features of the musculoskeletal system, and hence the likelihood of developing pathology. Genetic predisposition plays a significant role. It has been proven by geneticists that if there was a person in the ascending line in the family who suffered from capsulitis, the probability of the formation of pathology in descendants is 30-50% higher. This is a significant number.
• Hypothermia. The real enemy of healthy joints. With hypothermia, there is a decrease in general and local immunity, as a result, the pathogenic microflora is activated. Fairly said only for infectious capsulitis.
• Congenital malformations of the fetus. First of all, we need to talk about injuries, deformations. This is a direct path to the development of periarthritis in the form of capsulitis.

Important! This type of capsulitis is the most severe.

• Diseases of the cardiovascular system. Lead to ischemia of the musculoskeletal structures. The lack of oxygen and nutrients negatively affects the health of the shoulder joint. The result is capsulitis. First of all, we have to talk about angina pectoris, coronary heart disease, myocardial infarction.
• The presence of frequent acute respiratory diseases. ARI or SARS have an extremely negative impact on the health of the joints, since on the one hand they undermine the immune system, on the other hand they mobilize it excessively, which can become a factor in an autoimmune reaction.
• autoimmune factor. It makes itself felt for reasons that are not fully understood. As a result of the protective response of the body, the immune system takes healthy cells of the synovial bag and capsules for pathogens and begins to attack them.
• The presence of pathologies of the spinal column. Pathologies of the spine also do not add health to the blood flow. Ischemia, as already found out, leads to capsulitis.
• Other comorbidities musculoskeletal system.
• The presence of a focus of chronic infection. If it is not sanitized in time, infectious agents from the primary source with blood or lymph flow will reach the shoulder joint, creating a new source of damage.

Important! It is extremely rare for capsulitis to be caused by a single cause, more often the source of the problem lies in a whole complex of factors.

Stages of capsulitis

Despite the fact that capsulitis is a form of periarthritis, it is not homogeneous and itself has several stages of development:

1. The first and least dangerous stage is simple capsulitis. It is characterized by mild pain syndrome. At this stage, the mobility of the joint is preserved, significant deformations are not observed.
2. The second stage is acute capsulitis. In addition to the manifestations already described, stiffness during movements is added. This form of the disease occurs 1-3 months after the onset of the pathological process.
3. The third stage is chronic capsulitis. This is not yet running, but not the initial stage of the disease.
4. The fourth and final stage is sclerosing capsulitis. As a result of a long-term inflammatory process, adhesions form in the structure of the synovial bag and the surrounding musculoskeletal structures. It all ends with the formation of ankylosis and a site of complete immobility. This is an advanced stage that requires surgical treatment. But even in this case, the prognosis is unclear.

Symptoms of capsulitis

Capsulitis is not a disease that occurs all at once, as they say, "by magic". Symptoms develop gradually, over time, more and more aggravated:

• It all starts with pain. This is the alpha and omega of capsulitis. At the first stage, the pain syndrome is mild, aggravated by physical activity, attempts to move the affected limb. As the pathology moves forward, the pain becomes stronger and accompanies the patient constantly. Discomfort increases in the evening and morning, but unlike the pain of arthritis, the pain of capsulitis does not alleviate on its own.
• Violations of the functional activity of the joint. As a result of a long-term process, there is a violation of the motor activity of the shoulder joint. This happens due to the formation of multiple adhesions in the structure of the synovial bag. A similar symptom is most characteristic of the second and subsequent stages of capsulitis.
• Feeling of stiffness in the joint. driven by the same factors. Feels like a tight corset or bandage pulled over the shoulder.
• Ankylosis. Complete lack of mobility in the joint. Develops at the final stage of capsulitis.

Manifestations are layered gradually, as the disease "moves" forward from the first stage to the last stage.

Principles of diagnosis

The diagnosis is based on a number of laboratory, instrumental studies and functional tests. It is impossible to diagnose capsulitis on your own, so the most appropriate decision would be to visit a specialized specialist or, rather, specialists. These doctors are:

1. An orthopedist is a specialized doctor specializing in pathologies of the musculoskeletal system.
2. General surgeon. Gives necessary recommendations and conducts initial diagnostics.

At the initial consultation, the doctor asks the patient about complaints. The doctor also clarifies what diseases the patient had previously suffered (this is an anamnesis). Then comes the turn of the visual assessment of the shoulder joint. In some cases, hyperemia (redness) of the joint is possible, which suggests arthritis or periarthritis. Then comes the turn of functional tests, during which the doctor evaluates pain reactions, motor activity of the joint, etc.

Instrumental studies include:

• X-ray of the shoulder joint. By itself, it is not informative in the early stages. However, it allows differentiating capsulitis from arthritis. In the later stages of capsulitis, it makes it possible to identify areas of calcification.
• arthroscopy. Endoscopy. Arthroscopy is necessary for visual assessment of the internal cavity of the synovial bag. Informative, albeit unpleasant for the patient study. Allows you to see the anatomical structures with your own eyes.
• MRI/CT diagnostics. Provides detailed images of soft tissues and bones. This is the most informative study, which, however, is not accessible enough for the average patient.
• Joint ultrasound.

Laboratory research:

1. General blood analysis. Appointed to assess the general condition of the body. Gives a general picture of inflammation with leukocytosis, ESR, erythrocytosis, a large amount of C-reactive protein.
2. General urine analysis. Necessary in order to exclude the gouty process.
3. Biochemistry of blood.
4. Blood test for rheumatoid factor. It is prescribed to rule out rheumatoid arthritis.

In the complex of these studies, more than enough. An experienced doctor may suspect capsulitis already at the initial appointment.

Therapy Methods

To achieve the maximum effect from therapeutic measures, complex treatment should be used.

Medical treatment

Involves taking drugs of some groups:

• Anti-inflammatory. Needed to relieve inflammation. This includes Ketorolac, Nise, Ibuprofen, and others. Let's take these pharmaceuticals on their own in the form of tablets, creams and ointments, but in the minimum dosage. there is a high risk of blurring the clinical picture.
• Analgesics. Analgesics are designed to relieve pain. As in the first case, let's assume an independent reception.
• Chondroprotectors. So that the pathological process does not affect the cartilaginous tissue, the use of agents that protect these structures is shown. One of the most popular drugs is Structum.
• Hyaluronic acid.
• In some cases, intra-articular injection may be required steroidal anti-inflammatory drugs(Prednisolone, etc.).

As a rule, the use of anti-inflammatory and analgesic drugs is sufficient.

Shoulder immobilization

Orthopedic treatment is a necessary element of therapy. It consists in applying an elastic bandage bandage to the affected joint in order to exclude physical activity. The main reason for long-term capsulitis is the inability of the capsule and synovial bag to recover due to constant tissue injury. If there is no movement, there will be no capsulitis. However, the described technique is used only in combination with drug treatment.

Physiotherapy

It is prescribed only during the period of remission of capusitis. may exacerbate the course of the disease. Treatment by currents, cryotherapy, ultrasonic treatment is shown. Specific procedures are selected by a physiotherapist.

exercise therapy

Also shown during remission. A set of exercises is selected together with the exercise therapy doctor.

At the end of the acute period, a gentle gentle massage is shown.

Surgery

Shown at 3-4 stages of the course of capsulitis. It consists in the elimination of ankylosis.

Recipes for folk treatment

Should be used only in combination with the main drug therapy. Among the most effective recipes:

• Birch bud tincture. Apply 25-30 drops orally three times a day. By the same principle, tinctures of nettles, violet flowers are prepared (to prepare, take a tablespoon of dry raw materials, pour a glass of medical alcohol or vodka, leave for 2 hours).
• Infusion of walnuts with olive oil. The product is mixed and infused for 2 hours. Used for outdoor applications.
• Infusion of knotweed. Take tsp. knotweed, birch leaves and rose hips. Pour in a glass of boiling water. Soak gauze in the indicated product and apply on the affected shoulder for 2-3 hours.
• Baths for the shoulder(prepared with plain salt, 30 grams per 10 liters of water).
• The imposition of burdock on the affected joint. Lubricate the burdock with honey first. The application is applied for 4-7 hours.
• Radish with vodka in the form of a compress.

These recipes are not able to replace classical therapy, but they work great in tandem.

One of the most common causes of adhesive capsulitis in the shoulder is immobility, which can be the result of a shoulder injury or after a stroke. In such cases, it is necessary to carry out certain exercises, including passive movements in the shoulder, which will minimize the risk of developing a "frozen shoulder" Detailed description of the symptoms Information about the medical problems of close relatives Information about all medications and supplements that the patient takes When did the symptoms appear? Are there any activities that make the symptoms worse? Do you have a history of shoulder injuries and, if so, what kind of injuries? Does the patient have diabetes? Has the patient had recent surgery or periods of limited movement of the shoulder? Differentiated therapy for capsulitis of the shoulder joint involves different approaches depending on the stage of the process. With severe acute inflammation are shown:

Adhesive arthritis: symptoms and causes

Injuries, dislocations, overloads of the shoulder joint and operations on it;

• baths with cyclamen tubers;
• It is not recommended to make circular movements with the head when numbing the neck. All exercises should be done slowly and without sudden movements.
• What is shoulder arthritis?

Strong pain that occurs even at night, disturbing sleep;

metabolic disorders;

• Exercise 2. Sitting on a chair, put your hands down. Relax your shoulders. First, with your right shoulder, move up and back (counterclockwise), lower your shoulder. Then, with your left shoulder, do the same movement up and back (clockwise). Repeat these movements for 30 seconds. Then change direction.​
• The presence of oncological diseases.
• Capsulitis of the shoulder joint has other names - adhesive arthritis or humeroscapular periarthritis. This is a rather serious disease that can cause disability.
• ​During a physical exam, your doctor may ask you to do certain things to check for pain and evaluate your range of motion. They may include:​
• Non-steroidal anti-inflammatory drugs in the form of tablets or injections (indomethacin, diclofenac, movalis, rheumoxicam, melbek, etc.);
• Neurotrophic disorders that occur against the background of a violation of the innervation of tissues that ensure the normal functioning of the shoulder joint, they are possible against the background of degenerative diseases of the spine with damage to the nerve roots of the brachial plexus;

paraffin or wax applications;

​Let's take a look at the tried and true ways that promote shoulder health:​

Types of capsulitis and its treatment

Symptoms and treatment are closely related. Already with the appearance of a characteristic picture indicating the presence of a pathology, it is important to immediately begin to treat it.

• limited motor activity;
• elevated blood sugar levels;

Exercise 3. Sit on a chair, hands in the lock. Try to raise your arms above your head and stretch slightly. If you cannot perform this exercise without pain, pull your arms away from you, while slightly taking your shoulders back, helping them and reducing the load on them. In the course of the exercise, shift your shoulders to the center.​

Inflammation of the joint can be a consequence of various shoulder injuries. Patients who have suffered a rupture of the shoulder ligaments are shown physiotherapy exercises. For a quick recovery after surgery, you must strictly follow all medical recommendations.​

Capsulitis develops with mechanical damage (rupture) or inflammation of the capsule of the shoulder joint, leading to a decrease in the articular cavity and often complete immobilization of the joint. Raising the arms up. Hands must be raised straight up, like a football referee stating a goal. To get a healthy shoulder from the diseased side, on the opposite side, passing the hand through the chest. Get the opposite shoulder blade with the back of the palm of the sore hand, swiping the hand behind the back.

Drugs with a predominant analgesic effect, if NSAIDs are not effective (ketanov, analgin, ketalgin, dexalgin, renalgan);

Chronic diseases of the periarticular tissues (bursitis, periarthritis, tendovaginitis), leading to impaired blood supply to the joint;

Burdock root ointment mixed with butter;

Disease Prevention Exercises

keep emotional calm. Stressful situations can provoke muscle spasm and seizures. In addition, anxiety conditions contribute to faster muscle fatigue;

Treatment depends on the stage of the process. If treatment was started in the first few months after the onset of the disease and before the onset of clinical symptoms, then it usually gives good results and includes the following procedures:

The patient cannot rotate his hand inward;

osteochondrosis;

Exercise 4. Hands are straight, relaxed, at the same time wind up behind the back. At the same time, the chest is fed forward, the shoulders - back. The blades are connected. Then the arms and shoulders go forward. Choose the amplitude that is convenient for you.​

​In patients with diabetes, the risk of developing capsulitis increases by 10-35%. Patients treated with insulin have a high percentage of lesions with this disease. Moreover, in such patients, adhesive capsulitis often becomes acute.

This disease is also called "frozen shoulder".

The doctor may also ask the patient to relax the muscles and move the patient's arm towards the patient. This test can help distinguish a frozen shoulder from a possible rotator cuff injury.​

Local application of ointments containing anti-inflammatory drugs as basic active ingredients (dolobene, dip-relief, remisid, fastum);

The presence of concomitant pathology in the form of diabetes mellitus, especially against the background of insulin therapy;

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Capsulitis of the shoulder joint

Mixture (camphor, mustard, vodka, egg white). The medicinal mixture should be rubbed into the joint every day;

correct breathing;

Causes

physiotherapy treatment;

Symptoms may appear for no apparent reason, this happens gradually and spontaneously;

• hormonal imbalance, in particular menopause;
• ​Exercise 5. Alternately raising the arms, followed by straightening the back and shoulder joints. Raise one arm first, while the hand is relaxed, looking down. Then raise your other hand. Make sure there is no pain. Exercises are aimed at training muscles.​
• There are such types of adhesive arthritis of the shoulder joint:
• The causes of this disease are not completely clear, and the symptoms require study. In some cases, the inflammation may disappear with time, although it lasts for months. Experts distinguish the following main signs of this disease:
• The diagnosis of adhesive capsulitis can usually be made on the basis of physical examination and medical history. But if it is necessary to develop an adequate treatment strategy, instrumental research methods, such as radiography or MRI, can be prescribed, which also makes it possible to exclude other structural changes in the shoulder joint.
• Methods of physiotherapy treatment. Thermal procedures and electromagnetic effects are shown to restore microcirculatory processes in periarticular tissues. Shock wave therapy, magnetotherapy, electrophoresis with heparin, potassium iodide and novocaine, paraffin applications have shown themselves well;
• A common atherosclerotic process in the vessels that disrupts microcirculatory processes in tissues, in particular, in the shoulder area.
• An infusion of calamus root, St. John's wort, hawthorn fruit, lemon balm, pine buds, eucalyptus, violet. Strained infusion should be taken daily for a month.

correct posture when working at a computer. You need to sit straight in a comfortable position;

Stages of the inflammatory process

carrying out blockades directly into the joint;

1. Shoulder pain does not go away without painkillers.
2. professional features (if you often need to keep your hands in a raised position);
3. Exercise 6. Shoulder rotation. Touch your collarbone or chest with your thumbs. The arms are bent at the elbows. Start making synchronized circular motions. Include the whole body. Start with small amplitudes.​

post-traumatic;

Clinical picture

Reduction of the articular cavity by 4-6 times compared to the normal state;

• In most cases, the treatment for frozen shoulder is to control shoulder pain and increase the range of motion in the shoulder as much as possible.​
• Local administration of glucocorticoids by the type of intra- and periarticular blockades (dexamethasone, diprostpan).
• The symptoms of capsulitis of the shoulder joint are quite specific and are characterized;
• Before treatment with folk remedies, you should consult a specialist.
• hold the phone correctly. Some people are accustomed to holding the device between the ear and the shoulder joint. This is wrong, as it can lead to the development of pain in the shoulder joint;

Diagnostics

Therapy with non-steroidal anti-inflammatory drugs.

• The study of this pathology includes the following:
• against the background of cardiovascular diseases (heart attack, stroke) or as a result of heart surgery;
• Exercise 7. Thumbs touch the chest. With pulling movements, move the elbow of one hand forward and slightly to the side. Pull up a little. Repeat with the second hand. At the same time, you should feel how the muscles of the shoulder blades and shoulder joint are tensing.
• idiopathic.
• stiffness of the shoulder joint;
• ​Typically, medications include drugs such as aspirin and ibuprofen (Advil, Motrin.) and these drugs can help reduce the pain and inflammation associated with adhesive capsulitis. In some cases, your doctor may prescribe stronger painkillers and anti-inflammatory drugs.​

If, during treatment, capsulitis does not go into the resolution stage and the process becomes chronic, sooner or later, there will be indications for surgical treatment aimed at restoring the mobility of the shoulder joint. These goals can be achieved through arthroscopic or open interventions, during which adhesions are dissected and the volume of the joint cavity is restored.​

Fighting methods

Severe pain in the area of ​​the affected joint. Inflammation is often unilateral and is accompanied by the appearance of sharp pain when moving the shoulder. Pain is especially specific in this respect when trying to internal rotation (rotation); So, adhesive capsulitis is a serious opponent in the fight for health, which brings a lot of inconvenience and discomfort. Nevertheless, it is possible to defeat him if you consult a doctor in time and take care of your health.

water balance. Muscles will be less tired if a person drinks enough water.​

If a detailed clinical picture has already appeared, then often the implementation of the above measures gives modest results. When the symptoms subside and the body is on the mend, the complex of all these measures is more effective, since it is aimed at increasing the range of motion of the joint and reducing pain.

• examination by a specialist. Palpation reveals soreness of certain points of the shoulder;
• Inflammatory processes in cartilage or joints.
• Exercise 8. Sit down, press one arm, bent at the elbow, to the chest. Grab the elbow of the one that is pressed against the body with your free hand. Gently pull up. Feel how the muscles work. If you have had a rupture of the capsule of the shoulder girdle, you should perform this exercise very carefully, until the first pain sensation.

Post-traumatic adhesive capsulitis can develop after shoulder injuries: fractures, ruptures of the tendons of the rotator cuff, inflammation of the joints. A successful operation does not guarantee that the disease will not manifest itself in the future. In this case, the disease can affect not only the joint itself, but also the axillary tissue, and pain can be given to the heart.

Pain when moving the arm up and inward, which limits the range of motion of the joint.

Gymnastics

​Continue to use the affected shoulder and limb to perform daily activities as far as possible within pain and range of motion. It is possible to apply local heat or cold to the shoulder, which often reduces pain.

• There are no effective methods for the prevention of shoulder joint capsulitis, since the disease develops under the influence of many factors that are almost impossible to eliminate. The only thing that can help is the prevention of injuries and chronic overloads of the shoulder joint, the timely treatment of its chronic diseases.​
• Limiting the volume of physiological active movements. In the early stages of capsulitis, this is due to pain, in later periods - organic stiffness of the shoulder resulting from fibrous changes in the capsule;
• In the practice of an orthopedist, there is an interesting pattern: the more significant a joint is for the body, the more it is susceptible to various diseases. As a rule, the pathology of such joints is so versatile that a significant part of it is occupied by specific diseases. In this regard, shoulder joint capsulitis, which is quite common among the working population, is of practical interest.
• Shock wave therapy is an excellent treatment for shoulder capsulitis

The mechanism of the development of the disease is still something mysterious for scientists, yet methods of struggle have been found, and they have already proven their effectiveness.

clinical tests;

What can be done at home?

The disease can last for several years, and in some cases the mobility of the hand is not restored at all.

• Exercise 9. Sitting on a chair, put your hands on your belt. Shoulders make circular movements for 1 minute forward and then back. Shoulders are relaxed. Movements should be done slowly. If you feel pain, you should reduce the amplitude.
• The disease can be triggered by a shoulder injury
• Acupuncture is a procedure that has been used in China for several thousand years and has proven effective for many pain syndromes, although the mechanism of action is not yet fully understood. Acupuncture has also proved to be quite effective in adhesive capsulitis and can reduce pain.

Palpation point pain and swelling in the area of ​​the affected joint;

ethnoscience

Capsulitis of the shoulder joint is one of the inflammatory diseases of the articular elements of the joint of the shoulder with the scapula, which is based on the defeat of the capsule of this joint. The disease is characterized by:

• In addition to traditional medicine, folk remedies give a good effect:
• Exercises should be aimed at relieving fatigue and tension. The following complex will help maintain muscle tone, as well as prevent pain:
• Simple tasks will help to identify the amount of movement. The patient is asked to take hold of his head with both hands, place his hands on his belt, and also take them away from the body as much as possible;
• Adhesive capsulitis manifests itself in different ways, depending on the stage of its development:
• Exercise 10. Lie on your back, arms straightened at the elbows, palms facing up. As you inhale, raise one arm up as high as you can. Hold your hand in this position for 10 seconds. Exhale and repeat with the other hand. Do at least 5 sets.​
• Idiopathic arthritis is often diagnosed in women between the ages of 40 and 60. The disease is often detected when patients complain about a violation of the circulatory or respiratory organs.
• The following causes increase the risk of developing the disease:
• Transcutaneous electrical nerve stimulation. Electric current impulses allow you to increase the production of endorphins and block the conduction of pain impulses along the nerve fibers.
• Restriction of passive movements, characterizing the occurrence of degenerative changes in the capsule.

Diffuse and full-layer inflammatory lesion of the capsule of the shoulder joint;

compresses. Dimexide gives a quick result, but it cannot be used at the acute stage;

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Capsulitis of the shoulder joint: symptoms and treatment of the disease - Sustavy-Bezboli.ru

Alternate tilts of the head to the side;

1. In the first stage, there is severe pain in the shoulder. Pain tends to increase due to physical exertion. This stage can last for six months or even longer;
2. Joint diseases bring great discomfort, in particular severe pain and limited mobility, and adhesive capsulitis is no exception.
3. Symptoms of idiopathic arthritis can occur with various disorders of the nervous system, oncological diseases and ailments of the cervical spine.
4. Various disorders of the capsule of the shoulder joint;

Physiotherapy is actively used to treat adhesive capsulitis, and methods such as laser therapy, ultrasound, electrophoresis, etc. are used.

Causes

• ​The presence of a pattern: the more intense the pain caused by capsulitis, the greater the possibility of curing capsulitis with conservative methods.​
• Mandatory involvement in the pathological process of the synovial membrane (the inner surface of the capsule facing the lumen of the joint);
• laser therapy;
• head turns in both directions;
• x-ray;

Clinical manifestations of the disease

In the second stage, restriction of mobility joins the pain. The hand of such patients cannot rise high, but the elbow and hand are not involved in the inflammatory process. Speaking about the duration of this stage, it is impossible to say unambiguously. It all depends on the timeliness and literacy of the treatment;

1. First, let's talk about the etiology of the development of this problem.
2. A decrease in the range of motion of the shoulder joint signals that the person is sick. As a result of the development of the disease, rotation of the shoulder is given with increasing difficulty, it becomes difficult to put the injured arm behind the back. These are clear symptoms of capsulitis and arthrography is done to confirm the diagnosis. In the picture, you can observe inflammation or rupture of the shoulder cuff, a decrease in the articular cavity.
3. ​shoulder injuries and operations on it, suffered in the past (inflammation, torn ligaments, etc.);​
4. ​Exercise therapy is of great importance in the conservative treatment of frozen shoulder and includes stretching exercises that allow you to maintain as much mobility in the shoulder as possible.​
5. ​5,00​

Diagnostics

Capsulitis is one of the few diseases in orthopedics and traumatology that is extremely difficult to diagnose with high certainty, despite modern technologies. Therefore, patients very often can be treated for a long time for other diseases of the shoulder joint, behind which capsulitis actually hides.

Reducing the volume of the shoulder joint;

ultrasound;

Shoulder movement: lifting, lowering;

Treatment

1. The third stage, unlike the previous ones, can please, since this is a recovery period that occurs with the effectiveness of medical therapy.
2. Adhesive capsulitis is also called "frozen shoulder". This is due to the fact that the process affects the shoulder joint so much that it becomes completely immobile. In case of inaction, the process is unfavorable, up to disability.​
3. In addition to surgery, adhesive capsulitis is treated by prescribing physiotherapy exercises. It will not help if the muscles of the shoulder joint have ruptured, but in all other cases it is an effective tool that allows you to reduce and even completely eliminate pain, start the recovery process. A holistic treatment approach includes several weeks of physical exercise, physical therapy, and anti-inflammatory drugs.​
4. damage to the cervical spine;
5. Manipulations. This procedure is performed under general anesthesia and the patient does not feel pain. The doctor moves the shoulder joint in different directions to help loosen the tight tissues. Depending on the force used in this procedure, such movements can lead to bone fractures.

Prevention

Instrumental methods that may indicate capsulitis of the shoulder joint include arthroscopy and arthrography, during which a deformed capsule of the shoulder joint with multiple adhesions is recorded. An even more important diagnostic criterion is the reduction of the half-affected articulation. Recently, the diagnostic value of ultrasound and MRI of the shoulder joint in the diagnosis of capsulitis has increased.

Violation of the functional abilities of the shoulder and motor activity. reflexology; pumping up the muscles of the neck. In the prone position, you need to raise and hold your head as much as possible. An experienced doctor does not need expensive methods to determine the pathology. It is enough for him to examine the contours of the shoulder joint. In this area, the muscle becomes thinner and sinks As you can see, adhesive capsulitis is a fairly serious disease that is urgent.

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Adhesive capsulitis of the shoulder "frozen shoulder". Center Dikul.

It has not been possible to establish exactly the causes that cause capsulitis of the shoulder joint. Nevertheless, experts know the factors that contribute to the development of pathology, among them:

Therapeutic exercises are prescribed to relieve pain, restore the previous amplitude of rotation of the shoulder joint, and improve muscle tone.

the presence of diabetes mellitus and the use of insulin for its treatment;

Most cases of adhesive capsulitis heal within 12-18 months. With persistent symptoms, the following procedures can be prescribed:

As a rule, an orthopedic doctor deals with the diagnosis and treatment of adhesive capsulitis.

An x-ray examination in two projections and a general clinical blood test are mandatory. They do not confirm the diagnosis of capsulitis, but will help to exclude other pathology, accompanied by similar symptoms.

It's important to remember! Inflammation of the capsule of the shoulder joint that occurs with capsulitis can be represented as an acute one-stage or chronic recurrent process. The possibility of functional disorders in the motor activity of the upper limb depends on this!​

Treatment

cakes made of blue clay. Unheated clay can be applied for several hours;

Simple exercises for the neck and shoulder will help to stretch the muscles

Acupuncture

Capsulitis of the shoulder joint has characteristic symptoms, which include:

frequent damage and trauma to the joint;

Exercise 1. Sitting or standing, fasten your hands into the lock. Make circular movements, creating a "wave". First in one direction, then in the opposite direction.​

disruption of the circulatory system;

Invasive procedures

Steroid injections. Injecting corticosteroids into the shoulder joint can help reduce pain, decrease inflammation, and improve shoulder mobility. capsule expansion. The introduction of sterile water into the joint capsule in some cases helps to stretch the tissue, which improves the mobility of the shoulder joint. Surgery. If conservative treatment is not effective, then in this case, the patient with adhesive capsulitis becomes a candidate for surgery to remove scar tissue and adhesions inside the shoulder joint. As a rule, in such cases, arthroscopic operations are used, which are performed through small incisions around the joint.

An orthopedic doctor may be interested in answers to the following questions:

It's important to remember! The long course of capsulitis of the shoulder joint leads to a sharp decrease in the extensibility of its capsule with a decrease in the joint cavity and a sharp limitation of mobility. In such cases, the disease is called adhesive capsulitis!

Prevention

In the development of capsulitis of the shoulder joint, a key role belongs to:

Developed shoulder capsulitis is the cause of severe pain and dysfunction of the upper limb. With a long course of the disease, the capsule causes complete immobilization and. Treatment consists in eliminating the pain syndrome, and if necessary, surgical removal of the connective tissue strands of the intraarticular capsule is performed.

Causes of capsulitis

The development of the pathology of the capsule of the shoulder joint can provoke the influence of such factors:

• chronic inflammatory diseases;
• excessive load on the hand, which is associated with professional activities;
• hereditary connective tissue diseases;
• atherosclerosis;
• vascular diseases;
• frequent hypothermia;
• advanced age;
• hormonal disruptions;
• trophic disorders;
• inflammatory diseases of the joints;
• degenerative processes in the spine;
• injections of insulin into the hand for diabetes mellitus.

Capsulitis in the shoulder joint occurs mainly in athletes and people engaged in heavy physical labor.

Shoulder capsulitis symptoms

Early on in the disease Shoulder pain may be mild and occur with strenuous exercise.

The manifestation of damage to the capsule of the shoulder joint depends on the stage of the process. However, regardless of this, all patients are concerned about severe pain in the upper part of the arm, which is permanent and increases with movement. At the beginning of the disease, discomfort appears only after heavy exertion and is not observed for long. There is also stiffness in the hand and slight difficulty in performing everyday movements. With the progression of the process, capsulitis causes an increase in body temperature to subfebrile numbers for a long time.

In the case of the transition of the disease to the chronic stage, the pain in the shoulder becomes insignificant and permanent, and the violation of the general condition of the patient and dystrophic disorders in the arm come to the fore. Sometimes there are painful backaches associated with damage to the nerve root. With a long course of the inflammatory process, there is a risk of developing adhesions inside the joint. This contributes to a decrease in the range of motion in the limb, up to ankylosis and loss of limb function. At the same time, discomfort in the arm is practically absent and frozen shoulder syndrome appears. It is manifested by a constant feeling of numbness and lack of sensitivity of the shoulder and due to scarring of the articular tissue.

Diagnostics

For examination, the patient needs to pass a general urine test.

It is possible to identify capsulitis of the shoulder joint during an external examination of the patient by a qualified traumatologist. To confirm the presence of the disease, an x-ray examination is used, which clearly shows nonspecific signs of bone damage. With the help of magnetic resonance imaging, all structural changes in the tissues of the upper limb and the degree of their severity are determined. The patient also undergoes a general analysis of blood and urine.

How to treat?

Therapy of the lesion should be complex and designed to influence the cause of the development of inflammation. The patient necessarily requires long-term immobilization of the shoulder capsule and anesthesia. For this purpose, drugs or the introduction of funds directly into the joint cavity using mesotherapy or electrophoresis are used. Along with this, treatment with folk remedies is used.

Treatment with drugs

To eliminate, non-steroidal anti-inflammatory drugs are used, and with a significant severity of the process, the patient needs hormones. They are used in the form of ointments or intramuscular injections. And also the patient is shown taking chondroprotectors and vitamins, due to which normal trophism of the shoulder tissues is ensured. In addition, muscle relaxants and drugs that improve regional blood flow are used.

Immobilization

To save the patient from discomfort, the shoulder is plastered.

When pain occurs in the upper limb, it must be immobilized immediately. This is done by applying a plaster cast or tight bandaging with an elastic bandage. This will provide a reduction in pain and signs of the inflammatory process. In addition, a limited range of motion will avoid possible trauma to the shoulder joint.

Exercises

Therapeutic gymnastics is used after the elimination of inflammation and pain. It is especially useful during the rehabilitation period if the patient has adhesive capsulitis of the shoulder joint, which is manifested by limitation of arm movements due to connective tissue adhesions. Exercise therapy will help to avoid ankylosis of the joint and partially restore the function of the limb. With regular exercise, the frozen shoulder disappears over time and the sensitivity of the upper limb returns.

Physiotherapy

Restorative treatment consists in the use of such methods:

During the recovery period, mud therapy can be used.

• electrophoresis;
• acupuncture;
• magnetotherapy;
• baths with essential oils;
• mud treatment;
• laser therapy;
• paraffin applications.

Capsulitis is a chronic disease of the shoulder joint, in which the joint capsule is affected. The pathology is characterized by the development of neurodystrophic disorders in the periarticular tissues. As a result, the capsule and the synovial membrane undergo fibrosis, which leads to their wrinkling and a decrease in the volume of the articular cavity.

In people with shoulder capsulitis, doctors often look for signs of inflammation (synovitis) during arthroscopy. The inflammatory process has a sluggish course, and the nature of its relationship with fibrosis has not yet been established.

Pathophysiological changes in capsulitis:

• shortening of capsular collagen fibers;
• fatty infiltration of the joint capsule;
• atrophic changes in the ligaments of the shoulder joint.

A bit of history

The disease was first described by Duplay in 1882. He introduced into clinical practice the term "humeroscapular periarthritis", which has long been used to refer to all periarticular diseases. They indiscriminately called any inflammatory process in the shoulder joint.

Many scientists and doctors spoke negatively about the diagnosis of "humeroscapular periarthritis". In 1959, Pender called it the "wastebasket" into which doctors dump all dubious cases of shoulder pain.

In 1932, Codman proposed to designate capsulitis with the term "frozen shoulder". This name best describes the symptoms of the disease. The main symptom of pathology is a painless limitation of shoulder mobility. The modern term "adhesive capsulitis of the shoulder joint" was coined by Naviesar in 1945. Under this name, the disease appears today in the ICD-10.

Statistics

Capsulitis is the most common inflammatory disease of the shoulder. According to statistics, about 3-5% of the population of developed countries suffer from it. Pathology is most often detected in patients with diabetes mellitus. The prevalence of adhesive capsulitis among patients in this group is 16-36%.

Curious statistics:

• Most often, people aged 50-70 years suffer from the disease. As for secondary capsulitis, it can also develop in people younger than 40;
• According to statistics, women suffer from capsulitis more often than men. The approximate ratio between the sick is 3:1-5:1;
• in 7-10% of cases, both shoulders are affected with capsulitis. Shoulder joints in humans become inflamed at intervals of 6 months - 5 years;
• a number of authors claim that the disease is cured within 1-3 years. However, in practice, 20-50% of patients experience limited shoulder mobility for 10 years;
• after recovery, 10% of patients have minor pain and limited mobility of the shoulder. Among people with diabetes, residual effects are more common - in 85% of cases.

Relapses of adhesive capsulitis are rare in clinical practice. After recovery, the “affected” joint is unlikely to become inflamed again.

Classification

Depending on the causes and mechanism of development, primary, or idiopathic, and secondary capsulitis are distinguished. Let's see how they differ.

Table 1. Comparative characteristics of different types of capsulitis

	idiopathic	Secondary
Causes	Develops slowly but spontaneously and for no apparent reason	Occurs against the background of diabetes, hypo- or hyperthyroidism. May develop after shoulder injuries, cardiac or CNS surgery
Flow	Manifests gradually, has a sluggish course	After falls, bruises and operations, symptoms appear quickly. In people with diabetes, the disease develops slowly
Features of treatment	Patients are prescribed complex treatment aimed at combating inflammation and fibrosis.	First of all, the disease that provoked the development of capsulitis is diagnosed and treated. In parallel with this patient, the treatment of capsulitis is carried out.

Features of the course of the disease

In its development, adhesive capsulitis goes through three successive phases. Each of them has its own clinical picture. The first classification of the disease was proposed by Reeves in 1975.

Phases of development of capsulitis:

1. "Freezing". Lasts three to nine months. During this period, the first symptoms of capsulitis of the shoulder joint appear in a person. He is troubled by vague pains in his shoulder, which are worse at night. They are most intense at the very beginning. After 2-3 weeks, the person becomes better and he decides that he has recovered. The patient stops treatment, and capsulitis develops further.

Pain in the first phase of adhesive capsulitis is of an indeterminate nature.

1. "Frozen Shoulder" It lasts from four months to one year. At this time, the patient completely disappears any pain. They are replaced by pathological stiffness in the shoulder. It becomes difficult for the patient to move the upper limb. The most difficult thing for him is external rotation, a little easier - front and internal rotation.
2. "Thaw". Lasts from one to four years. During this period, the range of motion in the shoulder gradually increases. In most cases, the mobility of the shoulder joint is completely restored. However, some patients after recovery may be concerned about the residual loss of range of motion, but it does not prevent them from leading a normal life.

While treating patients with adhesive capsulitis, practitioners have discovered an interesting pattern. It turns out that the longer the pain phase lasts for the patient, the longer the recovery phase also proceeds.

Diagnosis of the disease

The diagnosis is usually made by exclusion. First, doctors look for traumatic injuries of the shoulder, ruptures of the rotator cuff, subacromial bursitis, and neuropathy in the patient. If doctors do not find these conditions, the person is diagnosed with adhesive capsulitis. With inflammation of the capsule in patients, hypotrophy of the deltoid muscle is detected. This symptom is nonspecific, that is, it can indicate many diseases of the shoulder joint.

Research methods for shoulder pain:

• radiography. Necessary to exclude fractures, and deforming. Some patients with long-term capsulitis show signs of osteoporosis on x-ray. The reason for its development is prolonged immobilization of the joint;

Adhesive capsulitis on x-ray.

• . Uninformative in the diagnosis of capsulitis. During the examination, doctors can detect fibrous changes in the joint capsule and swelling of the tendons of the rotator cuff of the shoulder. However, these signs are nonspecific. They can indicate both capsulitis and normal;

Shoulder ultrasound.

• magnetic resonance imaging (MRI). More informative diagnostic method. It can be used to detect disease-specific thickening of the joint capsule. However, due to the high cost of MRI, it is practically not used to diagnose capsulitis;

The results of MRI of the shoulder joint in adhesive capsulitis.

• arthrography. The only way to confirm the diagnosis. With its help, reliable signs of capsulitis are revealed - a decrease in the volume of the synovial cavity and the disappearance of the axillary pocket. Arthrography is rarely used in clinical practice due to its high invasiveness. Doctors usually diagnose capsulitis without this test.

Diagnostic criteria for adhesive capsulitis:

1. Slow onset of the disease.
2. Pain for at least 3 months.
3. Increased discomfort during movements in the shoulder-scapular region.
4. Night character of pains.
5. Absence of signs of other diseases of the shoulder joint on the radiograph.

How to treat capsulitis of the shoulder joint

The tactics of treating pathology differ in different phases. Since in the period of "freezing" a person is most concerned about pain and synovitis, he is prescribed painkillers and anti-inflammatory drugs. The patient is advised to limit the load on the shoulder joint. With a pronounced pain syndrome, a scarf bandage is put on the arm. A person wears it for several hours a day.

In the “frozen shoulder” phase, physiotherapy exercises and physiotherapy come to the fore. They help relieve stiffness and restore normal range of motion in the shoulder.

Non-steroidal anti-inflammatory drugs

are first-line drugs in the treatment of adhesive capsulitis. They stop the pain and that appear at the beginning of the disease.

However, there are no reliable data in the literature on the effect of NSAIDs on the natural course of the disease. These drugs have a symptomatic effect, and it makes sense to use them only to combat pain.

Non-steroidal anti-inflammatory drugs cause a lot of side effects. Their intake can lead to the development of complications from the digestive and cardiovascular systems. Use these drugs very carefully. This is especially important for older people.

Corticosteroids

According to the results of clinical studies, steroid hormones relieve pain in the first phase of the disease, but have a short-term effect. Medicines of this group are prescribed when it is necessary to achieve an urgent improvement in well-being.

Topical steroid therapy is commonly used to treat adhesive capsulitis of the shoulder. The drugs are injected into the synovial cavity under ultrasound guidance. When performing injections by the blind method, doctors "miss" in 60%. Naturally, this leads to worse clinical results.

In most patients, after the introduction of steroid hormones, relief lasts 2-3 weeks. For such patients, after a deterioration in well-being, the manipulation is performed again. The injections are given at intervals of 2-4 weeks. The course of treatment consists of 2-3 injections.

sodium hyaluronate

Intra-articular administration of the drug significantly reduces pain and improves the function of the shoulder joint. In terms of strength, hyaluronate is not inferior to corticosteroids, but causes fewer side effects. In clinical practice, the drug is still practically not used due to a weak evidence base.

Injections.

Aggressive rehabilitation tactics

In the fight against stiffness in the shoulder, the most effective low-load long-term mode of tissue stretching. There are simulators that allow for dosed and safe stretching of the joint capsule. Manipulations are performed in rehabilitation rooms under the supervision of specialists.

Exercise therapy can be used to combat shoulder stiffness. It is desirable that a set of exercises is selected by a rehabilitation doctor. The specialist will teach the patient the technique and mode of exercise. Subsequently, the person performs the exercises independently, at home.

Goals of therapeutic exercises:

• relaxation of the muscles of the shoulder girdle;
• increased range of motion in the shoulder;
• gentle stretching of the muscles.

To achieve improvement, you need to practice daily, several times a day. Therapeutic gymnastics must be combined with physiotherapy and manual therapy.

Physiotherapy

The complex treatment of capsulitis often includes drug electrophoresis, ultrasonic heating, sinusoidally modulated currents, ozokerite or paraffin applications on the area of ​​the shoulder joint. These procedures help to quickly get rid of stiffness and restore normal range of motion.

Arthroscopy

Arthroscopic interventions are used to treat resistant forms of capsulitis. They are performed if it is not possible to achieve improvement with conservative therapy. Before arthroscopy, the patient should try several non-surgical treatments.

In severe cases, patients with capsulitis require open surgery, but it is associated with many difficulties and complications.

Difficulties in the treatment of capsulitis in people with diabetes mellitus

Due to the effect on carbohydrate metabolism, diabetics are not recommended to use corticosteroids. If drugs of this group are nevertheless prescribed, they must be used carefully. During treatment with steroid hormones, patients require adequate hypoglycemic therapy and careful monitoring of glycemia (blood glucose levels).

In people with diabetes, any wounds heal very slowly. This significantly complicates the performance of operations on the shoulder joint. The recovery period in such patients lasts much longer, and complications occur more often.

Adequate glycemic control in patients with diabetes mellitus reduces the risk of developing capsulitis or speeds up recovery if the disease has already appeared.