Scapulohumeral Periarthritis: What It Is and How to Treat It

Scapulohumeral periarthritis

Scapulohumeral periarthritis is a generic term, now considered obsolete by the medical community, but still widely used in daily clinical practice to indicate shoulder pain of non-articular origin, caused by inflammation of the structures surrounding the glenohumeral joint: tendons, bursae, joint capsule, and muscles.

The term was coined in 1872 by the French surgeon Simon-Emmanuel Duplay and for over a century was used as a “diagnosis-container” for any painful shoulder. Today, a more specific diagnosis is preferred, because under the umbrella of scapulohumeral periarthritis fall different conditions that require different treatments:

• Supraspinatus Tendinitis (impingement, subacromial conflict)
• Calcific Tendinitis of the shoulder
• Adhesive Capsulitis (frozen shoulder)
• Rotator Cuff injury
• Subacromial bursitis
• Long head of biceps tendinitis

Despite this heterogeneity, physiotherapy treatment represents the first therapeutic approach for all these conditions, with very satisfactory results in the majority of cases.

What is Periarthritis?

The term “periarthritis” literally means inflammation of the structures around (peri) the joint (arthritis). In the case of the shoulder, the involved structures are:

Rotator Cuff Tendons

The rotator cuff is composed of four muscles and their tendons that wrap around the head of the humerus:

• Supraspinatus: the most frequently affected, responsible for initiating arm abduction
• Infraspinatus and teres minor: external rotators of the shoulder
• Subscapularis: internal rotator of the shoulder

Inflammation of these tendons (tendinitis) is the most common cause of periarthritis.

Subacromial Bursa

The subacromial bursa is a fluid-filled sac located between the rotator cuff and the acromion, which reduces friction during movements. Its inflammation (bursitis) causes pain, especially during arm elevation movements.

Joint Capsule

The joint capsule is the fibrous lining of the joint. Its inflammation and retraction cause adhesive capsulitis (frozen shoulder), characterized by pain and marked stiffness.

Long Head of Biceps Tendon

The biceps tendon passes through a bony groove in the head of the humerus. Its inflammation (bicipital tendinitis) causes pain in the front of the shoulder.

Causes

Mechanical Factors

• Repetitive overhead movements: manual labor (painters, masons), sports (swimming, volleyball, tennis)
• Subacromial impingement: mechanical compression of the tendons under the acromion during arm elevation
• Postural alterations: dorsal kyphosis and shoulder protraction reduce the subacromial space
• Scapular dyskinesis: altered scapular movement overloads the rotator cuff tendons

Degenerative Factors

• Age: after 40-50 years, rotator cuff tendons begin to degenerate (tendinosis)
• Reduced vascularization: the supraspinatus tendon has a poorly vascularized “critical zone,” vulnerable to degeneration
• Calcifications: calcium deposits in the tendons (calcific tendinitis)

Systemic Factors

• Diabetes: increases the risk of adhesive capsulitis by 2-5 times
• Thyroid pathologies: associated with adhesive capsulitis
• Rheumatoid arthritis: chronic inflammation of articular and periarticular structures
• Fibromyalgia: widespread pain that can affect the shoulder region

The kinetic chain plays a fundamental role in the genesis of periarthritis: distant postural alterations (pelvis, dorsal spine) impact shoulder biomechanics.

Symptoms

Periarthritis is inflammation of structures surrounding the shoulder joint, including rotator cuff tendons, bursa, and joint capsule, causing pain and restricted movement. Symptoms vary depending on the structure involved:

Rotator Cuff Tendinitis / Impingement

• Lateral shoulder pain with a “painful arc” between 60° and 120° of abduction
• Pain when lifting the arm overhead
• Night pain when sleeping on the affected side
• Preserved strength (unless there is a tendon injury)

Adhesive Capsulitis (Frozen Shoulder)

• Diffuse shoulder pain, often intense in the initial phases
• Marked stiffness: inability to lift the arm, rotate it, or bring the hand behind the back
• Three typical phases: painful phase (2-9 months), stiffness phase (4-12 months), thawing phase (5-24 months)

Calcific Tendinitis

• Acute and violent pain (in the calcification resorption phase)
• Marked limitation of mobility in the acute phase
• Can be asymptomatic if the calcification is in a quiescent phase

Rotator Cuff Injury

• Weakness when lifting the arm or rotating the shoulder
• Pain that may be less intense than tendinitis (rupture reduces compression)
• Crepitus during movement

Diagnosis

Clinical Examination

The physical therapist or doctor will perform:

• Mobility assessment: active and passive, in all planes of movement
• Rotator cuff tests: Jobe’s test (supraspinatus), Patte’s test (infraspinatus), lift-off test (subscapularis)
• Impingement tests: Neer’s test, Hawkins-Kennedy test
• Biceps tests: Speed’s test, Yergason’s test
• Palpation: search for specific tender points

Imaging Diagnostics

• Ultrasound: first-choice examination to assess the condition of tendons, bursa, and identify calcifications
• X-ray: shows calcifications, acromion shape, signs of osteoarthritis
• MRI: indicated if a tendon injury is suspected or for surgical planning

Treatment

Acute Phase

• Relative rest: avoid activities that trigger pain, but do not immobilize the shoulder
• Ice: 15-20 minutes after painful activities
• NSAIDs: anti-inflammatory drugs for pain and inflammation control
• Injections: corticosteroids for resistant acute forms (prescribed by your doctor)

Physiotherapy

The physiotherapy pathway is personalized based on the specific diagnosis:

• Manual therapy: joint mobilizations, soft tissue gliding techniques
• Muscle strengthening: progressive program for the rotator cuff and scapular stabilizers
• Scapulohumeral rhythm re-education: correction of scapular dyskinesis
• Stretching: of the joint capsule, pectoralis minor, latissimus dorsi
• Shockwave therapy: particularly effective in calcific tendinitis
• Physical therapies: laser therapy, ultrasound, magnetotherapy
• Home exercises: the cornerstone of long-term treatment

Exercises for Periarthritis

Your physical therapist will choose the most appropriate exercises based on the specific diagnosis. Below is a general program applicable to most forms of periarthritis.

Mobilization

Codman’s Pendulum Exercise

[IMAGE: Person leaning forward with one hand resting on a table. The painful arm hangs relaxed and swings in small circles and back-and-forth movements, using gravity for gentle traction. Side view showing torso inclination and arm pendulum.]

Supine Assisted Flexion with Stick

[IMAGE: Person lying supine holding a stick with both hands at shoulder width. The healthy arm guides the stick upwards over the head, assisting the painful arm. Arms remain extended. Side view showing upward movement.]

Assisted External Rotation with Stick

[IMAGE: Person lying supine with elbows tucked into sides, flexed at 90 degrees, holding a stick with both hands. The healthy arm pushes the stick laterally, externally rotating the painful arm in an assisted manner. Top view with detail of rotation.]

Stretching

Posterior Capsule Stretch (Cross-Body Stretch)

[IMAGE: Person standing, bringing the painful arm horizontally across the chest (horizontal adduction). The healthy hand grasps the elbow and gently pulls the arm towards the body, stretching the posterior shoulder capsule. Front view.]

Internal Rotation Stretch with Towel

[IMAGE: Person standing with a towel held with both hands behind the back. The healthy hand (upper, above the shoulder) pulls the towel upwards, bringing the painful hand (lower, at lumbar level) into internal rotation. Back view with detail of towel grip.]

Strengthening

External Rotation with Resistance Band

[IMAGE: Person standing with elbow tucked into side, flexed at 90 degrees. A rolled towel is placed between the elbow and side to maintain position. A therapeutic resistance band fixed to a stable point provides resistance. The forearm rotates outwards. Front view.]

Scapular Plane Elevation (Scaption)

[IMAGE: Person standing with a light weight (0.5-1 kg) lifting the arm in the scapular plane (30-45 degrees in front of the frontal plane) with the thumb pointing upwards, up to approximately 90-120 degrees. The movement is slow and controlled. Side view with indication of the scapular plane angle.]

Scapular Retraction with Resistance Band (Rowing)

[IMAGE: Person sitting or standing with a therapeutic resistance band stretched between the hands, arms extended forward. Hands pull the band towards the chest, elbows bend to the sides of the body, shoulder blades move closer to the spine. Back view showing scapular movement and band position.]

Recovery Times

Prevention

• Rotator cuff strengthening: regular exercises 3 times a week
• Stretching: of the posterior capsule and pectoralis minor
• Posture: correct dorsal kyphosis and shoulder protraction
• Ergonomics: avoid prolonged overhead activities, take breaks
• Warm-up: before overhead sports activities
• Diabetes and thyroid: controlling these conditions reduces the risk of adhesive capsulitis

For more information, consult the Complete Guide to Shoulder Pain.

Frequently Asked Questions (FAQ)

Frequently Asked Questions

Given that “scapulohumeral periarthritis” is an older term, what are the more specific diagnoses now used to describe shoulder pain?

Scapulohumeral periarthritis is a broad term encompassing various conditions. Modern medical practice favors specific diagnoses such as rotator cuff tendinitis, subacromial bursitis, or adhesive capsulitis, which allow for more targeted treatment strategies. This precision helps in understanding the exact structures involved and tailoring interventions accordingly.

What are the main goals of physical therapy in treating shoulder pain associated with these conditions?

Physical therapy aims to reduce pain and inflammation, restore shoulder mobility, and improve strength and function. Treatment typically involves a combination of manual therapy, therapeutic exercises, and patient education to facilitate recovery and prevent recurrence. A physical therapist guides individuals through a progressive rehabilitation program.

What are some common factors that contribute to the development of shoulder pain often categorized as scapulohumeral periarthritis?

Common contributing factors include repetitive overhead activities, prolonged poor posture, and age-related degenerative changes in tendons and bursae. Mechanical stress and overuse can lead to inflammation in the structures surrounding the glenohumeral joint. Understanding these factors is crucial for both treatment and prevention.

How is a definitive diagnosis established for shoulder conditions previously grouped under scapulohumeral periarthritis?

A definitive diagnosis typically involves a thorough clinical examination by a healthcare professional, assessing range of motion, strength, and specific pain patterns. This is often complemented by imaging diagnostics, such as ultrasound or MRI, to identify specific structural damage or inflammation in tendons, bursae, or the joint capsule. These tools help differentiate between various shoulder pathologies.

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Sources and Scientific References

1. Iordan DA et al. (2025). Understanding Scapulohumeral Periarthritis: A Comprehensive Systematic Review. Life (Basel). 15. DOI | PubMed
2. Zhu C et al. (2025). The clinical efficacy of proprioceptive neuromuscular facilitation technique in the treatment of scapulohumeral periarthritis: a systematic review and meta-analysis. BMC Musculoskelet Disord. 26:288. DOI | PubMed
3. Pasteur F (1958). [Physiotherapy of scapulo-humeral periarthritis]. Bull Mens Soc Med Mil Fr. 52:128-9. PubMed
4. MOTTA R (1960). [Note on the physiotherapy of scapulohumeral calcareous periarthritis]. Minerva Fisioter Radiobiol. 5:232-7. PubMed
5. Li YH et al. (2019). [Treatment of scapulohumeral periarthritis by Fuyang-pot warming combined with electroacupuncture stimulation]. Zhen Ci Yan Jiu. 44:610-4. DOI | PubMed