Adhesive capsulitis and its Homoeopathic management

Dr Jaspreet Kaur Kapoor 

Abstract
Life is all about movement and activities. The shoulder is the most flexible joint in the body, and given the number of everyday activities, it is involved in from-brushing our- hair to reaching up into the cupboard. It is difficult for anyone to lift heavy objects even to do simple works like opening the door, eating, walking, climbing stairs, typing, turning doorknobs and lifting things all of which require shoulder mobility.

Among many conditions of the shoulder joint “Adhesive Capsulitis” is one of the most common causes for patients suffering.

Key word:- Shoulder joint , adhesive capsulitis , frozen shoulder ,

Introduction
The frozen shoulder was first described as periarthritis involving the peri-articular soft tissues of the shoulder by Duplay in 1872. Codman coined the term “Frozen shoulder” in 1934.He described the frozen shoulder as “difficult to define, difficult to treat, difficult to explain”. J. S. Naviaser coined the term “Adhesive capsulitis” in 1945.

Definition
Adhesive capsulitis is also called as frozen shoulder. Adhesive capsulitis is a condition, which involves scarring, inflammation and tightening of the connective tissue around the shoulder joint, which results in shoulder pain and significant loss of range of motion of the shoulder.

The shoulder joint capsule may sometimes get inflammed leading to scarring and tightening of the shoulder joint capsule. This leads to marked loss of range of motion of the shoulder.

PREVALENCE AND AGE OF ONSET
Prevalence for frozen shoulder is seen in 3% to 5% in the general population with a significantly increased incidence amongst diabetes on the order of 10% to 20%. It appears to be most common in adults between the ages of 40 to 70 years. Women appear to be at a slightly increased risk 4:1. Diabetes also has a tendency to develop bilateral shoulder involvement.

AETIOLOGY & PATHOLOGY:-

• Cause for adhesive capsulitis is unknown. There is no evidence of infection. Injury is an inconstant factor and its significance is doubtful.
  Frozen shoulder mainly occur due to inflammatory condition like bursitis, tendinitis, capsulitis, myositis of shoulder joint or thickening, fibrosis, tightness necrosis, scarring, shrinkage of  the capsule, dryness of synovial fluid, bone damage of shoulder joint
• Pathology is not fully understood. It is believed that there is a loss of resilience of the joint capsule, with adhesion between the synovial folds.

CLINICAL FEATURES:-

Three stages for frozen shoulder are

1. Painful or freezing phase:

This phase lasts 10 to 36 weeks. The patient has Spontaneous onset of shoulder pain, with severely disrupts sleep. The patient often rests the arm, noting an abatement of pain and contributing to increased stiffness.

2. Stiffening or frozen phase:

This phase lasts to 4 to 12 months. The painful phase is often followed by a stiffening phase. The patient has a restricted range of movement (ROM) in a charistiactercs pattern of loss of external rotation, internal rotation and abduction.

3. Thawing phase:

The final phase is described as thawing and is characterized by the gradual recovery of range of movement (ROM). The thawing phase will last an average of 5 to 26 months and is reportedly directly related to the length of duration of the painful phase

Classification:-

1. Primary frozen shoulder:

Primary frozen shoulder refers to the idiopathic form of a painful, stiff shoulder. Possible causes include

• Immunologic
• Inflammatory
• Biochemical and
• Endocrine alterations

2. Secondary frozen shoulder:

Secondary frozen shoulder can be indicated by a precipitating event or trauma, which can be identified to explain the loss of motion. Possible causes include

• Limitations following surgery
• Soft tissue trauma or fracture

DIAGNOSIS:-

• Diagnosis of frozen shoulder based on signs and symptoms and a physical exam; paying close attention to the arms and shoulders.  Structural problems can only be identified with the help of imaging tests, such as an X – ray or MRI.

HOMOEOPATHIC POINT OF VIEW:-

• Samuel Hahnemann Says: In the chronic disease as affected by psora. The pain is pressive between the  shoulder-blades.
• -Sensation of pressure upon the shoulders.
•  In the limbs, drawing (tearing), tensive pains, partly in the muscles and partly in the joints(Rheumatism).
• -The joints, as it were, stiff, with painful, difficult motion, the ligaments seem too short.⁹
• J Henry Allen Says:  In the chronic miasm: As psora joint pains often is worse by motion and better by rest and warmth.
• The sycotic pain are worse by rest and the patient is relieved by moving, by rubbing, stretching, and better in dry, fair weather; worse at the approach of a storm or damp, humid atmosphere and a falling barometer or becoming cold; heat does not always relieve a sycotic patient; stiffness and soreness, especially lameness, is very characteristic of sycosis

TREATMENT:-

• Treatment options for frozen shoulder include:
• Painkillers– relieve symptoms of pain. Nonsteroidal anti – inflammatory drugs (NSAIDs).
• Exercise– frequent, gentle exercise can prevent and even reverse stiffness in the shoulder.
• Hot or cold compression packs– help to reduce pain and swelling. It is often helpful to alternate between the two.
• Physical therapy: exercises to maintain as much mobility and flexibility as possible.
• Corticosteroid injections– a type of steroid hormone that reduces pain and swelling. Corticosteroids may be injected into the shoulder joint to alleviate pain, especially in the ‘painful stage’ of symptoms. However, repeated corticosteroid injections are discouraged as they could cause damage to the shoulder.
• Shoulder arthroscopy– a minimally invasive type of surgery used in a small percentage of cases.

HOMOEOPATHIC MANAGEMENT:-
Homeopathy treats the person as a whole. It means that homeopathic treatment focuses on the patient as a person, as well as his pathological condition. The homeopathic medicines are selected after a full individualizing examination and case-analysis, which includes the medical history of the patient, physical and mental constitution etc. A miasmatic tendency (predisposition/susceptibility) is also often taken into account for the treatment of chronic conditions. The medicines given below indicate the therapeutic affinity but this is not a complete and definite guide to the treatment of this condition. The symptoms listed against each medicine may not be directly related to this disease because in homeopathy general symptoms and constitutional indications are also taken into account for selecting a remedy

• Phytolacca : aching , soreness, restlessness, prostration are general guiding symptoms. Shooting pain in right shoulder, with stiffness and inability to raise arm. Pains fly like electric shocks,shooting, lancinating, shifting rapidly.

• Ferrum met. : Shootings and tearing in the joint of the shoulder, and in the arm, or pullings or paralytic weakness, and heaviness aggravated on abducting arm. Cracking in the shoulder-joint. Nightly tearing and stinging in the arm. Cramps and numbness in the fingers. Persons of sanguine temperament; pettish, quarrelsome, disputative, easily excited, least contradiction angers; >. from mental exertion. Irritability:.Extreme paleness of the face, lips and mucous membranes which become red an flushed on the least pain, emotion or exertion. Worse in winter.
• Ferrum phos: Violent drawing, tearing pain right shoulder and upper arm, worse violent motion of arm, better gentle motion, so that patient hardly kept it still at all, sensitive, deadness in right hand. Acute rheumatism of right deltoid, unable to wear cloak. In right shoulder-joint acute rheumatism, red, swollen, very sensitive..Ferrum is used in first stage of inflammation.
• Ferrum acetate :  Pain in right deltoid. Especially adapted to thin, pale weak children who grow rapidly and easily exhausted. Worse sitting still and lying.

• Ferrum pic : pain in right side of neck and down right arm.

• Sanguinaria can. : Rheumatic pain in right arm and shoulder, worse at night in bed, cannot raise arm. Pain in top of right shoulder. Pain in right deltoid. R. arm hung helpless. Coldness in body. Burning of palms. Stiffness of finger-joints.

• Syphillinum : Rheumatism of shoulder joint, at insertion of deltoid worse at night. Sciatica. Rheumatic muscles are caked in hard knots or lumps.

• Solanum lycopersicum: sharp pain in right deltoid and pectorlis muscles. Pain deep in middle of right arm. Rheumatic pain in right elbow and wrist, and hands of both sides. Pains left after influenza.

• Sticta : offers a set of symptoms like coryza, bronchial catarrh and influenza, together with nervous and rheumatic disturbances. Rheumatic pain in right shoulder joint, deltoid and biceps. Swelling , heat, redness over affected joint. Rheumatic pains proceede catarrahal symptoms.

• Ruta g.: Wrenching pain in the shoulder-joint, especially when permitting arms to hang down or when resting on them. Dull tearings in bones of the arm and joints of elbow. Pain in forearms as well as in bones and joints of hands as if they had been beaten. All parts of body are painful as if bruised.

• Guaiacum : immovable stiffness very much marked. Contraction of limbs, stiffness and immobility. Joint swollen, painful and intolerant of pressure;can bear no heat. Unclean odour from whole body.

• Thiosinaminum : a resolvent externally and internally, for dissolving scar tissue, adhesions, strictures.

• Cocculus : painful contractures of limbs. Cracking of cervical vertebra when moving head. Paralytic pain in small of back. Pain in shoulder and arms as if bruised. Pressure in scapula and nape. Stiffness on moving shoulders. Worse after loss of sleep, riding, noise, menstrual period.

References:-

• D’Amato, K., and M. Rogers. “‘Frozen Shoulder’—A Difficult Clinical Problem”. Osteopathic Family Physician, Vol. 4, no. 3, 1, pp. 72-80,
• Kasper ,Fauci,Hauser,Longo,Jameson,Loseaczo;Harrison’s Principles of Internal Medicine 19^thedition;volume 2;page:2249.Accessed on: 30/1/2019
• Research In Pharmacy And Health Sciences; Volume 4;Issue4;oct-dec2018 Accessed on:30/1/2019
• Crawford.adams DavidL. Hamblen; Outline Of Orthopedics;13^thedition; Published by, Churchill Livingstone 2001,page:226
• The Journal Of Bone And Joint Surgery; Volume 89; no.7;March 2007; Accessed on : 4/2/19
• A.Donatelli; The Physical Therapy Of The Shoulder;4^thEdition;Published by, Elsevier; page: 320, & 321
• Samuel Hahnemann; The Chronic Diseases Their Peculiar Nature And Their Homoeopathic Cure;Volume1;Reprint Edition July 2009;Published by, Indian Books And Periodical Publishers New Delhi; Page 78,79.
• H. Allen; The Chronic Miasma Psora PseudoPsora And Sycosis; Reprint Edition1994; Volume 1and 2; Published by, B. Jain publishers PVT Ltd; New Delhi; page 250,251.
• William Boericke, MD. Pocket Manual Of HOMOEOPATHIC Materia Medics And Repertory

Dr Jaspreet Kaur Kapoor
M.D Part 2 (scholar), Department of Homoeopathic Materia Medica, Sri Guru Nanak Dev Homoeopathic Medical College , Ludhiana , Punjab , India
Jaspreetkapoor94@gmail.com