Treatment of capsulitis with drugs and alternatives

The method of treatment of inflammation of the synovial bag and joint capsule depends on the stage of the disease. This takes into account the fact that the pathology is prone to self-resolution. Treatment takes place in an outpatient setting.

1. Pain phase

Treatment is aimed at reducing pain syndrome. Restriction of the load on the joint is shown. In severe pain, the patient is recommended complete rest, but prolonged immobilization increases functional insufficiency. For relief of pain, NSAIDs and intra-articular glucocorticosteroids are used.

2. Phase stiffness

At this stage, drug therapy is not carried out. The treatment is aimed at increasing the motor activity in the lesion focus. To do this, use physiotherapy and other rehabilitation techniques.

3. Adhesive stage

At this stage, drug therapy is ineffective, so surgical intervention is shown to restore joint mobility. The volume of the operation depends on the degenerative changes in the joint tissues and the individual characteristics of the patient's body.

Drugs used in the treatment of capsulitis

The main groups of drugs for the treatment of capsulitis:

Painkillers - used to reduce pain. Patients are assigned both tablet forms and injections to block nerve endings.

1. Ketanov

A drug with analgesic properties and an active component is ketorolac tromethamine. Inhibits the synthesis of prostaglandins, has an anti-inflammatory and pronounced analgesic effect. Do not depress the respiratory center and does not cause an increase in the RV. Does not affect the psychomotor functions of the central nervous system.

• Indications for use: injection and tablets are prescribed for relief of severe and moderate pains of different localization. The drug is effective in the postoperative period, with acute pain due to sprains, fractures, dislocations, and also with toothache.
• Method of administration: intramuscularly at 10 mg with a further dosage of 10-30 mg every 4-6 hours. The maximum daily dose is 90 mg, and the duration of treatment is 48 hours. Tablets are taken orally 1 capsule every 4-6 hours. The duration of treatment should not exceed 7 days.
• Side effects: nausea, abdominal pain, increased drowsiness and weakness, headaches, diarrhea, dizziness, irritability, tachycardia. With intramuscular injection, local pain is possible.
• Contraindications: age of the patient is younger than 16 years, bronchial asthma, stomach and duodenal ulcer, renal failure, intolerance of active components, pregnancy and lactation.
• Overdose: shortness of breath, pallor of the skin, vomiting, increased weakness. Treatment is symptomatic, gastric lavage is recommended.

The drug is issued in the form of ampoules of 10 pieces per pack, and also in tablet form, 10 capsules per pack.

2. Diclofenac

Analgesic, anti-inflammatory and antipyretic. Contains the active substance - diclofenac sodium. With rheumatic diseases it weakens the painful sensations, reduces the stiffness and swelling of the joints, increases the volume of movements in the affected area.

• Indications for use: inflammatory diseases of the joints and soft tissues, injuries of the musculoskeletal system, acute attack of gout, neuralgia, neuritis, lumbago, bursitis, postoperative pain syndrome.
• Method of administration: intramuscularly 75 mg twice a day, treatment course 4-5 days. The dosage of tablets is selected individually for each patient.
• Side effects: dyspeptic phenomena, erosive and ulcerative lesions, bleeding in the gastrointestinal tract, allergic reactions, headaches and dizziness, increased drowsiness and irritability. Overdose is manifested by the intensification of the above reactions. Treatment is symptomatic.
• Contraindications: peptic ulcer of stomach and duodenum, kidney and liver diseases, last trimester of pregnancy and lactemia, bronchial asthma, intolerance of drug components, allergic reactions, patients younger than 6 years.

Diclofenac is released in the form of a solution for injection, as well as in the form of tablets for oral administration.

3. Denber

Highly selective cyclooxygenase II inhibitor from the NSAID group. Has a pronounced analgesic, moderate anti-inflammatory, anti-edematous and antipyretic effect.

• Indications for use: diseases of the musculoskeletal system, acute and chronic periarthritis, rheumatoid arthritis, bursitis, tendinitis, osteoarthritis, injuries of tendons, muscles and ligaments. The drug is effective in combat syndromes of various origins, as well as as symptomatic therapy for infectious and inflammatory diseases of the urinary system, in ophthalmology, gynecology, and respiratory damage.
• Method of administration: injections are administered intramuscularly once a day at intervals of 24 hours, intravenous administration is contraindicated. The recommended dosage is 50 mg per day. Tablets take 25 mg once a day. The course of treatment is from 4 to 6 weeks.
• Side effects: confusion, drowsiness, headaches and dizziness, nausea, vomiting, congestive heart failure, decreased kidney function, allergic reactions, edema of the lower limbs. Overdose has a similar symptomatology, treatment is symptomatic.
• Contraindications: intolerance of the drug components, patients of childhood, cancer. Injections are prohibited for heart attacks and strokes in the history, progressive form of atherosclerosis, arterial hypertension. The medicine is not used during pregnancy and lactation.

DENEBOL is available in the form of a solution for injection and in the form of tablets, rectal suppositories and gel for external application.

NSAIDs - non-steroidal anti-inflammatory drugs reduce inflammation and swelling. Reduce the severity of pain and stimulate the recovery process.

1. Friend

Analgesic, anti-inflammatory and antipyretic. Suppresses the formation of prostaglandin in the inflammatory focus, inhibits COX2. Relieves pain in the joints in a state of rest during motion, relieves swelling and stiffness.

• Indications for use: posttraumatic pain syndrome, osteoarthritis, osteoarthritis, bursitis, rheumatism, muscle pain, myalgia, neuralgia, vertebral pain, infectious diseases. The drug in the form of a gel is used for degenerative and inflammatory lesions of the musculoskeletal system, tendons and ligaments.
• The method of administration and dosage depend on the form of release of the drug. Tablets are taken orally at 100 mg per day, the maximum daily dosage is 400 mg. The gel is applied to the cleansed skin, triturating to a thin layer 3-4 times a day. The course of treatment is 10-14 days.
• Side effects: headaches, increased drowsiness, nausea and vomiting, gastralgia, pain in the digestive tract, ulceration of the gastrointestinal mucosa, fluid retention in the body, anemia and leukopenia, increased activity of liver enzymes. The gel can cause skin allergic reactions: itching, hives, skin peeling.
• Contraindications: gastrointestinal ulcer in the acute stage, hypersensitivity to the components of the drug, hepatic and renal insufficiency. Pregnancy and lactation, children's age of patients.
• Overdose: increased severity of adverse reactions. Treatment consists of symptomatic therapy.

Nyz is available in the form of tablets of 100 and 50 mg of the active ingredient, in the form of a suspension for oral administration, tablets and a gel for external application.

2. Dikloobl

Nonsteroidal anti-inflammatory drug with an active component of diclofenac sodium. Has a pronounced anti-inflammatory, analgesic and anti-edematous effect.

• Indications for use: various rheumatic diseases, gout, dystrophic joint diseases, soreness in soft tissue injuries or musculoskeletal system, ankylosing spondylitis, myalgia, primary dysmenorrhea.
• Method of administration: the drug is injected intramuscularly into the gluteus muscle at a dosage of 75 mg, the maximum daily dose is 150 mg. For long-term treatment, oral and rectal forms of the drug are used. Tablets take 50 mg 2-3 times a day. The duration of therapy is determined by the attending physician individually for each patient.
• Side effects: dyspepsia, glossitis, gastrointestinal bleeding, vomiting and ponoyu with bloody impurities. Also, headaches and dizziness, insomnia, fatigue and excitability, visual and taste disorders, palpitations and skin allergic reactions are possible.
• Contraindications: intolerance of the drug components, peptic ulcer of the stomach or duodenum, peptic ulcer, hemopoiesis disorders, bronchial asthma, children's age of patients, pregnancy and lactation.
• Overdose: headaches and dizziness, disorientation, convulsions, nausea and vomiting, abdominal pain, gastrointestinal bleeding. Treatment is symptomatic, effectively washing the stomach.

Diclobulle is available as a solution for injections, enteric-coated tablets, in the form of prolonged-action capsules and in the form of suppositories.

3. Adal

The drug from the group of NSAIDs with the active component is aceclofenac. Has anti-inflammatory, antipyretic and analgesic effect. Reduces the morning stiffness and swelling of joints in rheumatic diseases.

• Indications for use: elimination of pain syndrome and decrease in the severity of the inflammatory process with capsulitis, lumbago, rheumatic lesions of soft tissues. It is also used for relief of toothache.
• How to use: tablets take 1 piece twice a day. Duration of treatment is determined by the attending physician, for each patient individually.
• Side effects: nausea, vomiting, disorders of stool and digestion, increased activity of hepatic enzymes, pain in the epigastric region, hepatitis, gastrointestinal bleeding. Also, headaches, taste disorders, disorders of the urinary system, skin allergic reactions are possible.
• Contraindications: hypersensitivity to active components and other NSAIDs, ulcerous lesions of the mucous membranes of the gastrointestinal tract, impaired renal and hepatic function, hemopoietic system disorders. It is not used for treatment of pregnant women and children, and also during lactation.
• Overdose: headaches and dizziness, abdominal pain, nausea and vomiting, convulsions. There is no specific antidote, gastric lavage and enterosorbents are indicated.

Airtal has a tablet form of release.

In addition to the above NSAIDs for the treatment of periarthritis, Ketorol, Aceclofenac, Indomethacin and other agents can be used.

Glucocorticoids and glucocorticosteroids - hormonal drugs are used in cases of intense pain symptoms and inefficiency of NSAIDs.

1. Prednisolone

A synthetic analogue of hormones of cortisone and hydrocortisone, but unlike natural substances does not cause a delay of fluid in the body. Has anti-inflammatory, anti-shock, antitoxic and antiexudative properties.

• Indications for use: diffuse lesions of connective tissue and vessels, rheumatism, joint inflammation, bronchial asthma, leukemia, infectious mononucleosis, neurodermatitis and other allergic diseases.
• The method of application and dosage are individual for each patient and are determined by the attending physician.
• Side effects: ulceration of the digestive tract, obesity, hirsutism, increased brittleness of bone, osteoporosis, decreased sexual function, decreased resistance to infections, impaired blood clotting.
• Contraindications: hypertension, diabetes, pregnancy, psychosis, nephritis, peptic ulcer and duodenal ulcer, recent operations, active form of tuberculosis, syphilis, senile age of patients.
• Overdose is manifested by pronounced adverse reactions. Antidote does not exist, therefore symptomatic therapy is indicated.

Prednisolone is available in the form of tablets for oral administration, ampoules for injections, ointments for external application and eye drops.

2. Medrol

Synthetic glucocorticosteroid with the active substance - methylprednisolone.

• Indications for use: endocrine diseases, rheumatological pathologies, collagenoses, allergic reactions, pathology from the respiratory system and hematopoiesis system, oncological pathologies, gastrointestinal disorders, organ and tissue transplantation.
• The method of application and dosage depends on the severity of the disease and the individual characteristics of the patient's body.
• Side effects: muscle weakness and disorders of the musculoskeletal system, gastric bleeding, a decrease in the protective forces of the immune system, water-electrolyte disorders and metabolic changes.
• Contraindications: hypersensitivity to the components of the drug, pregnancy and lactation.

The drug is available in the form of tablets for oral administration.

3. Betamethasone

Synthetic corticosteroid with a strong anti-inflammatory effect.

• Indications for use: collagenoses, rheumatoid arthritis and acute rheumatic fever, scleroderma, dermatomyositis, impaired motor activity, redness and swelling of the skin, allergic rhinitis, allergic reactions, dermatoses, contact dermatitis, inflammatory diseases of the eyes, herpes zoster, lymph node tumors, hemorrhagic pathology. Diseases of soft tissues and inflammatory lesions of joints.
• The way of application and dosage depends on the stage of the disease state, therefore they are determined by the attending physician.
• Side effects: osteoporosis, weight gain, increased blood pressure, water retention in the body, ulceration of the gastrointestinal mucosa, insomnia, atrophy of the adrenal cortex.
• Contraindications: severe forms of hypertension, circulatory insufficiency, osteoporosis, active form of tuberculosis, syphilis, pregnancy and lactation, peptic ulcer and duodenal ulcer, mental illnesses, systemic mycoses, glaucoma, diabetes mellitus.

Betamethasone is available in the form of tablets for oral administration and as a solution for injections in ampoules.

In addition to the above medicines, Metacortalone, Cordex, Triamcinolone are used for treatment.

Hondoprotectors - the action of medicines is aimed at protecting cartilaginous tissue from destruction. Stimulate the processes of regeneration and nutrition.

1. Structum

Chondroprotective drug with the active component - chondroitin sulfate sodium salt. The active substance is the structural basis of bone and cartilaginous tissue. Promotes the restoration and maintenance of the normal structure of the cartilage matrix.

• Indications for use: degenerative-dystrophic diseases of the spine and joints, osteoarthritis, intervertebral osteochondrosis.
• Method of administration: 1 capsule once a day, irrespective of food intake, with sufficient amount of liquid. The recommended daily dosage is 1000 mg, the course of treatment is 3-6 months.
• Side effects: disorders of the digestive tract, nausea, vomiting, dyspepsia. It is also possible to develop allergic dermatitis, urticaria, and Quincke edema.
• Contraindications: intolerance of the components of the drug, pregnancy and lactation, patients younger than 15 years.
• Overdose: increased severity of adverse reactions. Treatment is symptomatic.

Structum stimulates the synthesis of hyaluronic acid, normalizes the viscosity of the synovial fluid and the homeostasis of the synovial environment of the joints.

2. Adgelon

The drug with the active substance is glycoprotein. Regenerating properties of the drug are widely used in degenerative joint lesions and ophthalmic pathologies. It stops the processes of peroxide lipid oxidation, that is, damage to cell membranes. In ophthalmic practice, activates fibroblastic elements and stimulates the regeneration of the cornea.

In the treatment of arthrosis inhibits degenerative processes and stimulation of cartilage regeneration. Activates the growth of fibroblasts and the proliferative effect of lymphocytes. Has anti-inflammatory, antioxidant and analgesic properties. Stimulates the accumulation of chondroblasts and their transformation into chondrocytes to fill damaged areas of the joint.

• Indications for use: the solution is used for insertion into the joint with polyarthrosis, osteoarthritis, capsulitis and other degenerative lesions. Drops are used to treat ophthalmic pathologies with damage to the cornea shell.
• Method of administration: the solution is administered 2 ml intra-articularly twice a week or a week later. Injections are performed in the hospital in compliance with the rules of asepsis. To achieve a stable therapeutic effect, the treatments are carried out by courses of 5-10 injections. The interval between therapeutic courses should be at least 1 month.
• Side effects: the development of allergic reactions, painful sensations at the injection site, hyperemia and edema of nearby tissues.
• Contraindications: injections are not prescribed for symptoms of synovitis, infectious skin lesions and for the treatment of children. Therapy is not carried out with intolerance of the drug components. Use during pregnancy and lactation should be done with extreme caution.

Adegelon is released in the form of drops of 5, 10 ml and as a solution for intra-articular injection of 2 and 5 ml in an ampoule.

3. Hondrolone

Chondroprotector with active substance - chondroitin sulfate 100 mg. It is used in the normal metabolism of cartilaginous tissue, replenishes the deficiency of glucosaminoglycans. Strengthens synthetic processes, reduces the severity of inflammatory reactions, reduces pain. The active component enhances the synthesis of cartilage macromolecules, normalizes the equilibrium of the processes of destruction and restoration of the cartilaginous tissue.

Chondrolon improves blood supply to joints by inhibiting lipid synthesis and improves blood rheology. Has chondroprotective, anti-inflammatory, analgesic, regenerating and chondro-stimulating action.

• Indications for use: the pathology of the joints, caused by degenerative dystrophic processes in the body. Used for arthrosis, reactive arthritis, osteoarthritis, intervertebral osteochondrosis, capsulitis. It is prescribed for fractures to accelerate the formation of bone callus.
• Method of administration: The drug is used intramuscularly, diluting the lyophilizate in 1 ml of water for injection. Injections are performed every other day, the course of treatment is 1-2 months.
• Side effects: allergic reactions, hyperemia, rashes, local fever, hemorrhages at the injection site.
• Contraindications: thrombophlebitis, coagulation disorders, pregnancy and lactation, patients of childhood.

The drug is released in ampoules with a lyophilized mass in each. In a package of 10 ampoules.

Also for the treatment of capsulitis, such chondroprotective drugs can be prescribed: Arthra, Teraflex, Piascladin, Alflutop, Noltrex, Ostenil, Synocrome, Fermatron, Synvisc.

Antibiotics - are used only if the inflammatory process is caused by infectious agents. Medications destroy the pathogenic flora, speeding up recovery.

1. Tetracycline

Antibiotic of a wide spectrum of action. It is used for inflammatory and infectious diseases of various locations. Before using the drug should determine the sensitivity to it of microflora, which caused pathology. As a rule, patients are prescribed 250 mg every 6 hours. The course of treatment is determined by the attending physician.

Side effects are manifested by violations of the gastrointestinal tract, allergic skin reactions and other lesions of the body. Tetracycline is contraindicated in cases of intolerance to its components, fungal diseases, kidney damage and leukopenia. It is not used during pregnancy and for treatment of patients younger than 8 years. Antibiotic has several forms of release: tablets, suspension and granules for the preparation of syrup.

2. Erythromycin

Antimicrobial agent, similar in its effect to penicillins. It is active against a wide range of pathogens. Therapeutic doses have bacteriostatic properties.

• Indications for use: infectious lung diseases, septic conditions, inflammatory pathologies, inflammation of bone marrow and bone tissue, purulent-inflammatory processes in the body.
• Usage: single dose is 250 mg, with severe conditions take 500 mg every 4-6 hours before meals. The course of treatment is determined by the attending physician, individually for each patient.
• Side effects: nausea and vomiting, stool disorders, liver function disorders, allergic reactions. With prolonged use, development of resistance is possible.
• Contraindications: hypersensitivity to the components of the drug, severe liver function abnormalities, allergic reactions in the anamnesis.

Erythromycin is released in the form of tablets for oral administration, as well as in the form of an ointment of 1%.

3. Lomefloxacin

Antibiotic from the group of fluoroquinolones with the active component - lomefloxacin hydrochloride. Has a wide spectrum of action and anti-tuberculosis activity, but does not affect the microorganisms of mycoplasma, ureaplasma and streptococci.

• Indications for use: infections of the bone system, urinary tract, digestive system, respiratory system, dermatological pathology. It is used in the complex therapy of infectious wounds, osteomyelitis.
• Method of application: daily dose is 400-800 mg, treatment course 10-14 days.
• Side effects: nausea, vomiting, fatigue, stool disorders, candidiasis, nervousness, heart rhythm disturbances, allergic reactions. Overdose is manifested by the intensification of the above reactions, treatment is symptomatic.
• Contraindications: intolerance of the drug components, pregnancy and lactation, pediatric practice.

Lomefloxacin is available in the form of tablets at a dosage of 400 mg each.

In addition to the above drugs, for patients with the capsulitis appoint Nimid and topical antibiotics Fastum, Voltaren-gel.

Medicamentous blockades - are appointed to reduce the intensity of the pain syndrome.

For blockade Novokain is used in combination with steroids (Kenalog, Hydrocortisone) and other drugs. Injections into the affected joint can be done no more than twice a month. This takes into account the risk of developing quite serious complications: a violation of skin pigmentation, degenerative changes in tendon fibers and articular tissues, accumulation of blood in the joint cavity. An expressed analgesic effect has injections with such drugs:

1. Metipred

Glucocorticosteroid hormone with the active substance - methylprednisolone. The mechanism of its action is based on interaction with steroid receptors in the cytoplasm. The drug inhibits the synthesis of enzymes and proteins that are involved in the destruction of joints, as well as cytokines involved in inflammatory and immune reactions. Reduces the tissue response to infectious, immunological, thermal or chemical stimuli.

• Indications for use: rheumatic and autoimmune diseases, allergic reactions, asthma and lower respiratory tract infections, cerebral edema.
• The method of administration and dosage depend on the form of the preparation. The course of treatment is determined by the attending physician, individually for each patient.
• Side effects: various violations of the gastrointestinal tract, increased blood pressure, heart failure, emotional lability, respiratory failure. In rare cases, there is a decrease in elasticity and rupture of tendons.
• Contraindications: intolerance of the components of the drug and lactose, acute and chronic viral infections. With special care, the drug is prescribed for congestive heart failure, diabetes and other endocrine pathologies. Use during pregnancy is possible only for medical purposes.

The drug has several forms of release: tableted, lyophilized powder for the preparation of solution for injection and suspension.

2. Novokain

Local anesthetic, used for analgesia by infiltration, conductive, epidural and spinal methods. Dosage is selected by the attending physician, individually for each patient. Adverse reactions are manifested by increased weakness, lower blood pressure, allergic reactions and dizziness.

Novocaine is contraindicated in cases of intolerance to its components. The medicine is released in the form of powder for the preparation of solution, ampoules with a ready solution, sterile solutions in 200 and 400 ml vials, in the form of ointments for external use and suppositories.

3. Kenalog

Synthetic glucocorticosteroid of systemic use with the active component - triamcinolone acetate. Has anti-inflammatory, anti-allergic and immunosuppressive effect.

• Indications for use: a suspension for injections used for blockade of joints with a violation of the function of the joint bag, dropsy joints, arthrosis, arthritis. Tablets are used to treat allergic diseases, chronic respiratory tract infections and hay fever. The method of administration and dosage are determined by the attending physician, for each patient individually.
• Side effects: nausea, vomiting, digestive disorders, flatulence, ulcerative lesions of the stomach and duodenum, arterial hypertension, increased coagulability of blood, hypertension, depressive states, headaches and dizziness, skin allergic reactions, disorders of the endocrine system, and more.
• Contraindications: intolerance of the drug components, pregnancy and lactation, ulcerous lesions of the stomach and duodenum, condition after severe injuries and surgical interventions, diabetes mellitus, increased tendency to thrombosis and bleeding.
• Overdose: nausea, vomiting, sleep disorders, fluid retention in the body, muscle weakness, hypertension. Hemodialysis is ineffective, therefore, a gradual decrease in the dosage of the drug is indicated until the pain symptoms are completely eliminated.

Kenalog is released in the form of tablets of 4 mg of the active ingredient in each and in the form of injections of 1 ml in the ampoule.

In addition to the above drugs, for blockade use Diprospan, Flosteron, Hydrocortisone and combinations of other medicines.

[1], [2], [3], [4], [5]

Vitamins

An obligatory component of treatment of a capsulitis and other degenerative diseases of the musculoskeletal system is vitamin therapy. Vitamins are necessary for saturation of an organism with useful substances, neutralization of negative influence of medicinal preparations.

Benefits of vitamins:

• Destruction of free radicals.
• Strengthening connective tissues.
• Minimization of pain.
• Activation of metabolic processes in the focus of inflammation.
• Strengthening the immune system.

When capsule is recommended to take such vitamins and minerals:

• B1 - thiamine affects the nerve fibers and reduces their excitability. Has minimal analgesic effect.
• B3 - nicotinic acid increases the amount of movement in the affected tissues, relieves pain.
• B5 - pantothenic acid has an analgesic effect. With prolonged use removes stiffness in the joints and strengthens the action of other vitamins.
• B6 - pyridoxine positively affects the functioning of neuromuscular fibers. Promotes the activation of metabolism in cartilage tissues, improving nutrition at the cellular level.
• B12 - has anti-edematous and anti-inflammatory effect. Relieves fatigue and promotes the synthesis of red blood cells.
• C - ascorbic acid increases the density of bones and prevents the development of degenerative processes. Takes part in oxidation-reduction reactions of the body. Increases the synthesis of collagen, provides restoration of the ligamentous and muscular apparatus, accelerates regeneration processes.
• E - tocopherol reduces pain, which allows to reduce the daily dosage of antiviral and analgesic drugs. Increases the amount of movement in the affected joints, improves well-being.
• Omega-3 - polyunsaturated fatty acid prevents the destruction of bone tissue, increases the elasticity of ligaments and tendons. The substance is part of the synovial fluid, so it improves the mobility of the joints and speeds up the recovery process.
• Selenium - an antioxidant substance, promotes strengthening of immunity. Relieves pain and inflammation. Participates in the synthesis of enzymes of the cartilaginous membrane.
• Copper - has antiviral, antibacterial and analgesic properties. Participates in metabolic processes, reduces pain and swelling. Increases joint mobility and oxygen saturation at the cellular level.
• Zinc - reduces the inflammatory process and painful sensations.

Vitamins should be taken with a capsule for a long period of time. Special vitamin-mineral complexes for the treatment of inflammatory joint damage have not been developed to date. But there are drugs that can be used to strengthen the body as a whole: Duovit, Pentovit, Alphabet, Centrum. The optimal multivitamin complex should be selected by the doctor, individually for each patient after a set of diagnostic procedures and taking into account the therapy.

Physiotherapeutic treatment

To eliminate inflammation, reduce pain and improve metabolic processes with capsule, physiotherapy is indicated.

Acute stage of the disease

• Magnetotherapy - on affected tissues are affected by an alternating magnetic field. The doctor applies special magnetic inductors to the pain zones. The procedure is carried out in a prone position for 10 minutes. The course of treatment consists of 5-10 procedures.
• Extracorporeal shock wave therapy - on the focus of inflammation affect the acoustic waves. The effect of the procedure can be compared with the course of intensive massage. Shockwave method removes puffiness, reduces pain and improves mobility of the affected limb. Treatment is carried out once a week, the course consists of 2-5 procedures.
• Electrophoresis with analgesics - anesthetics are injected into the affected tissues through the skin with the help of an electric current. For this, the joints are impregnated with medicated pads and electrodes. The duration of the session is 20-30 minutes, the course of treatment is 5-10 procedures daily.
• X-ray therapy - has anti-inflammatory and analgesic properties. Used locally on damaged tissue. X-ray irradiation depresses the immune system, stops acute inflammation.
• Decimetre wave therapy - on the fabric is affected by electromagnetic waves of the decimeter range. This ensures a deep penetration of impulses into tissues, resolves the foci of inflammation. The procedures are carried out for 30 minutes, daily for a week.

The phase of subsidence

• Paraffin applications - medicinal mixtures stimulate the regeneration processes in the periarticular tissues. Thanks to this, the healing process is accelerated and the pain sensations are minimized. Warm compresses are applied for 20-30 minutes, daily for 10 days.
• Cryotherapy - the tissues are exposed to dry cold air for 5-10 minutes. The procedures are carried out daily for 10-15 days.
• Electrostatic shower - to improve metabolism in affected tissues, use an electric field of high voltage. The procedure is carried out for 10 minutes, the course consists of 10-12 sessions.

Recovery phase

• Swimming - water procedures contribute to the development of affected joints with minimal stress and adverse reactions.
• Girudoterapiya - leech is attached to the inflamed area, which, when bitten, throws a special substance into the blood. Thanks to this, the effect of anesthesia and dilution of blood occurs. Treatment with leeches has a mild analgesic and pronounced antiseptic effect.
• Mud treatment - mud feed the affected tissues with useful substances and have a mild warming effect.
• Point massage - has a local effect on the damaged area, relieves muscle spasms and restores the mobility of the joints.

All physiotherapeutic methods are chosen by the attending physician, individually for each patient.

Massage with capsule

One of the effective non-medicament methods of treatment of neurodystrophic joint lesions is massage. When capsule massage procedures are combined with taking medications for complex effects on the body and accelerating the recovery process.

Massage has these properties:

• Reduces pain.
• Prevents the development of the angling form of the disease.
• Prevention of atrophy of muscle tissue and decreased activity of joints.
• Restoration of the functionality of the affected limbs.
• Prevents the formation of rough scar tissue.

When capsule the shoulder joint massage is directed to the collar zone, the humerus and shoulder, the large and deltoid pectoralis muscle. The procedures are carried out daily for 15-20 minutes. Thus the expressed therapeutic effect is swept up after passage of 2-3 full courses with a break in 10-20 days.

Such a massage effect is possessed by such procedures:

1. Acupuncture - relieves painful sensations by acting on active points of the body with the help of injected needles. The procedure is performed manually only by a qualified technician.
2. Tapping - on the affected tissues are established teips, that is, stickers made of special material. Adhesive tape fixes and supports the joints, relieving the load and improving blood circulation.

Massage and other manual techniques are contraindicated to carry out with the disease in the acute phase, severe pain and severe inflammation. This is due to the fact that the pressure on the affected tissue can aggravate the pathological process.

LFC for capsules

At the recovery stage, a therapeutic and physical complex is shown to develop the mobility of the affected joint. LFK at a capsule is necessary for:

• Return of muscle strength and tone.
• Strengthening of ligaments.
• Prevention of the development of contracture, that is, limited functionality of the joint.
• Normalization of blood circulation.
• Improvement and recovery of motor functions.

Gymnastics is held during rehabilitation and only under medical supervision. LFK includes exercises in different positions and with special equipment.

Rules for exercise of exercise therapy in periarthritis:

• Gradual increase in load.
• Systematic and regular procedures.
• During the gym the patient should not feel pain.
• All exercises should be conducted at a slow pace.

Gymnastics is contraindicated to carry out with high blood pressure, risk of bleeding, fever, circulatory failure of the second stage and above.

Exercises on capsules

Therapeutic physical culture during capsulitis is carried out at the stage of the subsidence of the disease and the stage of recovery. Exercises reduce pain, increase the mobility of the joint and improve the elasticity of its capsule. Gymnastics can be done only after minimizing pain and acute inflammation.

A great popularity and pronounced therapeutic effect is the set of exercises developed by Popov. The basis of his exercise therapy are rocking, sipping and spinning.

Recommended exercises for capsule shoulder-blade area:

• Maximize your shoulders and draw eight. During the exercise, alternate synchronous and sequential movements.
• Stand near the wall, firmly pressing her back to her. Lift your shoulders and stretch your arms up. Slowly return to the starting position.
• In the standing position, cross your arms outstretched. On inhalation, dilute the limbs, and cross on exhale.
• Raise your arms and simultaneously turn your torso towards the raised hand.
• Pull your arms forward and clasp the hands into the lock. Make a wave movement, gradually increasing the tempo, and then circular movements.
• Bend your arms in the elbows, slowly lower them and return to the starting position.

After each exercise Popov recommends doing warm-up gymnastics in order to develop damaged tissues.

Exercises for severe pain:

• Lie on your back, hands along the trunk. Perform 10-12 rotational movements with your hands, changing the position of the palm brush up and down.
• From the prone position, bend the forearms in the elbows and place the brush on the shoulder. Hold in this position for 2-3 seconds and return to the starting position. Do 7-10 repetitions.
• From the supine position on the back, spread out even hands to the sides and lift up. During exercise, there should be no painful sensations.

When performing therapeutic exercises, one should adhere to certain rules: gradual loading, regularity, slow exercise without jerks. Systematic performance of exercise therapy allows to restore mobility of the joint. In this case, it should be borne in mind that a persistent therapeutic effect can be achieved only with prolonged performance of the exercises recommended by the doctor in conjunction with other therapeutic procedures.

[6], [7], [8], [9], [10]

Alternative treatment

In addition to the methods of classical therapy, some patients resort to alternative treatment of the capsulitis. Consider the popular medicinal recipes:

• Take 500 g of salt and heat it. Pour salt into a tight sock or tissue pouch. Adjust to the affected joint for 15-20 minutes 3-4 times a day. Warming is contraindicated if the disease is in the stage of acute inflammation.
• Take in equal proportions mustard liquid, salt and honey. Thoroughly mix everything and apply to the affected tissue. Cover the compress with polyethylene and wrap it with a warm cloth. Leave on for 15-30 minutes. Carry out the procedure 2-3 times a day.
• ½ cup of grated radish and shredded horseradish mix with one tablespoon of vegetable oil. Mix everything well and apply to the inflamed area. Wrap the compress with parchment and a warm cloth. After an hour, remove and wash the skin with warm soapy water.

Alternative treatment is not able to cure capsulitis, but it can alleviate the symptoms of the disease. Use non-traditional methods can only be agreed with the doctor.

[11], [12], [13]

Herbal Treatment

Some medicinal properties are possessed by some plant components. Treatment with herbs in case of capsulitis is recommended for the following recipes:

• Take 10-20 g of dried and chopped nettle and pour a glass of boiling water. The product should be infused before cooling down, then it is filtered and taken 1 tablespoon 3-4 times a day.
• Dried and chopped raw materials of St. John's wort infused with a glass of boiling water and let it brew for 30 minutes. Strain and take 2-3 times a day for ¼ cup.
• Thoroughly grind two lemons with a peel and two heads of garlic. Fill the vegetable mixture with 200 g of honey. Mix everything well and take 2-3 times a day for 1 teaspoonful.
• Fresh burdock leaves rinse underwater and apply as a compress on the inflamed area. It is recommended to leave it at night.
• Mix in equal proportions the ground grass of the sweet clover, the flowers of St. John's wort, the cones of hops. Add to the vegetable mixture two tablespoons of eucalyptus and 50 g of Vaseline. Ready ointment apply on the sick joint and wrap it with a warm cloth.

Before using herbs, you should make sure that there are no allergic reactions.

Homeopathy

Alternative therapy, whose action is aimed at improving the condition of the affected organ, rather than eliminating the painful symptoms - is homeopathy. Its main goal is to normalize the work of all organs and systems, to activate the biological mechanisms of the body.

When capsulitis use such homeopathic drugs:

• Apis - burning joint pain, swelling and hyperemia.
• Bryonia - pain in the joints, (aggravated during movements and decreasing at rest), swelling of the affected tissues.
• Rus Toxicodendron - pain localized in the ligamentous apparatus and amplified at rest.
• Colchicum - acute pain and inflammation, joint deformity.
• Ledum - swollen joints, the local temperature is increased. The pain intensifies in the warmth and at night.
• Sulfur - degenerative changes with the defeat of the skin.
• Rhododendrom - pains in the joints are combined with severe headaches and a sense of weakness.

The dosage of homeopathic preparations is determined by the homeopath, individually for each patient. Although such drugs contain a small amount of active components, treatment should be carried out with extreme caution.

Homeopathy with capsulitis is contraindicated during pregnancy, with benign or malignant lesions of the body. Such therapy is recommended to be combined with traditional medicines.

Surgical treatment of capsulitis

If conservative therapy of the capsulitis did not give the desired results, then an operation is performed. Surgical intervention is aimed at restoring the mobility of the affected joint. Often use arthroscopic techniques. The main indications for their use are:

• Chronic pain in the joints (injections of corticosteroids are ineffective).
• Recurrent pain in the affected area.
• Degenerative changes confirmed by X-rays.
• Disability of work.

Surgical treatment, performed with periarthritis of the shoulder is called - subacromial decompression. The technique is based on the removal of a fragment of the scapula (acromion) and ligament from this region. Such interference leads to the fact that nearby tissues cease to be injured during movements, the contracture disappears and the full functionality of the limb is restored.

After the operation, the patient is waiting for a long recovery period. During rehabilitation, a complex of physiotherapy, therapeutic gymnastics and the intake of vitamins are shown. If the operation has gone without complications, the joint is restored within 3-5 months. According to statistics, in 95% of cases, surgery allows to avoid relapse of the disease in the future.

Rehabilitation after surgery for a capsule

The length of the rehabilitation period for inflammation of the synovial bag and joint capsule depends on the volume of surgical treatment and its results. Full recovery takes from 2 to 6 months.

• 1 week - the first day shows anti-inflammatory and analgesic therapy, the imposition of cold compresses. This allows you to minimize pain and swelling. The operated limb is immobilized with elastic bandages. In a week, patients are prescribed a special exercise therapy.
• 1-3 weeks - during this period, rehabilitation is aimed at maintaining muscle tone and stimulating circulation. Passive exercises are performed to develop the limb, but with minimal strain on the affected joint.
• 3-6 weeks - muscle tone is practically restored, therefore active gymnastics for development of the shoulder joint and a complex of physiotherapy are shown. Contraindicated to do sharp movements, you should also give up increased physical exertion and reduce the risk of injury to the joint.
• 6-12 weeks - for the full recovery shows increasing strength training. For gymnastics you can use weighting agents and special simulators. Effective classes in the pool.

The whole process of rehabilitation after the capsulitis should take place under strict medical supervision. If during the development of the joint there are sharp pains, swelling or hyperemia of the tissues, then you should abandon the exercises and immediately seek medical help. With all the medical recommendations, the recovery is quite quick and without complications.