Retractile capsulitis or frozen shoulder and osteopathy

Retractile capsulitis, also called "frozen shoulder", is often confused with shoulder tendinopathy because of the loss of mobility of the shoulder in both cases. It affects 2 to 5% of the population, mostly women, and often starts between the ages of 40 and 60.

Retractile capsulitis, as its name indicates, is a pathology that manifests itself by a retraction of the shoulder capsule. Explanation: around the shoulder, there is a more or less loose membrane that allows the proper movement of the glenohumeral joint. When this membrane retracts, i.e. when it loses its elasticity, the shoulder and particularly the glenohumeral joint is less free and movement becomes very complicated. The simple fact of raising the arm becomes an ordeal... The shoulder is thus frozen, we speak offrozen shoulder.

• Decrease of the articular amplitudes of the shoulder in active and passive! This means that there is a loss of mobility of the shoulder when the patient does the movement himself but also when a third person mobilizes the patient's shoulder.
• Shoulder pain
• Pain or even inability to sleep on the side of the affected shoulder

• Stage 1:
  • hot,
  • inflammatory,
  • painful
  • start of amplitude decrease
• Stage 2: Transitional stage
  • less pain
  • greater decrease in amplitude
• Stage 3:
  • almost no pain
  • large decrease in amplitude

This is a very good question...

The notion of psychological trauma has been evoked for many years as a triggering factor of this pathology. But it would seem that there is no link and that retractile capsulitis of the shoulder can occur even in the best of times.

But to date, there are no causes that have been highlighted only risk factors: 

• Prolonged immobilization of the shoulder (in cases of tendinopathy, post-surgery, stroke, etc.)
• Diabetes: 10 to 20% of diabetics have a retractile shoulder capsule.

Our society also plays a big role in the appearance of shoulder stiffness. In fact, in everyday life, we very rarely raise our arms more than 90°. As we do so, stiffness sets in and then we lose amplitude. It's a bit like the splits we were able to do at the age of 10, but without regular training at the age of 40, it's impossible to do.

The healing of a frozen shoulder is very long, from 1.5 to 2 years, and sometimes 4!
This long period is explained by the fact that it is necessary to wait for the collagen in the capsule to renew itself and unfortunately a collagen cell has a half-life of 200 days to 500 days.

7 to 10% of patients will have a sequelae of decreased amplitude more than 10 years after their retractable capsule.

The good news is that the retractable shoulder capsule almost never recurs on the same shoulder. But in 10% of cases, the second shoulder can be affected, especially in diabetics, but almost never at the same time as the first.

The medications do not treat the retractile capsule but are intended to relieve the pain associated with this condition:

• NSAIDs (non-steroidal anti-inflammatory drugs): do not exceed 8 to 10 days of treatment in cases of acute attacks. Prolonged treatment over several months is absolutely useless.
• Oral corticosteroid therapy: caution to be avoided in diabetics who may become unbalanced.

• Corticosteroid infiltrations within the joint provide relief and can be effective early in the disease.
• Osteoarthritis-distension: it is mostly done in stage 2 (transitional) and it is necessary to do 2 interventions but not more!

Applying cold (ice pack) for 15 minutes will reduce the pain. Be careful not to burn yourself, use a cloth between the ice and the skin.

However, to work on the shoulder, we can warm up the shoulder a little with heating creams or by putting heat to allow the shoulder to soften.

The shoulder must be moved! It is important to remember that the studies are in favor of a non-aggressive manual treatment, that is to say in the respect of no pain or little pain. It is the same when the patient performs his exercises, he must leave his comfort zone without hurting himself. Treating pain with pain is really not a good idea in cases of retractable shoulder capsule.

Long term physiotherapy sessions are much less effective than self-education work done by the patient. However, waves of sessions can be done when the patient is not motorized and coaching is needed.

Here are some examples of exercises:

Osteopathy must be part of the care pathway of the patient suffering from retractile capsulitis of the shoulder. Complementary to physiotherapy, it allows to give back mobility to the shoulder by working on the area but also on the compensations around it. This will optimize the work of the physiotherapist but also that of the patient.

The osteopath will therefore mobilize the shoulder, work on the shoulder muscles as well as on the joint, but also on the cervicals, the dorsal vertebrae and any other structure (muscular, ligamentary or fascial) likely to unbalance the body and the shoulder.

Marie Messager
Osteopath in Versailles
78 - Yvelines