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Capsulitis: Causes, Symptoms & Treatment

Capsulitis is an inflammation of the joint capsule that causes pain, swelling, and limited range of motion. It commonly affects the shoulder, foot, or finger joints.

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Things worth knowing about "Capsulitis"

Capsulitis is an inflammation of the joint capsule that causes pain, swelling, and limited range of motion. It commonly affects the shoulder, foot, or finger joints.

What is Capsulitis?

Capsulitis refers to an inflammation of the joint capsule – the connective tissue sheath that surrounds and stabilizes a joint. The joint capsule protects the joint, produces synovial fluid, and enables smooth movement. When the capsule becomes inflamed, it can cause pain, swelling, and restricted movement. The most commonly affected joints include the shoulder, the toes (particularly the metatarsophalangeal joints), and the finger joints.

Causes

Capsulitis can be triggered by a variety of factors:

Overuse or repetitive strain: Excessive mechanical stress on a joint through sports, poor posture, or repetitive activity.
Trauma: Direct injuries such as bruising, sprains, or tears affecting the joint capsule.
Inflammatory conditions: Diseases such as rheumatoid arthritis or other autoimmune disorders can predispose a person to capsulitis.
Immobilisation: Prolonged immobility of a joint can cause the capsule to thicken and become inflamed – a condition known as adhesive capsulitis (frozen shoulder).
Metabolic diseases: Diabetes mellitus significantly increases the risk of developing capsulitis of the shoulder.
Structural foot problems: Conditions such as flat feet or splayed feet can place excessive stress on the toe joints.

Symptoms

Symptoms vary depending on the affected joint but typically include:

Pain in and around the affected joint, often worsened by activity
Swelling and warmth around the joint
Restricted range of motion and joint stiffness
Tenderness when the joint is touched or pressed
In adhesive capsulitis of the shoulder: progressive stiffening over months with severely limited movement

Diagnosis

Capsulitis is diagnosed through a combination of:

Clinical examination: A physician assesses range of motion, pain response, and swelling of the joint.
Imaging studies: X-rays to rule out bony changes; ultrasound or MRI (magnetic resonance imaging) to evaluate the joint capsule and surrounding soft tissues.
Laboratory tests: If an inflammatory or rheumatic cause is suspected, blood markers such as CRP, ESR, or rheumatoid factor may be measured.

Treatment

Conservative Treatment

In most cases, capsulitis is managed with conservative approaches:

Rest and offloading of the affected joint
Ice application during the acute inflammatory phase to reduce pain
Anti-inflammatory medications (NSAIDs) such as ibuprofen or diclofenac
Physiotherapy: Targeted exercises to restore mobility, strengthen surrounding muscles, and improve joint function
Corticosteroid injections: A local injection of corticosteroids into the joint can rapidly reduce inflammation in severe cases

Surgical Treatment

If conservative treatment fails to provide sufficient relief over several months, surgical intervention may be considered. In cases of adhesive capsulitis of the shoulder, an arthroscopic capsulotomy (cutting or releasing the capsule) may be performed to restore movement.

Outlook and Prognosis

The prognosis for capsulitis is generally good. Mild cases often resolve within a few weeks. Adhesive capsulitis of the shoulder (frozen shoulder) may follow a longer course of 1 to 3 years but typically resolves completely. Early physiotherapy significantly improves the recovery process.

References

Zuckerman JD, Rokito A. Frozen shoulder: a consensus definition. Journal of Shoulder and Elbow Surgery, 20(2): 322–325, 2011.
Bunker T. Time for a new name for frozen shoulder – contracture of the shoulder. Shoulder & Elbow, 1(1): 4–9, 2009.
Dyer BP, Richardson J, et al. Outcomes of surgery for frozen shoulder: a systematic review and meta-analysis. Bone & Joint Journal, 103-B(5): 813–820, 2021.

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