Adhesive capsulitis of the shoulder joint diagnosis. Adhesive capsulitis of the shoulder joint treatment. Nonsteroidal anti-inflammatory drugs

Developed shoulder capsulitis causes severe pain and impaired function of the upper limb. With a long course of the disease, the capsule causes complete immobilization and. Treatment consists of eliminating the pain syndrome, and if necessary, surgical removal of the connective tissue cords of the intra-articular capsule is performed.

Causes of capsulitis

The development of pathology of the shoulder joint capsule can be provoked by the following factors:

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

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

Symptoms of shoulder capsulitis

At the onset of the disease, shoulder pain may be minor and occur with intense physical activity.

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 bothered by severe pain in the upper arm, which is constant and intensifies with movement. At the beginning of the disease, discomfort appears only after heavy exertion and does not last long. There is also stiffness in the hand and slight difficulty in performing everyday movements. As the process progresses, capsulitis causes an increase in body temperature to subfebrile levels for a long time.

If the disease progresses to the chronic stage, pain in the shoulder becomes insignificant and constant, and a violation of the patient’s general condition and dystrophic disorders in the arm come to the fore. Sometimes painful lumbago occurs associated with damage to the nerve root. With a prolonged course of the inflammatory process, there is a risk of developing adhesions inside the joint. This contributes to a decrease in the range of movements in the limb, up to ankylosis and loss of limb function. In this case, there is practically no discomfort in the arm and frozen shoulder syndrome appears. It is manifested by a constant feeling of numbness and lack of sensation in the shoulder and due to scarring of the joint tissue.

Diagnostics

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

Capsulitis of the shoulder joint can be detected 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. Using 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 blood and urine test.

How to treat?

Therapy for the lesion should be comprehensive and designed to influence the cause of the development of inflammation. The patient necessarily requires long-term immobilization of the shoulder capsule and pain relief. For this purpose, drugs are used or drugs are injected directly into the joint cavity using mesotherapy or electrophoresis. At the same time, treatment with folk remedies is used.

Treatment with drugs

To eliminate, non-steroidal anti-inflammatory drugs are used, and if the process is significant, the patient needs hormones. They are used in the form of ointments or intramuscular injections. The patient is also advised to take chondroprotectors and vitamins, which ensure normal trophism of the shoulder tissues. In addition, muscle relaxants and drugs that improve regional blood flow are used.

Immobilization

To relieve the patient of discomfort, the shoulder is cast.

If pain occurs in the upper limb, it must be immediately immobilized. This is done by applying a plaster cast or tightly bandaging with an elastic bandage. This will ensure a reduction in pain and signs of inflammation. In addition, a limited range of motion will avoid possible injury to the shoulder joint.

Exercises

Therapeutic gymnastics is used after eliminating 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 avoid joint ankylosis and partially restore limb function. With regular exercise, frozen shoulder disappears over time and sensation in the upper limb returns.

Physiotherapy

Restorative treatment consists of using the following techniques:

During the recovery period, mud therapy can be used.

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

Shoulder capsulitis is an inflammation of the synovium and capsule of the shoulder. This is not the most common disease, where patients more often encounter tendinitis and tendinosis, but this does not make the pathology any less dangerous. The essence of the threat lies in the likelihood of the formation of ankylosis - areas of immobility in the joint structure. 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 (complex damage to periarticular structures, in which the cartilage itself does not suffer), and 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 pathology described is: it deprives the state of its working population and excludes a person from active life.

Reasons for the development of the disease

Capsulitis has a multifactorial etiology. In practice, this means that the disease can be caused by many reasons, and having an impact at once, in combination. What reasons are we talking about:

• The first and most significant factor is the patient's age. There is a direct correlation between age and the risk of developing capsulitis. The older the patient, the higher the likelihood of morbidity. This form of periarthritis affects people over 40 years of age, which is associated with natural wear and tear of the musculoskeletal system.
• Heredity. It is not the disease that is inherited, but only the characteristics of the musculoskeletal system, and therefore 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 of the family who suffered from capsulitis, the likelihood of developing the pathology in the descendants is 30-50% higher. This is a significant number.
• Hypothermia. A real enemy of healthy joints. When hypothermia occurs, general and local immunity decreases, and as a result, pathogenic microflora is activated. This is true only for infectious capsulitis.
• Congenital malformations of the fetus. First of all, we need to talk about injuries and 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 musculoskeletal structures. 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, and myocardial infarction.
• The presence of frequent acute respiratory diseases. Acute respiratory infections or acute respiratory viral infections have an extremely negative impact on the health of the joints, since on the one hand they undermine the immune system, on the other, 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 body's protective response, the immune system mistakes healthy cells of the synovial bursa and capsule for pathogens and begins to attack them.
• The presence of pathologies of the spinal column. Spinal pathologies also do not add health to the blood flow. Ischemia, as has already been found out, leads to capsulitis.
• Other concomitant diseases musculoskeletal system.
• The presence of a focus of chronic infection. If it is not sanitized in time, infectious agents from the primary source through the blood or lymph will reach the shoulder joint, creating a new source of damage.

Important! It is extremely rare that capsulitis is 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. Characterized by mild pain. At this stage, joint mobility is maintained and no significant deformations are 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 advanced, 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 bursa and surrounding musculoskeletal structures. It all ends with the formation of ankylosis and an area of ​​complete immobility. This is an already advanced stage requiring surgical treatment. But even in this case, the prognosis is unclear.

Symptoms of capsulitis

Capsulitis is not a disease that occurs suddenly, as they say, “by magic.” Symptoms develop gradually, becoming more and more aggravated over time:

• It all starts with pain. These are alpha and omega capsulitis. At the first stage, the pain syndrome is mild and intensifies with physical activity and 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 pain with arthritis, pain with capsulitis does not ease on its own.
• Disturbances in the functional activity of the joint. As a result of a long-term process, a violation of the motor activity of the shoulder joint occurs. This happens due to the formation of multiple adhesions in the structure of the synovial bursa. This symptom is most typical for the second and subsequent stages of capsulitis.
• Feeling of stiffness in the joint. It is determined 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 layer on gradually as the disease “moves” forward from the first stage to the last stage.

Diagnostic principles

Diagnostics is based on a number of laboratory, instrumental studies and functional tests. It is impossible to diagnose capsulitis on your own, so the most correct solution 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 interviews the patient about complaints. The doctor also clarifies what diseases the patient has previously suffered (this is a history taking). Next comes 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. In itself, it is not informative in the early stages. However, it allows you to differentiate capsulitis from arthritis. In the later stages of capsulitis, it makes it possible to identify areas of calcification.
• Arthroscopy. Endoscopic examination. Arthroscopy is necessary for visual assessment of the internal cavity of the synovial bursa. Informative, although unpleasant for the patient, study. Allows you to examine 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 sufficiently accessible to the average patient.
• Ultrasound of the joint.

Laboratory research:

1. General blood analysis. It is prescribed to assess the general condition of the body. Gives a general picture of inflammation with leukocytosis, ESR, erythrocytosis, and 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. Prescribed to exclude rheumatoid arthritis.

The complex of research data is more than enough. An experienced doctor may suspect capsulitis already at the initial appointment.

Therapy methods

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

Drug treatment

Involves taking certain groups of drugs:

• Anti-inflammatory. Necessary to relieve inflammation. This includes Ketorolac, Nise, Ibuprofen, etc. It is permissible to take these pharmaceuticals on your own in the form of tablets, creams and ointments, but in a minimal dosage because there is a high risk of blurring the clinical picture.
• Analgesics. Analgesics are designed to relieve pain. Just as in the first case, we will allow self-administration.
• Chondroprotectors. To prevent the pathological process from affecting the cartilage tissue, the use of agents that protect these structures is indicated. 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 of applying an elastic bandage to the affected joint in order to exclude motor activity. The main reason for long-term capsulitis is the inability of the capsule and synovial bursa 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 capuslit because may worsen the course of the disease. Current treatment, cryotherapy, and ultrasound treatment are indicated. Specific procedures are selected by a physical therapist.

Exercise therapy

Also indicated during remission. A set of exercises is selected together with a physical therapy doctor.

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

Surgery

Indicated at stages 3-4 of capsulitis. It involves eliminating ankylosis.

Traditional treatment recipes

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

• Birch bud tincture. Apply 25-30 drops orally three times a day. Nettle and violet flower tinctures are prepared using the same principle (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. Suitable for external applications.
• Knotweed infusion. Take tsp. knotweed, birch leaves and rose hips. Pour a glass of boiling water. Soak gauze in the indicated product and apply to the affected shoulder for 2-3 hours.
• Shoulder baths(prepared with plain salt, 30 grams per 10 liters of water).
• Applying burdock to the affected joint. Pre-coat the burdock with honey. The application is applied for 4-7 hours.
• Radish with vodka in the form of a compress.

These recipes cannot replace classical therapy, but they work perfectly in tandem.

Adhesive capsulitis of the shoulder is a disease that affects the shoulder joint. It is characterized by intense pain syndrome, due to which the mobility of the shoulder is impaired. It is based on an inflammatory process in the capsule of the shoulder joint. Its individual sections stick together, which causes pain. The pathology is typical for persons from 40 to 60 years of age, predominantly female.

Causes

The reasons are still unclear. However, there are assumptions about the risk factors that provoke its development. During the course of the disease, the joint capsule changes. This leads to painful sensations that prevent you from performing not only active, but also passive movements.

Autoimmune diseases and diabetes mellitus are often triggers. Women also develop pathology after suffering a stroke or myocardial infarction. Sometimes a patient develops the disease without the presence of risk factors. In most cases, when adhesive capsulitis is identified, its cause remains a mystery. Stiffness can also be caused by injuries to the shoulder joint, which damage intra-articular structures. Surgeries can also cause stiffness.

Clinical picture and stages

With adhesive capsulitis of the shoulder, inflammation occurs, which subsequently forms scars and adhesions.

It is customary to distinguish three stages:

1. The stage of pain is the beginning of the disease, there are practically no changes.
2. Stage of limited mobility – the maximum manifestation of symptoms is observed.
3. Stage of recovery and consequences.

The acute phase of the disease may go away on its own after some time. However, this does not guarantee complete recovery. Without consulting a doctor, there is a risk of complications that often lead to disability in the patient.

Stage of pain

The disease manifests itself spontaneously. The first stage is characterized by the following symptoms:

• Pain syndrome. Appears during an inflammatory process. Pain appears regardless of the time of day. Sometimes the pain is so severe that without painkillers it interferes with the patient's sleep.
• Discomfort and unpleasant sensations while moving. There is also a slight limitation of mobility.
• On palpation the pain intensifies.
• In some cases, swelling is present.

The first stage can last up to 8 months. This depends on how quickly treatment follows.

Mobility limitation stage

Occurs due to the consequences of the inflammatory process. At this moment, the capsule shell sticks together, which forms adhesions that interfere with mobility. The clinical picture is quite pronounced. Based on the symptoms, an experienced doctor can make a diagnosis even without additional research.

This stage is characterized by the following symptoms:

1. Sharp pain with any movement in the shoulder joint. At the same time, there is no unpleasant sensation in the wrist and elbow joints.
2. Limitation of mobility. Sometimes there is a complete absence of it.
3. There is wasting of the surrounding muscles. They also decrease in size.
4. In some patients, limited mobility and pain interfere with self-care, leading to mental health problems.

This stage lasts up to a year.

Stage of recovery and consequences

At this stage, the patient is recovering. Pain syndrome decreases and range of motion increases. This outcome occurs in almost all patients. However, without rational treatment, the likelihood that the disease will pass without complications is quite small. The average duration of the entire disease is about 1.5 years.

According to statistics, almost half of the patients who have suffered adhesive capsulitis cannot fully restore motor activity.

Diagnostic methods

To begin with, the doctor conducts an examination and studies the medical history. An experienced doctor can make a diagnosis if symptoms are present, even without testing. However, diagnostic methods must also be prescribed so that there is no error in the established diagnosis. The following studies are prescribed:

1. Ultrasound of the joint.
2. Radiography.

To clarify the diagnosis, arthroscopy is performed. During this procedure, the structures of the shoulder joint can be assessed from the inside.

Treatment

Adhesive capsulitis is treated with conservative and surgical methods. When started early, conservative methods are highly effective. The main methods of conservative treatment are as follows:

• Taking non-steroidal anti-inflammatory drugs.
• Taking painkillers.
• Intra-articular injections of corticosteroids.
• Physiotherapy.
• Exercise therapy and massage after eliminating the inflammatory process.

Surgical treatment of shoulder capsulitis is indicated if there is no effect of conservative therapy for several months. Arthroscopy is performed. Using an arthroscope, adhesions are removed, which returns full mobility to the joint.

Traditional methods of treatment

In some cases, people do not rush to see a doctor and try to cure the disease on their own. Traditional medicine is quite widespread. There are also many treatment methods for treating adhesive capsulitis of the shoulder. Here are some of them:

1. Heat 0.5 kg of table salt to moderate temperature. Place in a fabric bag. Apply to the sore joint and hold for 15-20 minutes.
2. Mix salt, honey and mustard in equal proportions. Apply the resulting mixture to the shoulder joint, cover with polyethylene and insulate. Leave for 20-30 minutes.
3. 5 tbsp. l. grated horseradish mixed with 1 tbsp. l. vegetable oil. Apply the resulting mixture to the joint, insulate it and leave for an hour.

Such prescriptions cannot be used as independent treatment. Their use can be effective in combination with conservative therapy. They can only be used outside of an exacerbation of the disease, since they do not involve warming up the joint. In this case, folk remedies eliminate the inflammatory process and pain.

Prevention

To prevent the development of adhesive capsulitis, it is necessary to avoid injury to the shoulder joint. It is also necessary to avoid physical overexertion and promptly treat joint diseases. You should undergo preventive examinations periodically. General prevention is as follows:

1. Healthy lifestyle.
2. Proper nutrition.
3. Rejection of bad habits.
4. Avoiding stress.
5. Maintaining physical fitness.

If you take these points into account and adhere to them, the risk of developing the disease will significantly decrease.

Adhesive capsulitis of the shoulder is a type of pathological condition of the joint in which its mobility is reduced. This happens as a result of the development of the inflammatory process. One of the main symptoms of this disease is severe pain. If this pathology is not treated, over time it becomes impossible to move the arm. There is a complete loss of functionality of the joint. This condition is called frozen shoulder syndrome.

More information about the disease, causes of development

Adhesive capsulitis is a pathology that manifests itself in the shoulder joint (fibrosis). It is characterized by the formation of adhesions. The disease got its name as a result of the sticking together (adhesion) of individual tissue sections. However, this is a consequence. It is believed that inflammation of the shoulder joint capsule can provoke changes in structure.

In some diseases (osteoarthritis, rheumatoid arthritis), fibrosis does not develop. The cause of frozen shoulder syndrome is still unknown and may lie in another process that occurs against the background of inflammation. It is believed that this pathological condition is provoked by neurotrophic changes in the structure of the capsule of the shoulder joint, as well as the synovial membrane. With frozen shoulder syndrome, the inflammatory process is not intense.

The consequence of inflammation is pain. This reduces mobility, which reduces discomfort. If the shoulder does not allow you to move your arm for a long time, pathological changes occur in the structure of the joint, reduction of collagen fibers and fatty infiltration of the capsule. As a result, the ligaments atrophy. This means that adhesive capsulitis of the shoulder joint can lead to disability.

Factors under the influence of which the likelihood of developing this pathology increases significantly:

• injuries;
• disorders of the endocrine system and metabolism that occur with diabetes mellitus;
• development of chronic diseases (hypothyroidism, hyperthyroidism, lung pathology, stroke, cardiac dysfunction, surgery on this organ);
• changes in hormonal levels;
• patient age (from 50 to 70 years);
• inflammatory processes in the joints, provoked by various factors, namely professional activities, diseases.

Forms and stages of adhesive capsulitis

This type of shoulder pathology can manifest itself in different ways. Based on this, 2 forms of the disease are distinguished: primary or secondary capsulitis.

In the first case, there are no obvious symptoms of pathology. The disease develops very smoothly. Interestingly, primary capsulitis is provoked by a hidden factor, for example, a deviation in the functioning of one of the body systems or age-related changes. There are no obvious reasons for the development of pathology.

Secondary capsulitis usually occurs as a result of a fall or other injury, such as a work-related injury. The patient complains of discomfort in the joint and decreased mobility shortly after the injury. In this case, frozen shoulder is more treatable, since degenerative processes can be prevented in a timely manner. In 36% of cases, the cause of secondary adhesive capsulitis is diabetes mellitus.

The development of pathology occurs in stages. There are several stages:

1. The first phase is characterized by the appearance of pain. This condition is defined as subacute. The intensity of the pain increases over several weeks. In this case, the patient experiences discomfort at different times; the pain is not always associated with joint mobility. Often unpleasant sensations occur at night, while lying on the shoulder. The danger of this stage is that patients usually expect self-healing. In this case, time is lost, and the condition of the joint can greatly deteriorate. The duration of this stage is 3-9 months.
2. The second phase is characterized by a decrease in the intensity of pain. The discomfort may disappear completely, but the mobility of the joint is significantly reduced. A condition called frozen shoulder develops. The duration of this stage of the disease is long, about 12 months.
3. The third phase is characterized by improvement in the condition of the shoulder. Mobility is starting to return. However, this happens only in half of the cases. Usually the joint loses some functionality. The third stage of capsulitis lasts 1–2 years. In rare cases, recovery can take up to 4 years.

Symptoms, diagnosis

The main sign of the development of the disease is pain. The pain can be paroxysmal, long-lasting, or passing. It often appears during movement, but also occurs at rest, for example at night. The discomfort is felt more strongly when the patient is in a supine position on the affected shoulder.

Another clear sign of capsulitis is limited movement. A person loses the ability to move his arm to the side; it is often pressed against the abdominal cavity. This is due to the fact that internal rotation is less limited than external rotation. To make a diagnosis, the doctor performs an external examination. The degree of mobility of the arm is checked, and the angle of its abduction relative to the body is assessed.

Adhesive capsulitis is confirmed on the basis of these research results, which make it possible to exclude other diseases of the shoulder joint, for example, osteoarthritis, etc. For this, radiography is performed.

For capsulitis, the ultrasound method is ineffective. Magnetic resonance therapy gives the best results. It can be used to identify thickened areas of the joint capsule. However, the cost of this procedure is very high, so it is rarely used to diagnose capsulitis.

The most effective method in this case is arthrography. Its disadvantage is its invasiveness. Considering that an external examination, medical history and X-ray results are sufficient to make a diagnosis, invasive procedures are not performed.

In most cases, the diagnosis of adhesive capsulitis is confirmed by exclusion.

Therapeutic measures

To restore mobility to the joint, various methods are used. They are used sequentially. It is recommended to start with the least serious means. Available treatments:

1. Use of non-steroidal anti-inflammatory drugs. It is believed that they can help reduce the intensity of inflammation in the affected area. There have been very few studies confirming this theory, so it is impossible to judge the effectiveness of this method. However, nonsteroidal anti-inflammatory drugs are characterized by another property. They are able to relieve pain and act as an analgesic. For this reason, such drugs are recommended at different stages of development of adhesive capsulitis.
2. Glucocorticosteroids. With their help you can relieve pain. However, the disadvantage of this method is its short-term effect. Despite this, drugs in this group are still used. During the treatment of adhesive capsulitis, the drug is injected into the bursa or joint cavity. If you act blindly, there is a high chance that the substance will not get to the right place. This happens in 60% of cases. This result may cause the condition to worsen. To avoid this, it is recommended to administer corticosteroids under ultrasound guidance.
3. Physiotherapy. This method is known to improve the overall condition of the joint. The shoulder needs to be developed, but it is important to do it correctly. It is recommended to perform exercises when adhesive capsulitis enters the third phase. A patient with characteristic symptoms is prescribed gymnastics. The load level should be low. During gymnastics it is necessary to stretch the tissues, but this is done gradually. The exercises are quite simple, and in the future the patient will be able to perform them independently. For example, they make a “pendulum”. In this case, the patient leans on a chair, the arm with limited mobility should be lowered, no load is placed on it. It is recommended to make circular movements with this limb in different directions up to 15 times. The towel exercise is also very beneficial. To perform it, the towel is taken behind the back with both hands, the affected limb should be lower. The patient begins to lift the healthy limb upward. You can also do the finger walking exercise. You need to stand near the wall, bend your affected arm at the elbow, with your hand at waist level. Your fingers should move up the wall, imitating walking.

The last resort is surgery. Therapy should be based on exercise and medication. If these measures do not bring results, adhesions in the joint capsule can be removed surgically.

Folk recipes

Home remedies can relieve symptoms and help stop the development of the inflammatory process, but they cannot remove adhesions due to fibrosis of the joint capsule. Effective recipes:

• Blue clay. They make compresses. To do this, you need to combine the clay with water to obtain a viscous mixture. This folk remedy should be used for treatment within several hours.
• Cyclamen tubers. This plant is used to make baths.
• Applications using paraffin or wax.
• Ointment based on burdock root. The raw materials are washed and ground to a pulp. Then butter is added.
• Egg white, vodka, mustard, camphor. The components are combined, mixed until a uniform mass is obtained and rubbed into the skin on the affected area.

Treatment with folk remedies is carried out after consultation with a doctor.

You should not take measures to restore mobility of the shoulder joint on your own.

Shoulder capsulitis

Joint diseases bring enormous discomfort, in particular severe pain and limited mobility, and adhesive capsulitis is no exception.

First, let's talk about the etiology of the development of this problem.

Causes

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, even leading to disability.

The exact causes that cause capsulitis of the shoulder joint have not been established. Nevertheless, experts know the factors that contribute to the development of pathology, among them:

• frequent damage and trauma to the joint;
• metabolic disorders;
• elevated blood sugar levels;
• osteochondrosis;
• hormonal imbalances, in particular menopause;
• professional features (if you need to often keep your hands raised);
• against the background of cardiovascular diseases (heart attack, stroke) or as a result of heart surgery;
• inflammatory processes in cartilage or joints.

Stages of the inflammatory process

Adhesive capsulitis manifests itself in different ways, depending on the stage of its development:

1. At the first stage, severe pain appears in the shoulder. Pain tends to intensify due to physical activity. This stage can last for six months or even longer;
2. in the second stage, limited mobility is added to the pain. The arm 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 competence of the treatment;
3. the third stage, unlike the previous ones, can be encouraging, since this is a period of recovery, which occurs when medical therapy is effective.

As you can see, adhesive capsulitis is a fairly serious disease that cannot be delayed.

Clinical picture

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

• severe painful sensations that occur even at night, disrupting sleep;
• limited physical activity;
• the patient cannot rotate his arm inward;
• symptoms may appear for no apparent reason, this happens gradually and spontaneously;
• Without painkillers, shoulder pain does not go away.

Diagnostics

The study of this pathology includes the following:

• examination by a specialist. Palpation reveals pain at certain points of the shoulder;
• clinical tests;
• simple tasks will help identify the volume of movement. The patient is asked to grab his head with both hands, place his hands on his belt, and also move them away from the body as much as possible;
• X-ray;

Fighting methods

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

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, it usually gives good results and includes the following procedures:

• physiotherapeutic treatment;
• carrying out blockades directly into the joint;
• therapy with non-steroidal anti-inflammatory drugs.

If a detailed clinical picture has already appeared, then the above-mentioned measures often give modest results. When the symptoms subside and the body recovers, 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.

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

Gymnastics

Exercises should be aimed at relieving fatigue and tension. The following complex will help maintain muscle tone and also prevent pain:

• alternately tilting the head to the side;
• turning the head in both directions;
• shoulder movement: raising, lowering;
• pumping up the neck muscles. In a lying position, you need to raise and hold your head as much as possible.

What can you do at home?

Let's look at some tried and true ways to promote shoulder health:

• maintain emotional calm. Stressful situations can provoke muscle spasms and cramps. In addition, anxiety states contribute to faster muscle fatigue;
• correct breathing;
• correct posture when working at the computer. You need to sit upright in a comfortable position;
• hold the phone correctly. Some people are used to holding the device between their ear and shoulder joint. This is incorrect, as it can lead to the development of pain in the shoulder joint;
• water balance. Muscles will tire less if a person drinks enough water.

ethnoscience

In addition to traditional medicine, folk remedies provide good results:

• compresses. Dimexide gives a quick result, but it cannot be used at the acute stage;
• laser therapy;
• ultrasound;
• reflexology;
• blue clay cakes. Unheated clay can be applied for several hours;
• baths with cyclamen tubers;
• paraffin or wax applications;
• ointment from burdock root mixed with butter;
• mixture (camphor, mustard, vodka, egg white). The healing mixture should be rubbed into the joint every day;
• infusion of calamus root, St. John's wort, hawthorn fruit, lemon balm, pine buds, eucalyptus, violet. The strained infusion should be taken daily for a month.

Before treatment with folk remedies, you should consult a specialist.

So, adhesive capsulitis is a serious opponent in the fight for health, which brings a lot of inconvenience and discomfort. However, it is possible to defeat it if you consult a doctor in time and take care of your health.

• Symptoms, causes and course of the disease
• Troubleshooting

There are many diseases of the musculoskeletal system that limit the mobility of the limbs and cause pain. Thus, inflammation of the shoulder joint can be observed with a disease such as adhesive capsulitis of the shoulder.

Symptoms, causes and course of the disease

So, adhesive capsulitis is a disease characterized by damage to the synovial membrane and capsule of the shoulder joint. This disease is also called “frozen shoulder”, since the mobility of the shoulder is severely limited until it is completely lost. Unfortunately, in the absence of measures, a person can become disabled.

The causes of the disease have not been precisely established, but several influencing factors have been identified:

• injuries and injuries to the shoulder (especially frequent);
• metabolic disorders (for example, diabetes mellitus);
• diseases of the spine (namely osteochondrosis of the cervical or thoracic spine) can provoke the development of the disease;
• hormonal imbalances lead to changes in metabolism (this happens during menopause in women);
• features of the work, namely the posture with arms raised;
• capsulitis often occurs in people who have suffered a stroke, heart attack or other diseases of the cardiovascular system or heart surgery;
• other inflammations of cartilage or joint tissue.

Symptoms of the disease depend on the specific phase. There are three stages in total:

1. At the first stage, pain occurs in the shoulder area. They can be quite severe and often appear or become more pronounced after physical activity or after working with your hands. This period can last 6-8 months.
2. The second stage is characterized by limited mobility in the shoulder joint. So, the patient cannot raise his arm high. The hand and elbow move normally. The duration of this stage will depend on the measures taken. If the therapy was effective, then the next phase will begin.
3. The last stage is recovery. Joint mobility gradually returns.

In total, the disease can last from a year or a year and a half to three or even four. And in some patients the arm cannot move normally throughout their lives.

Troubleshooting

The doctor should tell you how to treat shoulder capsulitis after making an accurate diagnosis. Diagnosis involves x-rays, blood tests, and arthrography (examination of the joint itself). Only after the examination can you begin to act. Treatment has several directions:

• At the first stage of the disease, it is necessary to relieve symptoms. Painkillers are used to relieve pain.
• It is important to relieve inflammation, which is the cause of all troubles. Most often, non-steroidal anti-inflammatory drugs are used for this, such as Diclofenac, Indomethacin and others.
• Immobilization of the joint is not necessary and may even be harmful, since it will complicate the process of returning the limb to mobility during the recovery phase. But you can and should move your hand so that all movements do not cause pain.
• If the pain is very severe, the doctor may prescribe intra-articular injections of glucocorticosteroids. But such drugs can also be used in tablet form (although this will increase the number of side effects). Also, to relieve severe pain, blockade of nearby nerves (suprascapularis) is indicated.
• During the recovery stage, it is extremely important to restore the joint to its previous mobility. To do this, you need to perform certain exercises daily and several times. So, you can raise and lower your arms, make rotational movements with your arms with their maximum lifting. Try moving your hand behind your back and clasping it with your other hand, and then lightly pulling it towards your buttocks. Any exercises should be performed without pain and only after consulting a doctor! The load must be increased gradually so as not to damage the joint.
• Some procedures may also be prescribed, such as massage, laser, magnetic or sound therapy. But the effectiveness of such methods of therapy is not always high and depends on the degree of damage to the joint.
• If there is significant damage, but the mobility of the limb has not fully returned, then surgical intervention can help. An operation called arthroscopy is performed. Several punctures are made in the skin. Through one of them, an arthroscope with a camera is inserted into the joint cavity, allowing one to find the affected area. A special instrument is placed through another puncture, which, through the action of cold plasma, eliminates areas of fusion or wrinkling of the joint capsule. After such manipulations, movements become free and painless.

I wish you health and freedom of movement! Treat all diseases on time and correctly!

A large number of adults from 40 to 60 years old, especially women, report pain and severe limitation of movements in the shoulder joint. This condition is often called frozen shoulder in everyday life, and in the scientific literature - adhesive capsulitis. Sometimes these concepts are considered interchangeable when in fact they are not.

ANATOMY OF THE SHOULDER JOINT

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 impermeable to fluid, so intra-articular synovial fluid does not extend beyond its limits and lubricates the articulating surfaces.

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

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

CAUSES OF ADHESIVE CAPSULITIS

Adhesive capsulitis is based on a change in the joint capsule, which results in a sharp limitation of passive and active movements.

Typically, this disease occurs against the background of diabetes mellitus or autoimmune diseases, more often in women, and risk factors include previous strokes or myocardial infarction. Sometimes adhesive capsulitis can develop in people without obvious risk factors. Scientists still cannot identify the exact etiology of the disease. Typically, the reasons why a patient develops adhesive capsulitis remains largely a mystery.

Injuries can also cause stiffness in the shoulder joint.

Injuries involving damage to intra-articular structures cause chronic inflammation and pain. The pain causes the patient to use the joint less, and therefore stiffness gradually develops. To treat post-traumatic stiffness, it is necessary to identify the damaged structure, this could be the rotator cuff, biceps tendon or, for example, the labrum, reconstruct it and thereby create the preconditions for restoring the previous range of motion.

The reason for the development of stiffness in the joint can also be previous operations. As a result of operations, the anatomy of the bones that make up the shoulder joint, as well as the ligaments and tendons that support them, may be disrupted. For example, when the head of the humerus or greater tubercle is fractured, the attachment points of the main ligaments and tendons are displaced, which, if not treated correctly, can lead to stiffness in the joint.

Surgical repair 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.

SYMPTOMS OF ADHESIVE CAPSULITIS

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

Stiffness in the joint can make it very difficult to do normal tasks, such as brushing or getting dressed. Finding out the exact reasons for the development of stiffness in the joint helps to develop the correct treatment tactics and achieve recovery.

DIAGNOSIS OF THE DISEASE

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

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

Magnetic resonance imaging is a special study during which an image of the shoulder joint is formed using magnetic waves. MRI is very good at visualizing damage to the ligaments, tendons and other soft tissues around the joint.

The final and most accurate diagnosis can be made by arthroscopy. During arthroscopy, most structures within the shoulder joint can be visually assessed and debrided.

TREATMENT OF ADHESIVE CAPSULITIS

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

Unfortunately, it may take a long time to achieve satisfactory results. Sometimes steroid injections into the joint cavity may be necessary 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 pain relief is limited in time. Typically, conservative treatment takes from 2 to 4 months; joint function may not be fully restored.

If the results of conservative treatment are not satisfactory to the patient, surgery may be considered.

Surgeries on the shoulder joint at the present stage of development of medicine are performed arthroscopically.

During the operation, you can examine the joint cavity and intra-articular structures, remove scar tissue that impedes movement in the joint, and dissect the wrinkled joint capsule, which also allows you to increase the range of motion.

After surgery, under anesthesia, the surgeon carefully redresses the joint. Redress is a manipulation in which the surgeon forcibly flexes and extends the shoulder joint. In rare cases, such manipulations can lead to a fracture of the humeral head, especially in older patients with osteoporosis.

After surgery, you usually need to wear a special orthotic bandage for a short time. The sutures are removed 12 days after surgery. Good results can be obtained by using a special device for passive development of movements in the joint in the postoperative period. In the postoperative period, you will need to visit your doctor several more times, who will monitor the recovery process after surgery.

PRICES FOR OUR SERVICES

Initial consultation with a traumatologist-orthopedist, Ph.D. — 1500 rubles

• Studying the patient's medical history and complaints
• Clinical examination
• Identifying symptoms of the disease
• Study and interpretation of MRI, CT and X-ray results, as well as blood tests
• Establishing a diagnosis
• Purpose of treatment

Repeated consultation with a traumatologist-orthopedist, Ph.D. - for free

• Analysis of the results of studies prescribed during the initial consultation
• Establishing diagnosis
• Purpose of treatment

Arthroscopic surgery on the shoulder joint - 49,000 rubles

• Stay at the clinic
• Anesthesia
• Arthroscopic shoulder surgery
• Consumables

* Tests for surgery are not included in the price.

Intra- and periarticular administration, “blockade” with glucocorticoids (without the cost of the drug) - 1000 rubles

• Local anesthesia
• Local administration of glucocorticoid solution (Diprospan)

Appointment with a traumatologist - orthopedist, Ph.D. after surgery - free of charge

• Clinical examination after surgery
• View and interpret the results of radiographs, MRI, CT after surgery
• Recommendations for further recovery and rehabilitation
• Intra-articular injection of hyaluronic acid (if necessary)
• Removal of postoperative sutures and dressings