Scope of repertories in the management of adhesive capsulitis of shoulder joint

Dr Anita
ABSTRACT: Frozen shoulder”, or Adhesive capsulitis is characterised by pain and restricted movements of the shoulder usually in the absence of intrinsic shoulder disease. Frozen shoulder most frequently seen in diabetic cases and there is increased diabetes cases worldwide. The aim of this article is to establish a correlation between the frozen shoulder symptoms and the rubrics from different repertories that can be used in clinical settings.

KEYWORDS: Adhesive capsulitis of shoulder (Frozen shoulder), diabetes, Homoeopathic repertory

INTRODUCTION: Adhesive capsulitis was first described as “Peri arthritis” involving peri articular soft tissues of the shoulder by Duplay, in 1872. The term “Frozen shoulder” was first introduced by Codman in 1934. J.S NAVIESAR coined the term “Adhesive capsulitis” in 1945.

Adhesive capsulitis is characterised by pain and restricted movements of the shoulder usually in the absence of intrinsic shoulder disease. Patients with frozen shoulder typically experience insidious shoulder stiffness, severe pain that usually worsens at night, and near – complete loss of passive and external rotation of the shoulder.

EPIDEMIOLOGY/PREVALENCE: Prevalence for frozen shoulder is seen in 2% to 5% in the general population with a significantly increased incidence amongst diabetes on the order of 10% to 20%.  It appears to be most common in adults between the ages of 40 to 60 years. Women appear to be at a slightly increased risk   4:1 compared to men.

ETIOLOGY: Adhesive capsulitis can be classified into primary and secondary forms.

1. Primary adhesive capsulitis: insidious and idiopathic
2. Secondary adhesive capsulitis
   1. Problems directly related to shoulder joint – tendonitis of rotator cuff, bicipital tendinitis, fractures and dislocations around the shoulder.
   2. Problems not directly related to shoulder joint – diabetes, cervical spine disease, Parkinson’s disease, hyperthyroidism, hypothyroidism, ischemic heart disease, reflex sympathetic dystrophy. Most patients have undergone shoulder immobilization for prolonged period before developing adhesive capsulitis.

The precise pathophysiology of adhesive capsulitis remains uncertain. The prevailing hypothesis suggests inflammation initiates within the joint capsule and synovial fluid, followed by reactive fibrosis and adhesions in the synovial lining. The initial inflammation of the capsule causes pain, while the capsular fibrosis and adhesions reduce the range of motion.

SIGNS AND SYMPTOMS: CLINICAL FEATURES:

Three stages for frozen shoulder are

Stage 1(stage of pain): Patient complaints of acute pain, decreased movements, external rotation greatest followed by loss of abduction and then forward flexion. internal rotation is least affected. This stage lasts for 10-36 weeks.

Stage 2 (stage of stiffness): In this stage, pain gradually decreases and the patient complains of stiff shoulders. Slight movements are presents. This stage lasts for 4-12 months.

Stage 3 (stage of recovery): Patient will have no pain and movements would have recovered but will never be regained to normal. It lasts for 6 months to 2 years.

DIAGNOSTIC CRITERIA : In most cases, the diagnosis of adhesive capsulitis is primarily clinical, and imaging is not routinely indicated. However, imaging studies such as a shoulder X-ray and MRI may be considered if there is a concern about an alternative diagnosis or the need to evaluate for conditions such as fractures or other underlying pathology.

REPERTORIAL APPROACH TO FROZEN SHOULDER:

1.From “ Boenninghausen’s therapeutic pocket book” (BTPB)

SECTION	CHAPTER	RUBRIC	SUB RUBRIC
PARTS OF THE BODY AND ORGANS	UPPER EXTREMITIES	Shoulder
	Upper extremities	Left right
	Upper extremities	Joints of upper extremities	Shoulder joint
	Upper extremities	Joints of upper extremities	In general
SENSATIONS AND COMPLAINTS	SENSATIONS	Contractions (after inflammation)
	SENSATIONS	Stiffness see.Rigidity
	SENSATIONS	constriction	In joints
	SENSATIONS	Immobility of affected parts
ALTERATION OF STATE OF HEALTH	AGGRAVATION	Night
	AGGRAVATION	Combing hair
	AGGRAVATION	Hanging down , letting limbs
	AGGRAVATION	motion

2.From “Boger Boenninghausen’s characteristics and repertory”(BBCR)

CHAPTER	RUBRIC	SUB RUBRIC	SUB SUB RUBRICS
EXTREMITIES	UPPER EXTREMITIES	shoulder joint
	UPPER EXTREMITIES	Right left
	UPPER EXTREMITIES	Pain,	joints, shoulder
	UPPER EXTREMITIES	rotation of
	UPPER EXTREMITIES	Stiffness	joint, shoulder
	UPPER EXTREMITIES	Time	night
	UPPER EXTREMITIES	Aggravation	lying in bed, on affected side
	SENSATION AND COMPLAINTS	Inflammation	of internal parts

3.From Kent’s “Repertory of Homoeopathic Materia Medica”

CHAPTER	RUBRIC	SUB RUBRIC	SUB SUB RUBRICS
EXTREMITIES	Inflammation	Joints
EXTREMITIES	Motion	Upper limbs	Up and down Upward and outward
EXTREMITIES	Motion	Upper limbs	Backward and forward
EXTREMITIES	Pain	Joints	Motion Night
EXTREMITIES	Pain	Motion
EXTREMITIES	Pain	Shoulder	Left Lifting Motion, on Night Right
EXTREMITIES	Stiffness	joints	shoulder

4.From “Murphy’s Homoeopathic Materia Medica”

CHAPTER	RUBRIC	SUBRUBIC
57-Shoulders	Frozen shoulder
57-Shoulders	Pain, shoulders	Extending to
57-Shoulders	Pain, shoulders	left
57-Shoulders	Pain, shoulders	Motion ,on
57-Shoulders	Pain, shoulders	Right
57-Shoulders	Stiffness
40-Joints	Arthritis , inflammation
40-Joints	Pain ,joints
40-Joints	stiffness,of

5.From “Pocket manual of Homoeopathic Materia Medica and Repertory” by william boericke

CHAPTER	RUBRIC	SUBRUBIC
LOCOMOTOR SYSTEM	Joints	Pains
LOCOMOTOR SYSTEM	Inflammation (arthritis)	Acute Chronic
LOCOMOTOR SYSTEM	Shoulders scapulae	pains
LOCOMOTOR SYSTEM	Shoulders scapulae	stiffness
LOCOMOTOR SYSTEM	Aggravation	Night
LOCOMOTOR SYSTEM	Aggravation	motion
LOCOMOTOR SYSTEM	Articular	chronic
MODALITIES	Aggravation	Arms moved backward
MODALITIES	Aggravation	Left side Right side
MODALITIES	Aggravation	Motion
MODALITIES	Aggravation	Night

6.From “Synthesis 1.3 Android application” created by Archible SA based on synthesis repertory version 2009

1. EXTREMITIES-PAIN -SHOULDERS
2. EXTREMITIES-PAIN -SHOULDERS,left and right
3. EXTREMITIES-PAIN -SHOULDERS, night
4. EXTREMITIES-PAIN -SHOULDERS,motion,agg
5. EXTREMITIES-PAIN -SHOULDERS,placing arm over head,agg
6. EXTREMITIES-PAIN -SHOULDERS,putting the arm behind him,agg
7. EXTREMITIES-PAIN -SHOULDERS,raising arm, agg
8. EXTREMITIES-STIFFNESS -SHOULDERS,joints
9. EXTREMITIES-PAIN -SHOULDERS,Joints

CONCLUSION:
Though frozen shoulder is a self limiting condition, if left untreated will lead to loss of mobility in shoulder joint. Thus, various repertories like Boenninghausen’s Therapeutic Pocket Book (BTPB), Boger Boenninghausen’s characteristics and repertory, Murphy’s repertory, Kent’s repertory, Boericke’s repertory, Synthesis repertory contains numerous rubrics related to adhesive capsulitis of the shoulder joint helps in selection of similimum. Homoeopathy considers the individual as a complete entity, prioritising the patient’s overall well-being alongside their specific ailment during treatment. These are general guidelines for selecting the most similar remedy, but identifying the correct treatment for each distinct case largely relies on a through examination and individualisation of the case.

REFERENCES:

1. Roberts, H.A., Wilson, A.C. and von, B.C.M.F. (1999) The principles and practicability of Boenninghausen’s therapeutic pocket book for Homoeopathic physicians: To use at the bedside and in the study of the Materia Medica. B. Jain Publishers (P) LTD, New Delhi.
2. Kent JT. Repertory of the Homoeopathic Materia Medica. Enriched Indian ed. New Delhi. B Jain Publishers; 2017
3. Boger CM. Boger Boenninghausen’s Characteristics Repertory with corrected Abbreviations and word index. USA. B. Jain publication; 2015.
4. Murphy R. Homoeopathic medical repertory.3/e. B. Jain Publishers; New Delhi:
5. Archibel SA. Synthesis 1.3 Android app based on Synthesis Repertory Dr Frederick Schroyens; 2009.
6. Boericke William, Pocket manual of Homoeopathic Materia Medica and repertory, 9/e, B. Jain Publishers, New Delhi, 2012,
7. Le HV, Lee SJ, Nazarian A, Rodriguez EK. Adhesive capsulitis of the shoulder: review of pathophysiology and current clinical treatments. Shoulder Elbow. 2017 Apr;9(2):75-84. Doi: 10.1177/1758573216676786. Epub 2016 Nov 7. PMID: 28405218; PMCID: PMC5384535.https://pubmed.ncbi.nlm.nih.gov/28405218/
8. Kasper, Fauci, Hauser, Longo, Jameson, Loseaczo. Harrison’s Principles of Internal Medicine. 19/e; vol 2; 2249
9. 9.Ebenezer, J. Textbook of Orthopaedics (4th ed.). JP Medical Ltd. (2010, October 9). pg. no 378-380

Dr ANITA
PG Scholar, MD(HOM) Part 2
Department of Case Taking and Repertory
Government homoeopathic medical college and hospital, Bengaluru.
UNDER THE GUIDANCE OF Dr. ANUSUYA. M. AKAREDDY MD.HOM
Professor and Head of Department
Email : acsurpur555@gmail.com