Periarthritis

Periarthritis is a condition that causes pain and stiffness in joints, most commonly affecting the shoulder, where it is often called “frozen shoulder” or adhesive capsulitis. Understanding this condition can help you recognize symptoms early and seek appropriate treatment to restore movement and reduce discomfort.

Table of contents

• What is periarthritis?
• Other names for this condition
• Parts of the body affected
• What causes periarthritis?
• Who is at risk?
• Signs and symptoms
• Stages of the condition
• How is periarthritis diagnosed?
• Treatment options
• Prevention and self-care
• What to expect

What is periarthritis?

Periarthritis is a condition in which the soft tissues around a joint become inflamed and cause pain and stiffness^[1]. The term “periarthritis” describes a painful shoulder syndrome that is distinct from arthritis, with general preservation of the joint visible on imaging^[2].

The condition involves inflammation in the area surrounding a joint, rather than within the joint itself^[7]. When calcium crystals build up around the joint, this can result in inflammation and symptoms^[7].

The most common form is adhesive capsulitis, or frozen shoulder, which describes a process in which the body forms excessive scar tissue or adhesions across the joint, leading to pain, stiffness, and difficulty with movement^[2]. In this condition, the strong connective tissue surrounding the shoulder joint, called the shoulder capsule, becomes thick, stiff, and inflamed^[8].

Other names for this condition

frozen shoulder, adhesive capsulitis, scapulohumeral periarthritis

Parts of the body affected

While periarthritis most commonly affects the shoulder, it can occur in other joints throughout the body^[5][7].

• Shoulder
• Hip
• Knee
• Ankle
• Foot
• Elbow
• Wrist
• Fingers

In the shoulder, the condition primarily affects the ball-and-socket joint where the top of the upper arm bone (humerus) meets the shoulder blade (scapula)^[4]. A flexible capsule filled with a lubricating fluid called synovial fluid normally protects this joint and helps it move smoothly^[12].

What causes periarthritis?

The exact causes of periarthritis are not fully understood^[4][12]. However, an inflammatory process is probably involved^[12].

When periarthritis affects the shoulder, the shoulder capsule thickens and becomes stiff and tight. Thick bands of tissue called adhesions develop, and there is often less synovial fluid in the joint^[4]. The shoulder capsule can develop inflammation followed by a buildup of scar tissue, which causes the joint to become tight and restrict movement^[2].

The process usually begins with an injury, such as a fracture, or inflammation of the soft tissues^[12]. Sometimes freezing occurs because the shoulder has been immobilized for a long time by injury, surgery, or illness^[1][12]. A history of trauma is found in one third of patients with acute calcific periarthritis^[5].

When pain from inflammation causes a person to avoid moving the shoulder, this leads to further contraction of the capsule. The upper arm bone has less space to move, and the joint may lose its lubricating synovial fluid^[12]. In advanced cases, bands of scar tissue (adhesions) form between the joint capsule and the head of the upper arm bone^[12].

Periarthritis can be primary or secondary. Primary (or idiopathic) periarthritis can occur spontaneously without any specific trauma or event^[2]. Secondary periarthritis is often observed after injury or surgery^[2].

Who is at risk?

Several factors can increase the likelihood of developing periarthritis:

Age: Frozen shoulder most commonly affects people between the ages of 40 and 60^[4][8]. The condition affects mainly people in this age range, with an average age of 45 years^[5].

Gender: The condition occurs in women more often than in men^[4][8]. Some researchers note that periarthritis involving joints of the elbow, wrist, hand, and great toe shows a higher proportion of pre- and perimenopausal women^[5].

Medical conditions: People with diabetes and thyroid conditions are at increased risk for developing frozen shoulder^[4]. Between 10% and 20% of people with diabetes develop frozen shoulder^[8]. Other conditions that increase risk include hypothyroidism (underactive thyroid gland), hyperthyroidism (overactive thyroid gland), Parkinson’s disease, heart disease, and stroke^[8][10].

Shoulder injury or surgery: Any shoulder injury or surgery that results in the need to keep the shoulder from moving increases the risk of frozen shoulder^[1][8]. Having to keep a shoulder still for a long period is a major risk factor^[1].

Repetitive activities: Repetitive microtrauma in the hand (especially in manual workers) and the feet (due to footwear) is thought to be a possible cause of acute calcific periarthritis^[5].

Signs and symptoms

The primary symptoms of periarthritis are pain and stiffness in the affected joint^[1][10].

When periarthritis affects the shoulder, the most common symptom is shoulder pain. At first, you may feel pain only during activity. As time goes on, you may feel pain at any time, with or without arm movement^[21]. The pain may be dull or sharp and may be felt in the front, back, or top of the shoulder^[10].

You may experience stiffness and loss of range of motion in the shoulder. Any movement of the shoulder causes pain, and the shoulder’s ability to move becomes limited^[1]. The shoulder becomes very hard to move over time^[4]. These symptoms may make everyday tasks like bathing or dressing difficult^[21].

Other symptoms can include:

• Grinding, clicking, popping, or cracking in the shoulder joint. Loss of cartilage, which leaves an unsmooth surface, causes these noises. The noises occur with or without pain^[21].
• Loss of sleep. It’s difficult to find a comfortable sleeping position. Any shoulder movement may hurt^[21]. For some people, the pain worsens at night, sometimes disrupting sleep^[1].

In acute calcific periarthritis, patients present with a sudden onset of pain, localized swelling, redness, tenderness, and restricted range of motion. Symptoms reduce in severity within 4 to 7 days and resolve on their own in 3 to 4 weeks^[5].

Stages of the condition

Frozen shoulder typically develops slowly in three stages^[1][4]:

Stage 1: Freezing stage
In the “freezing” stage, you slowly have more and more pain. Any movement of the shoulder causes pain, and the shoulder’s ability to move becomes limited^[1]. As the pain worsens, your shoulder loses range of motion^[4]. This stage lasts from 6 weeks to 9 months^[1][4].

Stage 2: Frozen stage
Pain might lessen during this stage. However, the shoulder becomes stiffer, and using it becomes more difficult^[1]. Painful symptoms may actually improve during this stage, but the stiffness remains^[4]. During the 4 to 6 months of the “frozen” stage, daily activities may be very difficult^[4]. This stage lasts from 4 to 12 months^[1].

Stage 3: Thawing stage
The shoulder’s ability to move begins to improve^[1]. Shoulder motion slowly improves during the “thawing” stage^[4]. Complete return to normal or close to normal strength and motion typically takes anywhere from 6 months to 2 years^[4]. This stage lasts from 5 to 24 months^[1].

How is periarthritis diagnosed?

During a physical exam, a healthcare provider will ask you to move your arm in certain ways to check for pain and see how far you can move your arm on your own (active range of motion). Then you may be asked to relax your muscles while the provider moves your arm (passive range of motion). Frozen shoulder affects both active and passive range of motion^[6].

Frozen shoulder can usually be diagnosed from signs and symptoms alone^[6]. However, imaging tests such as X-rays, ultrasound, or MRI (magnetic resonance imaging) can help rule out other problems^[6].

Acute calcific periarthritis has specific imaging findings which allow it to be differentiated from other disorders when combined with the clinical presentation^[5].

Treatment options

The goals of treatment for periarthritis are to relieve pain and restore movement and shoulder function^[13]. Most frozen shoulder treatment involves controlling shoulder pain and preserving as much range of motion in the shoulder as possible^[6].

Conservative management leads to improvement in most cases^[9]. More than 90% of patients with adhesive capsulitis respond to conservative interventions to control pain and restore motion^[13]. The condition is self-limiting, and long-term outcomes are essentially the same regardless of the treatment used^[13].

Physical therapy and exercises

Physical therapy and home exercise are first-line treatments for all stages of frozen shoulder^[13]. A physical therapist can teach you range-of-motion exercises to help recover your shoulder movement^[6]. Physical therapy, with a focus on shoulder flexibility, is the primary treatment recommendation for frozen shoulder^[4].

The cornerstone of periarthritis treatment is physical therapy. Stretching and mobility exercises help maintain and gradually increase range of motion^[19]. Your commitment to doing these exercises is necessary to regain as much movement as possible^[6].

Pain relief medications

Pain relievers such as aspirin and ibuprofen can help reduce pain and inflammation associated with frozen shoulder^[6]. Nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen or aspirin, can help reduce pain and inflammation^[19].

In some cases, a healthcare provider might prescribe stronger pain-relieving and anti-inflammatory drugs^[6]. Oral corticosteroids can be prescribed in place of NSAIDs, as they provide a stronger anti-inflammatory effect. However, they should not be given routinely due to their potential adverse effects^[13].

Injections

Injecting corticosteroids into the shoulder joint might help decrease pain and improve shoulder mobility, especially in the early stages^[6]. These injections are often combined with physical therapy and anti-inflammatory medications^[13]. For more severe pain, your doctor may recommend corticosteroid injections, which can offer temporary relief^[19].

Some sources mention PRP therapy (Platelet-Rich Plasma therapy) as a treatment option. This involves using a patient’s own blood, which is processed to extract a concentrated platelet-rich plasma solution and then injecting it into the affected shoulder joint to promote healing and reduce inflammation^[10].

Surgical and other procedures

Failure to obtain symptomatic improvement and continued functional disability after 3 to 6 months of conservative treatment are general indications for surgical management^[9]. Most frozen shoulders get better on their own within 12 to 18 months^[6].

Invasive options for difficult cases include^[13]:

• Extracorporeal shockwave therapy
• Manipulation under anesthesia
• Hydrodilatation (hydrodistention): An arthrographic distension or hydrodilatation procedure may be performed^[1]
• Arthroscopic capsular release: Rarely, arthroscopic surgery is needed to loosen the joint capsule so that it can move more freely^[1]

Prevention and self-care

While periarthritis is not always preventable, there are steps you can take to reduce your risk^[10]:

• Maintain a healthy weight: Excess weight can put strain on the shoulder joint and increase the risk of periarthritis^[10].
• Regular exercise: Regular exercise can help maintain flexibility and strength in the shoulder joint^[10].
• Blood sugar control: In diabetic patients, maintaining blood glucose levels within normal range can decrease the chances of developing periarthritis^[10].
• Early mobilization: Early mobilization after an injury or surgery and regular shoulder exercises can reduce the risk of developing periarthritis^[19].
• Protect your joints: Avoiding injuries to joints can reduce the chances of getting this type of condition or making it worse^[20].

What to expect

Periarthritis is generally self-limiting. Symptoms usually start slowly and get worse over time, but within 1 to 3 years, symptoms typically get better^[1][4]. After a period of worsening symptoms, a frozen shoulder tends to improve, although full recovery may take up to 3 years^[4].

The entire cycle of frozen shoulder can last anywhere from several months to up to two years if left untreated^[19]. Some studies on the natural history of the condition have noted long-term pain in many patients who receive nonoperative treatment, with as many as 10% of patients never fully recovering normal shoulder activities^[13].

It’s unusual for frozen shoulder to recur in the same shoulder. However, some people can develop it in the other shoulder, usually within five years^[1].

Acute calcific periarthritis symptoms reduce in severity within 4 to 7 days and resolve on their own in 3 to 4 weeks^[5]. Prompt diagnosis results in appropriate management and reduces the likelihood of unnecessary diagnostic and therapeutic procedures^[5].