Capsulitis of the shoulder

Inflammation of the synovial bag and joint capsule is capsulitis. The shoulder and knee are most often affected. Let's consider the features of the disease and its treatment methods.

Stiffness and pain in the joint that lasts for several days may indicate progressive inflammation. The disease is characterized by the appearance of severe pain and a sharp decrease in the functionality of the affected area. If the pathology is in a mild stage, then it is difficult for the patient to move his hands. Severe forms of the disorder can cause disability.

According to the international classification of diseases ICD-10, capsulitis is included in the category: M00-M99 Diseases of the musculoskeletal system and connective tissue, subcategory M60-M79 Diseases of soft tissues:

M70-M79 Other diseases of soft tissues.

• M75 Shoulder lesions.
  • M75.0 Adhesive capsulitis of the shoulder.

Diffuse damage was first described in 1882. The term scapulohumeral periarthritis was introduced into medical practice. In 1932, the pathology was called "frozen shoulder" due to the pronounced symptom of stiffness and limitation of movement. In 1945, the disorder received its modern name - adhesive capsulitis.

The disease lasts from six months to several years. The affected tissues surrounding the joint become inflamed and hard. Adhesions gradually begin to form, limiting movement and causing acute pain. Most often, the pathology is associated with traumatic injuries and autoimmune reactions of the body. Treatment is long-term, consisting of a course of drug therapy and physiotherapy. In especially severe cases, surgical intervention is performed.

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Epidemiology

According to medical statistics, the incidence of capsulitis among adults is 2-3% per year. In most cases, the disease is diagnosed in patients aged 40-70. If the pathology occurs in people under 40, then this is most likely a secondary form of diffuse damage.

Statistics show that women get sick three times more often than men. In 10% of cases, after the resolution of the pathological process in one joint, the second joint becomes affected (time interval from six months to 5 years). The development of the pathological process in the second limb does not affect the course of the disease in the first. After complete recovery, relapses of capsulitis are unlikely.

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Causes capsulitis of the shoulder

The etiology of inflammation of the synovial bag and joint capsule is not completely known. The causes of capsulitis are associated with neurotrophic disorders that lead to morphological changes (fibrosis, reduction of the joint cavity). The disease can develop against the background of other pathologies: diabetes mellitus, cancer, myocardial infarction, stroke, hyperthyroidism.

The inflammatory process is most often associated with the following reasons:

• Prolonged stress on the joint due to heavy lifting, sports or awkward hand positions.
• Professional factor: blue-collar workers, athletes, musicians.
• Injuries and bone displacements.
• Diseases of the skeletal system.
• Secondary pathology against the background of autoimmune, infectious or allergic lesions.

Based on the known causes, capsulitis is divided into the following types:

1. Traumatic (post-traumatic) – develops after injuries (dislocation, damage, penetrating wounds) and operations in this area.
2. Idiopathic - occurs due to unknown reasons, but most often the following factors contribute to its occurrence:

• Infectious chronic diseases.
• Oncological diseases.
• Endocrine disorders.
• Mental disorders.
• Disorders of the circulatory and respiratory systems.

The disease has a long course, which, with constant exposure to irritating factors, can lead to disability.

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Risk factors

The exact causes of the development of diffuse joint damage have not been established, but doctors identify a number of risk factors for capsulitis:

• Diseases of the musculoskeletal system.
• Diseases of the spine.
• Age over 40 years.
• Congenital joint deformities or underdevelopment.
• Hereditary predisposition.
• Hypothermia.
• Frequent colds.
• Cardiovascular disorders.
• Endocrine disorders.
• Mechanical injuries.
• History of osteochondrosis.
• Heart attack, stroke, heart muscle surgery.
• Staying in a pose with raised arms for a long time.

Very often, the painful condition develops against the background of existing pathologies. Thus, the inflammatory process can appear with disorders of the nervous system or disorders of the respiratory organs.

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Pathogenesis

Both joints and periarticular tissues are susceptible to degenerative processes. The pathogenesis of capsulitis is a kind of response of the body to their reactive inflammation. The most vulnerable places are the attachment points of tendons, joint bags and ligaments to the joint itself.

The mechanism of disease development is associated with the impact of provoking factors (chronic or infectious diseases, hypothermia, stress, injuries). A failure in the immune system leads to the fact that leukocytes begin to attack the joints of the body. Against this background, inflammatory reactions occur, causing severe pain and impairing joint mobility.

Capsulitis often develops against the background of arthritis. Patients over 40, professional athletes and people whose work involves increased physical activity are susceptible to the disease.

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Symptoms capsulitis of the shoulder

Capsulitis is characterized by a gradual course, so the symptoms of the disease depend entirely on the phase of the inflammatory pathology.

The following stages of the disease are distinguished:

• Painful – lasts about 9 months with sharp, aching pains with sudden movements.
• Peak – lasts less than a year, characterized by a violation of the functionality of the affected limb.
• Remission – lasts up to 3 years, recurs. The pain subsides for a while and mobility is restored, but after a while the pathology makes itself known again.

Let's take a closer look at the symptoms of each stage of inflammatory damage to the synovial bursa and joint capsule:

1. Mild pain that occurs after lifting heavy objects and strains. The affected limb remains mobile, but there is stiffness that does not make itself felt at rest.
2. Stiffness is accompanied by difficulties in performing normal movements. Painful sensations make themselves known even at rest. Discomfort increases at night, body temperature rises and general well-being worsens.
3. Without proper treatment and in its absence, the disease becomes chronic. The pain becomes less pronounced, but sometimes sharp shooting pains occur. Local signs of inflammation are almost not noticeable, but the general well-being worsens: sleep is disturbed and increased nervousness develops.
4. The disease takes an adhesive form, which is the most dangerous complication of capsulitis. Adhesions and adhesions appear in the joint capsule. The adhesion process significantly reduces the mobility of the limb and increases painful sensations. In rare cases, ankylosis occurs, which completely restricts movement. With severe fusion, mobility is restored surgically.

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First signs

In order to diagnose capsulitis, you should pay attention to the first signs of the disease:

• Limited range of joint rotation.
• Painful sensations when moving.
• Deterioration of general well-being.

At the initial stage, there is slight discomfort in the affected limb, which intensifies after physical activity. The duration of the first signs is about 6 months. It is at this point that you need to seek medical help to prevent further progression of the disease.

An inflammatory disease affecting the synovial membrane of the shoulder joint is capsulitis.

The following causes of diffuse shoulder damage are identified:

• Injuries and mechanical damage.
• Metabolic disorders.
• Hormonal disorders.
• Arthritis.
• Osteochondrosis of the spine (thoracic and cervical spine).
• Cardiovascular diseases (ischemia, myocardial infarction).
• Hereditary predisposition.
• Long-term static load on the shoulder.

The disease does not affect the bone base and cartilaginous articular surfaces. A prolonged course of the inflammatory process leads to the formation of dense fibrous scars in the joint. Because of this, shoulder mobility is limited. Advanced stages occur with adhesions between the articular surfaces of the bones. In this case, the patient is diagnosed with adhesive or adhesive scapulohumeral periarthritis.

Diagnosis of inflammatory pathology is based on its symptoms. Visual examination and anamnesis allow the doctor to make a preliminary diagnosis. Capsulitis is necessarily differentiated from diseases with similar symptoms. The patient is prescribed X-ray of the shoulder joint, MRI, ultrasound, arthrography, as well as a set of laboratory tests.

After the final diagnosis is made, a treatment plan is drawn up. The therapy consists of several stages. First of all, patients are prescribed painkillers (capsules, tablets, ointments, intramuscular injections). To prevent the disease from becoming severe and adhesions from developing, intra-articular administration of glucocorticosteroids and other anti-inflammatory drugs is indicated. During the rehabilitation process, the patient is prescribed a course of physiotherapy and therapeutic exercises, a special diet and vitamins.

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Stages

The main difference between inflammation of the synovial bag and joint capsule and other joint lesions is that there is no damage to cartilage or other tissues. That is, all changes occur only in the synovial bag.

As capsulitis progresses, the following stages of the disease are distinguished:

1. Mild – the painful sensations are insignificant and make themselves known after prolonged exertion. In rare cases, slight stiffness occurs during movement.
2. Acute - elevated subfebrile body temperature, swelling of the affected area and pain. It becomes difficult to move, which negatively affects performance and general well-being.
3. Chronic – the discomfort gradually subsides, but shooting pains occur when moving. The affected joints wear out, limiting mobility. The patient suffers from sleep disorders and increased nervousness.
4. Complicated - severe damage to the joint capsule leads to disability. Intense acute pain makes itself felt with any movements and at rest, completely limiting its functionality. Adhesions form on the damaged membranes, there is a risk of developing ankylosis.

Treatment of the disease in the early stages has a favorable prognosis. Later stages significantly complicate the treatment process and the prognosis for recovery.

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Forms

Capsulitis is classified into several stages and types, which depend on the severity of the disease and its symptoms.

The main types of pathology depending on its causes:

• Post-traumatic – the disease develops after injuries: fractures, tendon ruptures, inflammatory and infectious processes.
• Idiopathic - this type is most often diagnosed in women aged 40 to 60 years. The main factor of the disease is disorders of the circulatory and respiratory organs.

Most often, capsulitis refers to damage to the shoulder, but the pathological process can also affect other areas:

• Shoulder-scapular (shoulder) - the most common type of disease. It can occur due to metabolic disorders, trauma to the shoulder or neck, cervical osteochondrosis.
• Elbow joint capsulitis (tennis hand) – people whose work involves regular microscopic trauma are most susceptible to this disorder. At the initial stages, pain appears with increased loads, and later becomes chronic.
• Finger damage – pain and hyperemia of periarticular tissues and their swelling. Factors causing the disease are frequent hypothermia of the hands and increased loads on the upper limbs.
• Knee - this type of inflammation is characterized by severe pain when bending the joints. Women over 40 are most susceptible to the disease.
• Capsulitis of the ankle joint is a rare disease that occurs due to increased loads on the lower limbs.
• Hip joint damage is another rather rare form of disorder, typical for elderly people. Patients complain of pain in the hip area, radiating to the knees and shins. Discomfort occurs during physical exertion and any movements.

All types of capsulitis have similar symptoms, treatment tactics and diagnostic methods.

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Adhesive capsulitis

Total damage to the joint capsule with severe pain and impaired mobility is adhesive capsulitis. Chronic fibrous inflammation accounts for about 2-5% of all cases of the disease. The peculiarity of this form is that it can last for many years and have two outcomes: the functions of the affected joint are completely restored or irreversible complications develop.

Causes of adhesive periarthritis:

• Traumatic injuries.
• Previous joint surgeries.
• Reduced physical activity.
• Increased stress on joints.
• Infectious and inflammatory diseases of the body in chronic form.
• Metabolic disorders, endocrine and hormonal disorders.

All of the above factors lead to the joint capsule losing its elasticity and hardening, impairing mobility.

The adhesive form of the disease is characterized by long-term painful sensations and limited mobility of the affected limb. It is chronic pain that makes the patient seek medical help. But the complicated form of the disorder is difficult to treat.

To eliminate adhesion, drug therapy is indicated, and in particularly severe cases, surgical intervention. The patient also faces a long rehabilitation period. In particularly advanced cases, the pathological condition leads to disability, that is, the loss of the functional capabilities of the affected limb.

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Complications and consequences

Without timely diagnosis and treatment, capsulitis can lead to serious problems. The consequences and complications of the disease are most often manifested by the following pathologies:

• Joint calcification.
• Transition of the disease to a chronic form.
• Limitation of mobility.
• Fibrous adhesion of tissues.
• Atrophy of the affected limb.
• Cyanosis and edema.
• Ankylosis (partial or complete fusion of articular surfaces).

Long-term course of the disease leads to sleep disorders due to constant pain. The patient faces difficulties in performing movements and self-care. Against this background, psychasthenic syndrome and loss of working capacity develop.

To avoid the development of consequences, at the first painful symptoms you should consult a doctor and undergo a set of diagnostic examinations. Treatment of inflammation in the early stages facilitates the recovery process and minimizes the risk of complications.

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Diagnostics capsulitis of the shoulder

In order to establish with high accuracy the presence of inflammation of the synovial bag and joint capsule, it is necessary to undergo a series of examinations. Diagnostics begins with a visit to a surgeon or traumatologist-orthopedist. The doctor collects anamnesis and asks about when painful symptoms first appeared, whether they were preceded by injuries, operations or diseases of the musculoskeletal system.

At the next stage, the patient is examined and the stage of the disease is determined:

• Simple form – pain in the joint when abducting the affected limb, painful sensations during palpation, limited movement.
• Acute form – radiating pain, severe limitation of movement, soreness and swelling.
• Chronic – moderate pain, progressive limitation of movement, signs of mechanical blockade.

After examination, the patient is prescribed a set of instrumental diagnostic methods: MRI, ultrasound, arthrography and radiography of the affected joint. It is also necessary to take tests to identify signs of inflammation and assess the general condition of the body. If the results of the examinations do not give a clear picture, then differential diagnostics are carried out.

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Tests

Diagnosis of any disease includes laboratory tests. Tests are necessary to assess the general condition of the body and identify the characteristics of the course of the disease being diagnosed.

If capsulitis is suspected, the patient is prescribed the following tests:

• General blood test – allows you to assess the stage of the inflammatory process, leukocytosis, ESR, erythrocytosis, and the amount of C-reactive protein.
• General urine analysis – performed to rule out gout, that is, acute inflammatory arthritis.
• Biochemical blood test.
• Blood test for rheumatoid factor – allows to exclude rheumatoid arthritis.

Based on the results obtained, the doctor can make a final diagnosis or prescribe additional tests.

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Instrumental diagnostics

Another important stage of examinations when capsulitis is suspected is instrumental diagnostics. Using special equipment, the condition of the damaged joint and surrounding tissues is assessed.

Most often, patients are prescribed the following set of instrumental examinations:

• X-ray - this method is most informative in the last stages of the disease, as it allows you to see degenerative changes and areas of calcification. In the early stages of inflammation, X-rays make it possible to differentiate pathology from arthritis.
• Magnetic resonance imaging and computed tomography – these studies provide a detailed layered image of soft tissues and bones. Thanks to this, the doctor can draw conclusions about the stage of the disease and prescribe effective methods of treatment.
• Arthroscopy is one of the most informative examinations. With the help of an endoscope, a visual assessment of the internal cavity of the synovial bag and other anatomical structures is performed. A sharp decrease in the volume of the joint cavity and the absence of an axillary pocket allow us to confirm capsulitis.
• Ultrasound examination of the joint – this method is considered uninformative, since its low resolution capabilities do not record diffuse fibrous changes in the thin tissues of the capsule. During diagnostics, edema of adjacent tendons may be detected, which occurs with tendinitis and other lesions of the musculoskeletal system.

The above studies are carried out not only at the diagnostic stage, but also during the treatment process to determine the dynamics of the disease and the effect of the therapy.

Differential diagnosis

As a rule, the diagnosis of capsulitis is not difficult. But in the early stages, the disease requires differentiation, since its symptoms are blurred and similar to other pathologies of the musculoskeletal system.

Differential diagnostics is carried out by the exclusion method and is compared with arthritis and arthrosis, lesions of the cervical spine, degenerative processes in the joints and periarticular tissues.

Comparison of capsulitis is most often made with the following diseases:

Symptoms/disease	Capsulitis	Arthritis	Arthrosis
Pain, swelling and localized increase in temperature	Pain occurs during movement, there is slight swelling. Painful points are palpated. The temperature in the affected area is elevated.	The pain is spontaneous and increases with any movement. The joint is swollen and painful, the local temperature is elevated. Sharp shooting pains occur upon palpation.	Any movement causes pain, there is no swelling, and no increase in temperature at the site of the lesion. Mild discomfort may occur upon palpation.
Changes in joints and surrounding tissues	There is no deformation.	There is deformation of the joints and changes in soft tissues.	Severe degenerative changes due to bone growths in the joints.
Movements in the joint	Partially limited	The joint is immobilized	Saved
Limb movements	Not violated	There are restrictions	Slightly limited
Laboratory research	Blood picture is within normal limits. In the acute phase there is an increase in ESR.	In the blood there is C-reactive protein, increased ESR, seromucoid and fibrinogen.	No changes
X-ray	In the later stages of the disease, calcifications and periostitis are detected.	The joint space is narrowed, there is osteoporosis of the epiphyses, and erosions on the articular surfaces.	The joint spaces are narrowed, there are osteophytes and subchondral osteosclerosis.

Differential diagnostics is performed by a number of specialists: therapist, surgeon, orthopedist, neurologist, rheumatologist. A full range of diagnostic procedures is used for research, i.e. both laboratory and instrumental methods.

Treatment capsulitis of the shoulder

Drug treatment of capsulitis is carried out at the first stages of the disease to stop the inflammatory process and reduce pain. The medications are selected by the doctor, individually for each patient.

Prevention

To prevent neurodystrophic diseases and minimize the risk of developing capsulitis, you should follow these recommendations:

• Engage in moderate physical activity regularly.
• In case of prolonged loads on one joint, observe a rest regimen and do massages.
• Treat infectious and inflammatory diseases of the body in a timely manner.
• Avoid situations that traumatize the joint. Not only macro, but also microtraumas are dangerous.
• Take vitamins and maintain a balanced diet.

The above-mentioned preventive measures help protect the body from damage to the musculoskeletal system and the transition of degenerative diseases into a chronic form.

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Forecast

Capsulitis has a favorable prognosis, provided that the disease was diagnosed in the early stages and effective treatment was prescribed. In this case, the patient has a high chance of full recovery in a short period of time. If periarthritis has become chronic, then treatment may take more than one year. The lack of medical care leads to complete loss of joint mobility, disability of the patient and loss of ability to work.

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