Conservative treatment of frozen shoulder. Adhesive capsulitis

What is capsulitis

The joint capsule is a kind of membrane that surrounds the joints and prevents displacement of parts of the bone. It is located as close as possible to the cartilage and ligaments, therefore it reliably protects them and is responsible for the smoothness of movements.

Capsulitis is an inflammatory process in the joint capsule, in which, in fact, no component of the joint is damaged. Tissues and bones remain in place, like joints, there are no growths, however, despite this, acute pain occurs. It is not similar to the one that accompanies a person during the treatment of osteoarthritis, since it is more intense.

Most often, capsulitis occurs:

• due to a domestic or sports injury, after a blow to the joint area;
• against the background of rheumatic diseases;
• for diabetes;
• for problems with the thyroid gland;
• during menopause in women aged 50-60 years.

Women aged 50-60 years are at risk for developing capsulitis.

Capsulitis (frozen shoulder)

For the first time, a kind of “shoulder” syndrome, accompanied by pain and a significant limitation in range of motion, but not associated with damage to the shoulder joint itself, was described by Durlay in 1882. He also introduced the term “shoulder-scapular periarthritis” into practice, which later began to be unreasonably applied to the entire group of periarticular diseases of the shoulder joint. In 1932, Codman proposed the term “frozen shoulder” to refer to this condition, which is still popular in the English-language orthopedic literature [6,7,8]. This name reflects one of the most characteristic signs of the disease - the natural onset during the course of the disease of a period of “stiffness” - painless restriction of movements in the shoulder joint. In domestic medicine, similar terms were used - “locked shoulder” [1], glenohumeral periarthritis with limitation of movements in the shoulder joint [2]. In 1945, Naviesar proposed the modern name - “adhesive capsulitis”. Despite the fact that the disease appears under this name in the International Classification of Diseases, 10th revision (code M75.0), the term is rightly criticized due to the fact that with this disease, adhesion of neither capsule nor synovium is observed; rather, there is retraction of the joint capsule. In most modern scientific articles, the condition is simply referred to as “capsulitis” [4,9,10,13–15]. Who gets capsulitis? A limited number of studies on the epidemiology of capsulitis show its significant prevalence. In particular, in Scandinavian countries, the incidence among adults is about 2% per year [6,7]. In the vast majority of cases, capsulitis occurs in people aged 50 to 70 years. The disease rarely occurs before the age of 40; it is almost always a secondary form. Women get sick more often than men (ratio 3:1–5:1). The dominant and non-dominant limbs are affected with equal frequency. In 7–10% of cases, as the process resolves in one joint, damage to the second joint develops with an interval of 6 months to 5 years. The development of the process in the second joint is autonomous and does not affect the course of the disease in the initially affected one. After recovery, repeat episodes of capsulitis in the same joint are extremely rare. Etiology and pathogenesis The etiology of capsulitis is still unknown. It is assumed that the cause is neurotrophic disorders in the capsule and synovium of the joint, leading to specific morphological changes - fibrosis and a significant decrease in the volume of the joint cavity. Arthroscopic findings in the pain phase indicate the presence of a moderate inflammatory process (hyperemia) in the synovium. A biopsy in the capsule reveals abnormalities in the content of cytokines, growth factors and matrix metalloproteinases, which may be involved in pathological processes. However, the extent to which inflammation is related to the main pathological process—capsular fibrosis—is unknown. At least with other causes of aseptic synovitis, such as rheumatoid arthritis or secondary synovitis in osteoarthritis, such pronounced fibrosis of the capsule is never observed. A number of signs bring capsulitis closer to diseases of the group of reflex sympathetic dystrophy or complex regional pain syndrome type I [3], a prominent representative of which is Sudeck's syndrome. These signs include: a phased course, the development of fibrosis in a late stage, a clear therapeutic effect of glucocorticosteroids. Simultaneous ipsilateral lesions of the shoulder joint and hand are well known in the form of classical variants of capsulitis and Sudeck syndrome (“shoulder-hand syndrome” or Steinbrocker) [2], which suggests a common pathogenesis of these diseases. Capsulitis occurs independently or can develop against the background of some other condition. In the latter case, they talk about secondary capsulitis. Among the causes of secondary capsulitis, type 2 diabetes mellitus is known, in which capsulitis occurs in 10–30% of cases. Frequent cases of capsulitis have been described in patients with hyperthyroidism, cancer, after myocardial infarction, stroke, cardiac surgery and catheterization of the brachial artery. In addition to the association of capsulitis with Sudeck's syndrome, the connection of this disease with another mysterious representative of neurotrophic disorders - Dupietren's contracture - has been proven. This disease is also associated with diabetes and has a common feature with capsulitis - it also develops fibrosis, but without pain syndrome, palmar aponeurosis [6,7]. There is currently no evidence to suggest that simple rotator cuff tendinitis (the most common cause of shoulder pain) can progress to capsulitis. These are different in both pathogenesis and clinical manifestations of the disease. Clinical picture Capsulitis is characterized by a phased course. Clinical manifestations vary during different periods of the disease. The onset is usually spontaneous, without any previous events, and is subacute in nature, when pain in one shoulder joint increases over 1–3 weeks. In this case, the pain has little to do with any specific movement, and often intensifies at night and when lying on the sore shoulder. The first, pain phase without treatment lasts from 3 months to a year, then the pain gradually decreases and the “stiffness” phase begins - actually a painless limitation of the range of motion in the joint. The characteristic appearance of the patient during this period of the disease gave the disease its name - “ankylosed” or “frozen shoulder”. This phase lasts from 4 to 12 months, followed by a period of resolution, during which the range of motion in the joint is gradually restored. In most cases, the disease ends with recovery, but in half of the patients there is no complete return to the original range of motion, which, however, does not interfere with their daily life. The duration of the resolution phase is 12–24 months. There is a certain pattern - the longer the pain phase lasts, the longer the recovery phase lasts. On average, the duration of the disease without treatment is from 1.5 to 2 years, but in some cases it can reach 4 years. In isolated cases, there is a significant residual limitation in the range of motion in the shoulder joint. Despite the overall good prognosis, the patient’s disability is limited throughout the entire period of the disease; in the first two phases he experiences significant difficulties in self-care, which requires active intervention aimed at shortening the period of disability. The classic phase course of the disease may be disrupted. Thus, during the period of acute pain subsiding, careless movement (tugging on the arm, falling), rough manipulation of the joint can again increase the pain syndrome. Diagnosis and differential diagnosis Due to the obviousness of the clinical picture of the disease, there are no diagnostic criteria for capsulitis. When making a diagnosis, clinical signs are mainly used. On examination, the following picture is typical: the patient holds his arm pressed to the body in a position of internal rotation of the shoulder (forearm pressed to the abdomen). After 2–3 weeks from the onset of the disease, hypotrophy of the deltoid muscle on the affected side is noticeable. This is a nonspecific symptom that occurs in all diseases of the shoulder joint area, and develops from “disuse” of the muscle due to pain. Palpation reveals diffuse tenderness of the joint capsule and adjacent muscles. The most important data for diagnosis is obtained by analyzing the range of motion in the affected shoulder joint. In the first phase of the disease, movement in the joint is significantly limited due to pain. At the same time, both active and passive movements are impaired to an equal extent. This feature is a key feature that allows for a differential diagnosis of capsulitis with damage to the tendon apparatus of the rotator cuff (subacromial syndrome), in which passive movements in the joint, especially rotation, are preserved. External rotation of the shoulder is most affected by capsulitis (Fig. 1), then abduction (checked by fixing the scapula) and then internal rotation. It is often possible to see that there is no external rotation. Normally, its volume is 150–170 degrees. Tests for resistance to active movement, so important in the diagnosis of simple tendinitis of the shoulder joint [4,5], are not very informative for capsulitis. The patient either does not notice an increase in pain in response to tension, or it is diffuse in nature, which does not allow localization of the specific affected tendon. If in the first phase of the disease the main factor limiting movement in the joint is pain, then in the second, painless phase, active and passive movements in the joint are limited only by the mechanical factor - the patient does not experience pain, but is not able to move the arm to the usual extent. Accordingly, in the final phase of the disease, the patient reports that in the recent past his (her) shoulder hurt, then it hardly moved, and now it is gradually “developing.” In most cases, diagnosing capsulitis is not difficult. The only necessary condition (especially in the first, painful phase of the disease) is the exclusion of diseases of the shoulder joint itself, which are also manifested by a pronounced limitation in the range of both active and passive movements. Table 1 presents a list of diseases of the shoulder joint with which it is necessary to make a differential diagnosis of capsulitis, and their characteristic diagnostic signs. Thus, making a diagnosis of capsulitis involves a standard X-ray examination and determination of acute-phase indicators (ESR and C-reactive protein) in order to exclude other (intra-articular) causes of severe dysfunction of the shoulder joint. In the case of capsulitis, no deviations from the norm are detected. When capsulitis lasts for many months, regional osteoporosis is sometimes visible on an x-ray while the joint space is preserved. The reason for this phenomenon is both the limitation of the load on the limb (the so-called disuse osteoporosis) and the manifestation of the underlying process - it is known that in other forms of reflex sympathetic dystrophy regional osteoporosis is determined. The only instrumental method to confirm the diagnosis of capsulitis is arthrography, which reveals a sharp decrease in the volume of the cavity of the shoulder joint and the disappearance of the axillary pocket. However, the method is not used in practice due to its invasiveness and the sufficiency of information obtained during clinical examination. Ultrasound is also of little value in diagnosing capsulitis. The resolution capabilities of the method do not allow us to detect diffuse fibrotic changes in the thin capsule of the shoulder joint. Detectable changes in the form of swelling of the adjacent tendons of the rotator cuff are not specific and occur with common tendinitis. Magnetic resonance imaging has greater resolution, making it possible to detect capsule thickening, but due to the high cost of the study, it is rarely used in the diagnosis of capsulitis. Scintigraphy reveals increased uptake of radiopharmaceutical (technetium-99) in the area of ​​the affected joint, but these findings are not specific for capsulitis [6,7]. Thus, the basis for diagnosing capsulitis is the collection of anamnesis and clinical examination data. Standard radiography of the shoulder joints and laboratory tests are used to exclude other diseases. Treatment Treatment of capsulitis depends on the phase of the disease. It is necessary to reassure the patient by informing him of the overall good prognosis of the disease. This is important, since patients are often concerned about the increasing limitation of movements and the lack of effect from the treatment methods taken. The treatment and outcomes of idiopathic capsulitis and its secondary forms do not differ, however, with the development of capsulitis against the background of diabetes mellitus, there are certain restrictions in the use of GCS. Treatment during the pain phase of the disease During this period of the disease, treatment is aimed at reducing pain. It is necessary to limit the load on the joint to the limit of tolerance. The criterion is pain. All movements that do not cause increased pain are allowed (and recommended). Rest (wearing your arm in a bandage) is recommended only for very severe pain, and then only for a few hours a day. It is known that long-term immobilization further increases the functional insufficiency of the joint. Drug therapy in this phase of the disease is aimed at quickly relieving pain and transferring the disease to the resolution phase of the process. Traditionally, treatment of pain due to capsulitis begins with nonsteroidal anti-inflammatory drugs (NSAIDs). Despite the uniqueness of the inflammatory process in capsulitis, it is present, and the use of NSAIDs in this disease has a pathogenetic justification. However, taking into account the age group of patients (these are people of mature and older ages), it is necessary to take into account the risk of developing undesirable reactions (drug gastropathy, damage to the kidneys, intestines, cardiovascular system). In this regard, aceclofenac (Aertal) has advantages over other NSAIDs. Not inferior in anti-inflammatory activity to such standard NSAIDs as diclofenac and indomethacin, aceclofenac at the same time has significantly better tolerability, which has been proven in numerous studies. The favorable tolerability profile of aceclofenac is due to the predominant inhibition of COX-2 in the body. Aceclofenac is a drug with a short half-life (4–6 hours), which eliminates the cumulative effect (observed, for example, with piroxicam and lornoxicam), which is undesirable in older people. The daily dose of aceclofenac is 50–200 mg and is determined by the patient himself according to the criterion of sufficiency. The duration of administration is also determined by the effectiveness in relation to pain. The drug is taken until the pain disappears. For capsulitis, intra-articular administration of glucocorticosteroids (GCS) is effective. It is necessary to administer GCS specifically into the affected joint, and not “injection” of periarticular tissues, which, if it has an effect, is only due to the systemic action of the drug. Early intra-articular injection of GCS allows pain relief, reducing the natural duration of the pain phase. The diagram and puncture of the shoulder joint itself are shown in Figure 2. The effect of GCS is due not only to its anti-inflammatory effect, but possibly to some other mechanism of action on the pathological process. The effect of GCS in Sudeck syndrome is known, in which there is practically no inflammation. The regimen of intra-articular injections is determined by the specific situation. In some patients, the effect of GCS injection lasts for a limited period of time (2–3 weeks), after which the pain intensifies again. In such patients, intra-articular injections of GCS are repeated at an interval determined by the duration of the effect of the previous injection (after 2-4 weeks), but no more than 3 injections. In the absence of contraindications to GCS injections, full single doses of long-acting drugs are used, since the dose-dependence of the onset of effect is shown. Difficulties arise with concomitant diabetes mellitus. In this case, the use of long-acting drugs with a clear systemic effect (triamsinolone and betamethasone) is fraught with an increase in blood glucose levels, although special studies in this direction have not been conducted. However, it has been shown that intra-articular administration of 35 mg of methylprednisolone acetate in patients with diabetes does not affect blood glucose levels [12]. GCS can also be used orally during the painful phase of capsulitis. Thus, in a placebo-controlled study, Buchbinder et al. [13] showed the effectiveness of taking 30 mg of prednisolone per day for 4 weeks for capsulitis. However, given the risk of adverse reactions from systemic administration of GCS in such a large dose, the method is not recommended for widespread practice. This method is indicated in cases of particularly severe pain syndrome, torpid to other methods of treatment (shoulder-hand syndrome). Other methods of relieving pain in capsulitis are used when the above had no effect or could not be used due to a high risk of adverse reactions (diabetes mellitus or uncontrolled arterial hypertension). Among these methods, blockade of the suprascapular nerve, intra-articular injections of high molecular weight hyaluronic acid preparations have been described [14]; the use of calcitonin is pathogenetically justified, since it is effective in Sudeck syndrome. The effectiveness of any of the physiotherapeutic methods for capsulitis has not been proven. In studies in which a prospective analysis of the dependence of the outcome of the capsulite on the type of treatment was not shown, the advantage of any of the methods regarding the long -term prognosis is not shown - after a year of observation, the vast majority of patients noted a noticeable improvement [9]. However, in relation to direct results (after a month of treatment), the advantage of GKS therapy is shown in comparison with physiotherapeutic methods [10,11]. Treatment in the phase of stiffness during this period of disease drug therapy (NSAIDs and intra -articular injections of GCS) are not shown. The purpose of treatment in this phase is to increase the volume of movements in the affected joint, which is achieved by aggressive rehabilitation tactics. Recall that in the pain phase of capsulite therapeutic exercises is limited by the permissible pain of the volume of movements. A feature of rehabilitation in capsulitis is the use of a low -loading long -term tissue stretching mode. The advantage of this regime is indicated in comparison with the regime in which the stretching is carried out by short -term efforts with a large load and tissue resistance [15]. Currently, in a number of clinics there are special simulators that allow in the software mode to carry out dosed stretching of the capsule of the shoulder joint. However, such manipulations can be carried out in ordinary rehabilitation rooms under the guidance of a medical gymnastics specialist. At the same time, the task of the specialist is to teach the patient the technique and the exercise mode, which he will continue to perform on his own. The most common exercises aimed at stretching the capsule of the shoulder joint are shown in Figure 3. It is important to convince the patient of the need for daily reusable exercises. In the future, the patient’s motivation is reinforced by the obvious results of his efforts. How long should rehabilitation continue? It depends on the initial degree of impaired function, the speed of positive dynamics, achievement of the desired result and can be carried out for months. As already mentioned, in most patients with capsulite, a small restriction of the volume of movements in the affected joint is preserved for life. Earlier, in the treatment of the contracture of the shoulder joint caused by the capsulite, the joint mobilization under general anesthesia was recommended. However, the results of such treatment are ambiguous. Cases of deterioration in the condition after excessively gross manipulation on the joint and even fractures of the shoulder bone are known. The method can be recommended to patients in the absence of positive dynamics for 6 months in the 2nd phase of the disease and the patient’s reluctance to expect a natural completion of the process. Manipulation should be carried out by an orthopedist with experience of such procedures. There are reports of efficiency in capsulitis of arthroscopic manipulations on the affected shoulder joint. The latter include synovectomy (in the presence of synovitis signs) and/or partial mobilization of a fibrous -changed capsule. If the patient turned in the process of resolving the process, treatment is limited to the advice to gradually increase the load on the limb. Regular medical exercises aimed at stretching the joint capsule, to a certain extent accelerate the recovery process. The conclusion of capsults of the shoulder joint is a frequent disease in the practice of the rheumatologist. As a rule, the condition is not difficult to diagnose. Despite the impressive impaired joint function in the debut, the disease is prone to self -dissolution and has a generally good prognosis. The task of treatment is to accelerate the natural process of recovery. Treatment is carried out on an outpatient basis and consists in stopping the pain syndrome (NSAIDs, analgesics, intra -articular administration of GCS) and rehabilitation. The results of treatment largely depend on the patient’s correct representation of his disease and on his active participation in the rehabilitation process. The patient should be ready for the fact that in the affected joint after recovery there will be a minimum restriction of movements.

Literature 1. Astapenko M.G., Eryalis Extra-articular diseases of soft tissues of the musculoskeletal system, M. Moscow, 1975. 2. Zulkarneev R.A. “Painful shoulder” – glenohumeral periarthritis and shoulder-hand syndrome. Kazan University Publishing House; 1979. 3. Novikov A.V., Yakhno N.N. Complex regional pain syndrome as a variant of chronic neuropathic pain. RMJ, 2001, volume 9, no. 25, 1152–1160 4. Belenky A. G. Pathology of the shoulder joint. Humeroscapular periarthritis. Farewell to the term: from approximation to specific nosological forms. "Consilium medicum", 2004, vol. 6, no. 2. 5. Nikiforov A.S., Mendel O.I., Humeroscapular pain syndrome: modern approaches to diagnosis and treatment. RMJ, 2006, volume 14, no. 8, pp. 621–6 6. Dias R. et al. Frozen shoulder. BMJ, 2005.331: 1453–56 7. Rizk TE, Pinals RS. Frozen shoulder. Seminars Arthritis Rheumatism 1982;11:440–52. 8. Reeves B.The natural history of the frozen shoulder syndrome. Scand J Rheumatol 1975;4:193–6 9. Dudkiewicz I et al. Idiopathic adhesive capsulitis: long–term results of conservative treatment. Isr Med Assoc J 2004 Sep;6(9):524–6.. 10. Carette S, et al. Intraarticular corticosteroids, supervised physiotherapy or a combination of the two in the treatment of adhesive capsulitis of the shoulder: a placebo controlled trial. Arthritis Rheum 2003;48:829–838. 11. Van der Windt DA, et al. Effectiveness of corticosteroid injections versus physiotherapy for the treatment of painful stiff shoulder in primary care: randomized trial. BMJ 1998; 317:1292–6. 12. Habib GS, Abu–Ahmad R. Lack of effect of corticosteroid injection at the shoulder joint on blood glucose levels in diabetic patients. Clin Rheumatol. 2006 Jun 29; 13. Buchbinder R, et al. Short course prednisolone for adhesive capsulitis (frozen shoulder or stiff painful shoulder): a randomized, double blind, placebo controlled trial. AnnRheum Dis 2004;63:1460–9. 14. Calis M. et al. Is intraarticular sodium hyaluronate injection an alternative treatment in patients with adhesive capsulitis? Rheumatol Int 2006, 26; 536–40 15. Vermeulen HM et al. Comparison of high–grade and low–grade mobilization techniques in the management of adhesive capsulitis of the shoulder: randomized controlled trial. Phys Ther. 2006 Mar;86(3):355–68.

What is adhesive capsulitis

One of the most common types of the disease is “frozen shoulder syndrome” ( adhesive capsulitis ):

• it is an inflammation of the connective tissue that covers the shoulder joint;
• often becomes chronic;
• occurs against the background of a deficiency of synovial fluid (its reserves can be replenished by intra-articular injections of a liquid endoprosthesis) - the joints rub against each other and become inflamed.

How does adhesive capsulitis develop and what does it lead to? Comment from a sports traumatologist:

With frozen shoulder, pain occurs at night, making it difficult to sleep on your side. Gradually it spreads to the rest of the day, becomes more intense, intensifies with temperature changes, changing seasons, and vibrations. There are cases where the symptom disappears on its own after a few years, but generally it requires treatment.

Analgesics do not control frozen shoulder pain

Causes of the disease

This issue has not yet been fully resolved. But there are known factors that can influence the occurrence of this disease. Among them:

• bruises and injuries to the shoulder (a large number of them increases the likelihood of illness), problems with the spine;
• disruptions in the functioning of the body (hormonal, metabolic, musculoskeletal, cardiovascular system);
• emotional stress, heavy physical activity, professional characteristics (constant work with arms raised high).

Based on this, the likelihood of developing “frozen shoulder” in people with diabetes, hyperthyroidism, hypothyroidism, Parkinson's disease, or those who have had a heart attack or stroke is much higher. Capsulitis of the shoulder joint mainly appears in people after 50 years of age, with women suffering from it more often than men.

Treatment of adhesive capsulitis

As is the case with the treatment of osteoarthritis of the shoulder joint, therapy for capsulitis is always complex. It is aimed at relieving pain, improving mobility and removing inflammation from the capsular tissue. Depending on the clinical picture and the patient’s age, a complex of the following measures is selected:

• Alternate exposure to heat and cold to relieve inflammation.
• Neurostimulation through the skin using small electrodes.
• Shoulder immobilization is required.
• The physiotherapist selects the optimal set of stretching exercises to prevent congestion.
• Massage courses shown.
• Cryotherapy repairs inflamed tissue around the shoulder joint.

Time will tell which method will help you. Some people effectively deal with shoulder pain with acupuncture, others practice yoga, and others use electrical stimulation. At an appointment with an orthopedist, you can hear recommendations to try various methods for capsulitis in order to choose the most effective one.

One way or another, if you have pain in your shoulder or other joint, do not self-medicate: the inflammatory process is always stress for the body, which reduces immunity and becomes a powerful blow to other systems.

Establishing diagnosis

As with all diseases, diagnosis begins with interviewing the patient. This will be followed by a test, for which the patient will have to perform several movements: put his hands on his waist, move them back or behind his head. With capsulitis, it will be impossible or extremely difficult to perform them. The doctor will also be able to notice deformation of the joint and sinking of muscle tissue in this place. If you press on certain points, the patient will feel a sharp, severe pain. For an even more accurate diagnosis, an X-ray or ultrasound of the shoulder joint is used, but if there are still doubts, they can be dispelled with the help of tomography and MRI. Another method to differentiate adhesive capsulitis of the shoulder is arthrography. It makes it possible to determine the volume of synovial fluid, from which a conclusion can be drawn about the presence or absence of an inflammatory process. To prescribe the most accurate treatment regimen, you may have to donate blood, urine for laboratory tests, do an ECG and fluorography. This will allow you to choose the right medications for shoulder capsulitis, determine the dosage of the medication, and minimize side effects.

Symptoms and diagnosis of glenohumeral periarthritis

In the clinic of glenohumeral periarthritis, the main one is pain. The pain usually occurs for no apparent reason, sometimes at night, when lying on the painful side. It can be aching or sharp, intensifies with movement and radiates to the neck or upper limb. Pain may occur when the arm is abducted, placed behind the back or behind the head. Painful areas are identified in the teres major and pectoralis major muscles. Pain also occurs when the shoulder is abducted to 60-90°, which is associated with damage to the supraspinatus tendon.

The second important sign of glenohumeral periarthritis is contractures (stiffness) in the shoulder joint. The range of movements suffers sharply. When the arm is abducted, the scapula immediately moves (normally, it begins to rotate around its sagittal axis after the shoulder is abducted to 90°). The patient is unable to maintain the upper limb in lateral abduction. Rotation of the shoulder, especially inward, is difficult, but pendulum-like movements of the shoulder within 40° remain free.

When x-raying a joint, doctors identify the following signs:

• Osteosclerosis;
• Uneven or unclear bone contour;
• Deformation;
• Osteophytes (bone growths) at the sites of attachment of ligaments to the greater tubercle.

X-rays show osteoporosis in the area of ​​the greater tuberosity or near the joint. Single or multiple clearings of bone tissue are visible in the area of ​​the greater tubercle and humeral head, similar to a cyst. It is often possible to see calcifications in linear soft tissues. They are located under the acromion process of the scapula.

Doctors at the Yusupov Hospital make a diagnosis based on clinical manifestations and X-ray examination of the shoulder joint. In the most complex cases of glenohumeral periarthritis, magnetic resonance imaging is performed. It allows you to enhance the contrast of the image, which allows you to clearly differentiate soft tissue structures. The method avoids radiation exposure and provides horizontal, sagittal and frontal tomographic sections with reliable information about the magnitude of pathological changes.

Features of treatment

Treatment is always complex and necessarily includes manual techniques. Targeted intervention improves the quality of recovery and prognosis of the disease. In addition, diagnosis is increasingly moving towards instrumental studies, without the results of which treatment is prescribed less and less. Neurologists, orthopedists, traumatologists and doctors of other specialties try to establish the type of glenohumeral periarthritis, but in the end they prescribe standard treatment methods based on medications (NSAIDs, muscle relaxants), physiotherapy and non-specific physical exercises. Such treatment, unfortunately, is selected without reference to the characteristics of the disease of a particular person. Such therapy is aimed exclusively at the shoulder joint, but the shoulders, like other parts of our body, are parts of a harmonious integral system of the body and are closely connected with the neck, spine, chest, sacrum, as well as with internal organs.

An osteopath's approach to treatment is always holistic. Features of osteopathic correction of disorders: - non-invasive effects and the absence of unwanted “side effects”, which are constant companions of drug therapy; — a systemic assessment of the body, taking into account all the connections of the shoulder joint with other parts of the body described above; - high palpation skills - the ability to “feel” the body and the processes occurring in the tissues; — soft impact on structures accurately, effectively and safely.

This approach allows us to accurately diagnose the causes that led to frozen shoulder in each specific clinical case. Manual diagnostics does not require instrumental confirmation, since it involves assessing the natural functions of the body - physiological stress, rhythms in tissues, biomechanics of joints. An osteopath identifies incorrectly functioning structures that cause pain and limit mobility.

In addition to the periarticular and articular structures of the glenohumeral region, adjacent biomechanical disorders of the musculoskeletal system also take part in the clinical picture of frozen shoulder. Structural and mechanical damage to the joints and spine simply cannot be reversed with medications. In such cases, only physical manual correction is effective. This is exactly what osteopathy does - human mechanics. In patients with these pathologies, disturbances in the polysynaptic reflex excitability of the brain stem are observed, and osteopathy is an effective method of treating pain and motor disorders in patients with glenohumeral periarthritis and related diseases. Osteopathic treatment includes the correction of local, regional and global disorders of the locomotor system that can affect the function of the shoulder joint.

For example, the disorder may arise as a result of pulling from the left or from the right. Failure of the liver to function through the fascia chain often leads to tension and tension in the shoulder joint.

In this case, the liver may not hurt, but glenohumeral periarthritis is difficult to notice. Or stomach.

Various gastrointestinal diseases, endocrine pathologies and even stress limit the mobility of this organ. The result is limited mobility of the diaphragm, impaired biomechanics of the thoracic region and pain in the glenohumeral region.

However, an integrated approach is not limited to osteopathic correction. In addition to it, our clinic successfully uses physical therapy, massage, and kinesio taping.

Exercise therapy is based on the use of individually selected physical activity aimed at relieving compression of nerve roots, strengthening the muscle corset, developing correct motor patterns and increasing range of motion.

Our patients achieve these goals through regular exercises and sessions using special rehabilitation equipment - in particular kinesiotherapeutic units such as Redcord.

Treatment using the Neurac method is based on painless activation of the muscle frame. The installation involves the deep stabilizer muscles. This allows you to stabilize the shoulder joint, increase the elasticity and functionality of the muscles and ligaments.

The results of working in the Redcord installation are achieved by turning off the superficial muscles and working only the deep ones.

Treatment of shoulder capsulitis

It must be comprehensive, taking into account the patient’s lifestyle, age and the presence of concomitant diseases.

• To eliminate pain, analgesics (injections, blockades, tablets, ointments) are used.
• Non-steroidal anti-inflammatory drugs are used to stop the inflammatory process.
• Manual therapy helps relieve spasm and restore joint mobility, improves blood circulation and tissue nutrition.
• At the improvement stage, physical therapy with a special set of exercises, as well as various types of physiotherapy, are recommended.

In very rare cases, when therapeutic methods fail to restore joint mobility, surgery is resorted to. Today, arthroscopy is used for this - an intervention with minimal damage, which is performed under local anesthesia. As a result of manipulations, the joint capsule expands, which further contributes to its normal functioning. Folk remedies (rubbing, compresses, restorative herbal mixtures) are used as maintenance therapy.

Exercise therapy for glenohumeral periarthritis

At the initial stage of treatment of glenohumeral periarthritis, patients do the following exercises from the starting position “lying”:

• They clench and unclench their fingers, shake the brush;
• Bend your arms at the wrist joint;
• Holding your arms along your body, turn your palms down and up;
• Keep your arms along the body, while inhaling, bring your hands to your shoulders, and while exhaling, lower them.

You can bend your elbows and spread your forearms to the sides, bringing the back of your hand as close as possible to the horizontal surface. The hands should be kept on the shoulders, the elbows in front of you, as you inhale, spread the elbows to the sides, and as you exhale, place them vertically again.

The following exercises for shoulder osteoarthritis are done while sitting:

• Place your hands on your waist, spread your elbows to the side and bring them towards each other at low speed;
• Hands are located at the waist, simultaneously rotate both shoulders forward and backward;
• As you inhale, bend your elbows, and as you exhale, lightly swing them back and forth;
• Place your hand behind your back and raise your palm to your shoulder blade.

Rehabilitation specialists at the Yusupov Hospital select an individual set of exercises for each patient for glenohumeral periarthritis. These exercises are suitable for treating the disease at home.