What's behind the diagnosis?
The term “humeral periarthritis” combines several different conditions, and treatment depends on which one the patient has. With rotator cuff tendonitis, pain occurs when raising the arm in a certain sector, and the doctor can passively raise the arm higher. With adhesive capsulitis, both active and passive movements are limited, especially external rotation of the arm. A separate category is calcific tendinitis, when calcium salts are deposited in the tendon and the pain becomes very acute.
- Tendonitis and rotator cuff impingement
- Adhesive capsulitis - frozen shoulder
- Calcific supraspinatus tendinitis
- Tendinitis of the long head of the biceps
- Subdeltoid bursitis
- Partial cuff tear
Causes and risk factors
Most often, the process is triggered by overload: work with raised arms, repairs, sports with throwing movements. The second typical situation is forced immobility of the shoulder after injury, chest surgery or stroke. A separate group consists of metabolic and endocrine disorders: in people with diabetes, frozen shoulder is noticeably more common and lasts longer. Thyroid diseases and prolonged bed rest also contribute to contraction of the capsule.
- Work and sports with raised hands
- Shoulder injury or bruise
- Long-term immobilization of the hand
- Diabetes mellitus
- Thyroid diseases
- Cervical osteochondrosis with reflexive hand sparing
Symptoms and stages
Classic frozen shoulder goes through three phases. During the painful phase, pain increases, especially at night and when trying to lie down on the painful side, the range of movements gradually decreases. In the stiffness phase, the pain subsides, but the hand remains limited: it is impossible to reach the back of the head and place the palm behind the back. During the recovery phase, mobility slowly returns. The entire cycle takes from several months to one and a half to two years.
- Night pain that prevents you from sleeping on your side
- Limitation of arm elevation and external rotation
- Difficulty getting dressed and combing one's hair
- Pain radiates to the outer surface of the shoulder
- Gentle pose with a hand pressed to the body
- Over time, the volume of the shoulder muscles decreases
Diagnostics
The doctor evaluates active and passive movements, performs special tests on the cuff and capsule, and checks sensitivity and strength of the hand. Ultrasound shows the condition of the tendons, the presence of fluid and calcifications, and is available in most clinics. An X-ray is needed to rule out arthrosis, fracture and to see calcium deposits. MRI is prescribed if a cuff tear is suspected and before surgery. If numbness in the arm bothers you, the cervical spine is additionally examined.
- Examination and range of motion tests
- Ultrasound of the shoulder joint
- X-ray of the shoulder in two projections
- MRI for suspected cuff tear
- MRI or X-ray of the cervical spine for numbness
- Glucose and HbA1c, thyroid hormones
Treatment and recovery
The main task is to relieve pain so much that a person can do gymnastics, because it is movement that restores volume. In the acute period, anti-inflammatory drugs, a gentle regimen without complete immobility, and physiotherapy are used. If the pain is severe, the doctor may perform a blockade in the area of the joint or bursa. Next, they include stretching exercises that are performed daily and for a long time. Shock wave therapy is effective for calcific tendinitis. Surgical treatment is considered if the shoulder remains stiff after many months of exercise.
- Pain relief as prescribed by a doctor
- Daily therapeutic exercises to stretch the capsule
- Physiotherapy: magnetotherapy, laser, ultrasound
- Shock wave therapy for calcifications
- Blockade with glucocorticoid for severe pain
- Monitoring blood sugar and thyroid function
- Arthroscopic capsule release for persistent stiffness