yogabook / pathology / capsulitis

Definition

Capsulitis refers to inflammation of the fibrous membrane (stratum fibrosum); inflammation of the synovial membrane is known as synovitis (synovitis). Common sites for capsulitis include the shoulder joint (adhesive capsulitis/frozen shoulder), metatarsophalangeal joints (particularly the second, MTP2), the hip joint, knee joint and finger joints, as well as wrist joint and ankle joint. The causes often lie in overuse (unfamiliar or highly repetitive stresses) or faulty biomechanics/kinematics of the joint; however, capsulitis may also occur secondarily in RA or osteoarthritis. A traumatic cause is also possible, as is a post-operative condition or one caused by immobilisation. Predisposing factors include gout, diabetes mellitus and infections. Untreated capsulitis can affect adjacent ligaments and lead to joint instability. In addition to morning stiffness, a sensation of tightness, tenderness and pain on movement, capsulitis can lead to restricted mobility—often due to pain—and swelling. Due to the pain, the patient often exhibits a correspondingly altered, pain-avoiding movement pattern. Capsulitis is usually treated conservatively with reduced weight-bearing and, if necessary, anti-inflammatory drugs; cooling may also be helpful. Rigid immobilisation should be avoided. After the acute phase, mobilisation is carried out to restore lost range of motion in the joint. The diagnosis is usually made clinically, primarily through tenderness on palpation and range of motion tests. A chronic course with increasing restricted mobility may develop as a complication. A special case is adhesive capsulitis of the shoulder joint, in which fibrotic processes lead to a significant restriction of mobility. The most common locations are:

1. radial wrist
2. ulnar wrist
3. back numbers wrist
4. MTP (often MTP 2): predisposing factors include weak foot muscles, a long second toe, transfer metatarsalgia in hallux valgus, soft shoe soles, very thin shoe soles, tight shoes, high-heeled shoes, defects in the dorsal kinetic chain of the lower limb such as shortening of the triceps surae, spread foot, foot deformities, obesity, trauma, underlying conditions such as osteoarthritis, PA and RA, as well as occupational and sporting stresses. In terms of symptoms, in addition to signs of inflammation, there may also be a reduction in strength in the toes and changes in gait to avoid pain
5. MCP
6. PIP is particularly suited to intensive climbing.
7. knee joint
8. hip joint
9. Ankle
10. Shoulder joint: Special case (adhesive capsulitis/frozen shoulder)

Cause

1. Overload
2. altered biomechanics of the kinetic chain
3. Trauma
4. secondary to primary arthritis

Predisposing

Symptoms

1. Signs of inflammation
2. sensation of tension
3. tenderness
4. Pain on movement
5. Limited mobility, painful range of motion
6. feeling of instability in the joint

Diagnosis

1. clinical

Complications

1. progressive chronic pain
2. progressive stiffening of the joint
3. secondary damage caused by avoidance behaviour and over-conservation
4. Muscle atrophy, loss of strength, reduced joint strength

Therapy

1. Preservation
2. Cooling
3. NSAIDs, if necessary
4. Stretching
5. Treatment of the underlying causes, where these are known and can be addressed
6. if necessary, orthosis