ADHESIVE CAPSULITIS

People often walk into the OPDs complaining about, pain in the arm at night while sleeping or its difficult for me to comb my hair or wear my vest etc. On assessing your doctor might tell you that you are suffering from adhesive capsulitis. What is Adhesive capsulitis? Adhesive capsulitis is also known as frozen shoulder, it is a condition in which the movement of the shoulder become limited. This happens because the connective tissue i.e., the joint capsule around the shoulder becomes thick, stiff and inflamed. Lack of use of shoulder often causes the shoulder capsule to thicken and becomes tight.

Although the cause remains unclear, it can be classified as primary or secondary. Frozen shoulder is primary if the onset is idiopathic while secondary results from a known cause or a surgical event. Three subcategories of secondary frozen shoulder include systemic (diabetes mellitus, and other metabolic disorders), extrinsic (cardiopulmonary disease, cervical disc,CVA, humerus fractures, Parkinson’s disease), and intrinsic factors (rotator cuff pathologies, biceps tendinopathy, calcific tendinopathy, AC joint arthiritis).

Patients presenting with adhesive capsulitis often report an insidious onset with a progressive increase in pain and a gradual decrease in active and passive range of motion. It is a self limiting disease with symptom resolution as early as 6 months upto 11 years.

It progresses through three overlapping clinical phases:

1. Acute/painful/freezing phase: gradual onset of shoulder pain at rest with a sharp pain at extremes of motion, and pain at night with sleep interruption which may last anywhwere from 3-9 months.
2. Adhesive/frozen/stiffening phase: Pain starts to subside, progressive loss of glenohumeral motion in capsular pattern. Pain is apparent only at extremes of movement. This may occur at around 4 months and last till about 12 months
3. Resolution or thawing phase: Spontaneous, progressive improvement in functional range of motion which can last anywhere from 1 to 3.5 years.

Some conditions can present with similar impairments and should be included in the differential diagnosis. These include, but are not limited to, osteoarthiritis, acute calcific bursitis/tendinitis, rotator cuff pathologies, rotator cuff pathologies, parsonage- Turner syndrome, a locked posterior dislocation of a proximal humeral fracture.

Treatment usually involves pain relief methods until initial phase passes. If the problem persists, therapy and surgery may be needed to regain motion if it doesn’t return on its own.

Some simple treatments include:

• Hot and cold compresses
• Anti-inflammatory drugs
• Physiotherapy
• Home exercise programme
• Surgical Interventions
• Manipulation under anaesthesia
• Shoulder arthroscopy

• Do hot and cold fermentation. Alternate hot(for 5 mins) and cold (2 mins) helps in reducing the pain and inflammation.
• Apply sesame oil (til oil) or heat some mustard oil with some garlic in it and apply it warm.
• Turmeric milk at night helps to reduce the pain and get good sleep.

Nutrition

• Having Overnight soaked flax seeds helps in reducing the pain.
• Soaked nuts especially walnuts and almonds.
• Have more fruits and raw vegetables as it helps to reduce the pain and inflammation
• Milk and milk products also help in better healing

You can do the exercises given below at home whenever you get such symptoms, but you should always visit an expert physiotherapist whenever the symptoms flare up or there is no improvement

Here are some exercises which can be done at home

The key to the recovery for the frozen shoulder patients is proper stretching, mobilization of the joint and exercises performed by the physiotherapists.

Expert Treatment

There are various advanced techniques available these days which gives a better and complete recovery from the ailment. As compared to with the conventional and traditional treatments which are available with most of the therapist, these new techniques give the best results in the long run.

In these treatments, we work on the muscles and fascia. Basically, whenever there is pain, inflammation, injury, postural imbalance, due to overstretching or over-contraction etc. result in taught band formation known as trigger points. These points are basically reducing the length of the muscle which impairs the joint function and ROM. Every muscle has a trigger point patter. We are working on the faulty biomechanics by releasing these trigger points. Releasing the trigger points results restoring the normal biomechanics, with normal ROM and joint function.

These techniques include:

• Soft tissue release: This helps in restoring the length of the muscle, by releasing the trigger points with various techniques like myofascial release, IASTM, Ischemic compression, Active release technique, passive release technique, Positional release technique and muscle energy technique.
• Dry Needling: In this technique, we insert thin filament needles in the trigger points of the muscles to break them resulting in muscle relaxation, only after having a through knowledge of anatomical structures.
• Deep tissue Release: there are many advanced techniques, which includes massage strokes, and are modifies to address specific conditions like cramps, strains, light, muscular and joint stiffness or breakdown of adhesions and bad scars. This stand alone in the form of tissue treatment, if therapist wants to target deeper muscles or to increase range of motion at any joint using basic but very specific techniques of compression and stretching of the muscles. This is applied by the therapist to treat patients.
• Joint mobilizations: These techniques help in restoring the normal joint ROM by giving graded oscillations to the joints. We use the latest 3-d mobilization technique known as KKMT which gives very fast results to restore the movement by correcting the altered biomechanics.
• Lymphatic Drainage: Our body tends to accumulate extracellular fluid, in cause tissue trauma and lymphoedema is a common condition when the lymph nodes are excised due to which the lymphatic fluid accumulates. This can be drained by lymphatic drainage to release the pressure in the tissues and also helps in increasing the blood circulation.
• Taping: We use various tapes and techniques to apply it. We use Kinesio tape, rigid tape, semi- elastic etc. Taping helps in restoring the function of the muscle, supporting the structure involved, and restricting the joint or the muscle movement.