Frozen Shoulder

What Is Frozen Shoulder?

Frozen shoulder (adhesive capsulitis) is a condition causing pain and progressive stiffness in the shoulder joint. The joint capsule becomes thickened and tight, with adhesions forming. It typically follows a predictable course over 1-3 years.¹

Three Stages

• Freezing (2-9 months) - Gradual onset of pain, increasing stiffness
• Frozen (4-12 months) - Pain may decrease, stiffness peaks
• Thawing (5-24 months) - Gradual return of motion

Symptoms²

• Progressive loss of motion (all directions)
• Pain, especially at night
• Unable to reach behind back
• Difficulty with daily activities
• Both active and passive motion limited

Risk Factors

• Diabetes (2-4x higher risk)
• Thyroid disorders
• Age 40-60
• Female sex
• Immobilization (after surgery, injury)
• Other shoulder conditions

Diagnosis

• Clinical examination (restricted active and passive ROM)
• X-ray to rule out other causes
• MRI can show thickened capsule

Treatment³

Conservative

• Physical therapy - stretching within pain tolerance
• NSAIDs for pain
• Heat before exercise
• Corticosteroid injections (especially in freezing stage)

Interventional

• Hydrodilatation (injecting fluid to stretch capsule)
• Manipulation under anesthesia
• Arthroscopic capsular release

Prognosis

Most cases resolve eventually, but may take 1-3 years. Some people have persistent mild stiffness. Diabetes cases may take longer and be more resistant to treatment.

References

1. Zuckerman JD, Rokito A. Frozen shoulder: a consensus definition. J Shoulder Elbow Surg. 2011;20(2):322-325.
2. Neviaser AS, Neviaser RJ. Adhesive capsulitis of the shoulder. J Am Acad Orthop Surg. 2011;19(9):536-542.
3. Dias R, Cutts S, Massoud S. Frozen shoulder. BMJ. 2005;331(7530):1453-1456.