Traitement médical actuel de la capsule rétractile idiopathique et secondaire

Abstract

Management of adhesive capsulitis of the shoulder depends on its severity, its stage, its physiopathology and its nature (idiopathic or secondary adhesive capsulitis). Today, there is no high level of evidence for its treatment's efficiency. During the first stage, called “freezing phase”, the main symptom is pain. The urgency is to relieve the pain and to prevent the shoulder from stiffness. The first treatment is painkiller with or without NSAID. If the patient is not enough relieved, we suggest intra-articular injection of corticosteroids which are efficient in reducing pain and gaining articular mobility in the short term. During stage two, called “frozen shoulder”, the objectives will be to improve articular mobility and to relieve pain. We suggest intra articular injection of corticosteroids in second line therapy, if there is no contraindication, when pain is intense and inflammatory. It showed to relieve pain and to improve mobility in the short term and to improve articular mobility in the mid term, in comparison to oral treatment, placebo and physical exercices. There is no place for oral corticosteroids, as it showed no superiority and they have many side effects, except in case of contra indication to intra-articular injections of corticosteroids. We still have to determinate if the earliness of diagnostic (thanks to the MRI) and the earliness of intra-articular injection could reduce the disease evolution. If the patient is not enough relieved and stiffness is important, we can propose capsular distension followed by intensive mobilization. At every stage, rehabilitation is very important in order to gain articular mobility. No study shows side effects of physical exercises. Several other treatments are under development and show promising results such as radio arterial embolization, intra-articular injection of hyaluronic acid, etc. These treatments could be really interesting in case of chronic stiff capsulitis as an alternative to surgery.