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General Practice 2023

Treatment for adhesive capsulitis: remédios, physical therapy (and others)

Treatment for adhesive capsulitis: remédios, physical therapy (and others)
Treatment for adhesive capsulitis: remédios, physical therapy (and others)

Treatment for Adhesive Capsulitis, or Frozen Shoulder Syndrome, can be done with physical therapy, painkillers and can take 8 to 12 months of treatments, but it is also possible that there is a complete reduction of the condition in about 2 years after the onset of symptoms, even without any type of treatment.

The doctor may indicate the use of analgesics, anti-inflammatory drugs, corticosteroids or steroid infiltration for pain relief, but physical therapy is also indicated and when there is no improvement in the condition, surgery may be indicated.

Adhesive capsulitis is an inflammation of the shoulder joint that causes pain and intense difficulty moving the arm, as if the shoulder were really frozen.The diagnosis is made by the physician after analysis of imaging tests, such as X-ray, ultrasound and arthrography, which are essential to assess shoulder mobility.

The treatment can be done with:

1. Medicines

The doctor may prescribe analgesics, non-steroidal anti-inflammatory drugs and corticosteroids in pill form to relieve pain in the most acute phase of the disease. Corticosteroid infiltration directly into the joint is also an option for pain relief, and as it is performed, at the average criterion, or every 4-6 months, none of these drugs exclude the need for physical therapy, being complementary.

2. Physiotherapy

Physiotherapy is always recommended because it helps combat pain and restore shoulder movement. In physiotherapy, pain relief equipment and warm compresses can be used to facilitate movement of this joint.Several manual techniques can be used, in addition to stretching exercises (within the pain limit) and later muscle strengthening exercises must be performed.

Recovery time varies from one person to another, but usually lasts from a few months to 1 year, with progressive improvement of symptoms. Although there may not be a significant improvement in the range of motion with the affected arm, in the first sessions it is possible not to develop muscle contractures in the trapezius muscle that can cause even more pain and discomfort.

There are specific techniques that can help break adhesions and promote amplitude, but it is not recommended that the patient keep trying to force the joint to move the arm, because this can generate minor trauma, which in addition to aggravating the pain, does not bring any benefit. At home, only the exercises recommended by the physical therapist should be performed, which may include the use of small equipment, such as a ball, a stick (broom handle) and elastic bands (theraband).

Hot water packs are useful to put on before doing the stretches because they relax the muscles and facilitate muscle stretching, but crushed ice packs are indicated at the end of each session because they reduce pain. Some stretches that can help are:

These exercises should be performed 3 to 5 times a day, lasting from 30 seconds to 1 minute each, but the physical therapist may indicate others according to the needs of each person.

See some simple exercises that help relieve shoulder pain at: Proprioception Exercises for Shoulder Recovery.

3. Suprascapular nerve block

The doctor can perform a suprascapular nerve block, in the office or in the hospital, which brings great pain relief, being an option when medications have no effect and make physical therapy difficult.This nerve can be blocked, because it is responsible for providing 70% of the sensations of the shoulder, and when it is blocked there is a great improvement in pain.

4. Hydrodilation

Another alternative that the doctor may indicate is distention of the shoulder with an injection of air or fluid (saline solution + corticosteroid) under local anesthesia which helps to stretch the shoulder joint capsule, which promotes relief from pain. pain and facilitates shoulder movement

5. Surgery

Surgery is the last treatment option when there are no signs of improvement with conservative treatment, which is done with medication and physical therapy. The orthopedic doctor may perform an arthroscopy or closed manipulation that may restore shoulder mobility. After surgery, the person needs to return to physical therapy to speed up healing and continue with stretching exercises for complete recovery.

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