Adhesive Capsulitis

What Is Frozen Shoulder?

Adhesive capsulitis, commonly called frozen shoulder, is a condition characterized by pain and significant loss of motion in the shoulder joint. The shoulder capsule thickens and tightens, restricting movement. It typically develops gradually, worsens over time, then eventually resolves—often over a period of one to three years.¹

Stages²

Stage 1: Freezing (2-9 months)

• Pain with any movement
• Pain often worse at night
• Progressive loss of motion
• Most painful stage

Stage 2: Frozen (4-12 months)

• Pain may decrease
• Stiffness remains or worsens
• Daily activities difficult
• Motion severely limited

Stage 3: Thawing (5-24 months)

• Motion gradually improves
• Pain continues to decrease
• Recovery varies widely

Risk Factors

• Age 40-60
• Women more affected
• Diabetes (much higher risk)
• Thyroid disorders
• Parkinson's disease
• Cardiac disease
• Prolonged immobilization

Symptoms³

• Dull, aching pain
• Pain in outer shoulder/upper arm
• Worse with movement
• Night pain common
• Progressive stiffness
• Difficulty with daily tasks

Diagnosis

• Physical examination key
• Active and passive ROM both limited
• X-rays to rule out other conditions
• MRI sometimes used

Treatment Options

Conservative

• Physical therapy (essential)
• NSAIDs for pain
• Corticosteroid injections
• Heat before stretching
• Home exercise program

Interventional

• Hydrodilatation (capsule stretching)
• Manipulation under anesthesia
• Arthroscopic capsular release

Physical Therapy Focus

• Gentle stretching within tolerance
• Pendulum exercises
• Wall crawls
• Pulley exercises
• Progress as tolerated

Prognosis

• Most recover with conservative treatment
• Full recovery can take 1-3 years
• Some residual stiffness possible
• May recur or affect other shoulder

References

1. Neviaser AS, Hannafin JA. Adhesive capsulitis: a review of current treatment. Am J Sports Med. 2010;38(11):2346-2356.
2. Reeves B. The natural history of the frozen shoulder syndrome. Scand J Rheumatol. 1975;4(4):193-196.
3. Le HV, Lee SJ, Nazarian A, Rodriguez EK. Adhesive capsulitis of the shoulder: review of pathophysiology and current clinical treatments. Shoulder Elbow. 2017;9(2):75-84.