1 4 . H O W T O U S E T H E W I R E L E S S P R O F E S S I O N A L O N S P E C I F I C
I N D I C AT I O N S
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WIRELESS PROFESSIONAL
14.8.3 adhesive capsulitis
The SECEC (European Society for Surgery of the Shoulder and the Elbow) gives the following clinical
definition for retractile capsulitis: limited active and passive mobility, by a minimum of 30%, in the 3 planes,
for more than 3 months.
This limitation results from the thickening (inspissation) and fibrosis of the joint capsule with recess
disappearance, which translates into a loss of active and passive shoulder mobility.
This affliction is idiopathic in a third of cases, but in the other two thirds there is a prior shoulder
pathology that can be of a highly variable nature (shoulder trauma, shoulder surgery, hemiplegia,
subacromioncoracoid impingement, etc.). The diabetic population is particularly at risk, with 20% of this
population presenting capsulitis at some stage. Note that the initial development is a reflex sympathetic
dystrophy (even if this does not exactly conform with a strict definition of the term, since it essentially
affects the limb extremities); this reflex sympathetic dystrophy then regresses as the capsule fibrosis and
the joint ankylosis develops.
Clinically, we see the development of a first entirely painful acute phase, then the shoulder gradually
loses mobility as the pain recedes; then, the shoulder is just stiff and painless. At this point there is a loss
of active and passive mobility affecting especially the abduction and external rotation of the shoulder
(external rotation is reduced to at least 50% compared to the healthy side).
There is spontaneous evolution towards recovery for a period of time that varies from 3 months to 2 years,
depending essentially on the quality of the rehabilitation treatment used.
The objectives of rehabilitation are first to relieve pain in the acute phase, and then to restore the
biomechanical and neuromuscular qualities of the shoulder.
14.8.3.1 Protocol
Phase 1 (acute phase):
TENS
The criterion for moving from phase 1 to phase 2 is achieving a shoulder that is not painful at rest. Clinical
examination often exposes a set of symptoms similar to those of rotator cuff tendinopathy, for which
the same therapeutic approach can be used. This clinical presentation is the result of the compensatory
mechanisms established during the acute phase.
Phase 2:
Disuse atrophy Level 1, then Disuse atrophy Level 2.
14.8.3.2 treatment frequency
Three to five sessions per week.