Introduction

Adhesive capsulitis, commonly known as frozen shoulder, is characterized by painful and progressively restricted shoulder mobility due to fibrotic changes in the joint capsule. It affects approximately 2–5% of the general population, with a higher incidence in individuals with diabetes. First described by Codman in 1934 and later termed adhesive capsulitis by Neviaser in 1945, the condition can be primary (idiopathic) or secondary to trauma or surgery (1).

Symptoms

Pain and stiffness are the hallmark features, with persistent discomfort that is often worse at night. Over time, the shoulder’s active and passive range of motion becomes restricted, especially in external rotation. The condition progresses in stages:

1. Freezing – significant pain with gradually worsening motion (1–3 months)
2. Frozen – marked stiffness with diminishing pain (4–12 months)
3. Thawing – gradual recovery of motion (5 months to 2 years) (2)

Causes

Primary adhesive capsulitis arises without a clear cause, though it involves inflammation and fibrosis of the joint capsule. Secondary cases can occur after shoulder injury, surgery, or prolonged immobilization. The pathophysiology involves excessive collagen deposition and contraction of the joint capsule.

Risk Factors

Several factors increase the risk of developing adhesive capsulitis:

– Endocrine disorders such as diabetes and thyroid disease
– Systemic conditions including Parkinson’s disease, stroke, and cardiovascular or pulmonary disease
– Demographic trends show it is more common in women aged 40–60, and often affects the non-dominant shoulder
– People with Dupuytren’s contracture or autoimmune disorders may also be more susceptible

Diagnosis

Diagnosis is clinical, based on a history of shoulder pain and reduced active and passive motion, particularly external rotation. Imaging can support the diagnosis:

– MRI or MR arthrography may show a thickened coracohumeral ligament or obliterated fat in the rotator interval
– Arthrograms might show decreased capsular volume
– MRI can also detect capsular and synovial thickening

Treatment Options

Conservative Management

Initial management includes nonsteroidal anti-inflammatory drugs (NSAIDs) and oral corticosteroids for pain control. Intra-articular corticosteroid injections often provide greater short-term improvements, especially when combined with physiotherapy.
Physical therapy is essential as it focuses on stretching and mobilizing joints. Supervised exercise is generally more effective than passive modalities.
Hydrodilatation (capsular distension with fluid) is sometimes used, but evidence of its added benefit over corticosteroid injection alone is mixed (3)

Minimally Invasive or Surgical Interventions

Manipulation under anesthesia may be considered after failure of conservative treatment.
Arthroscopic capsular release is another option for chronic or refractory cases. Postoperative rehabilitation is essential to maintain the regained mobility (3).

Living With Adhesive Capsulitis

Although adhesive capsulitis is often self-limiting over 1–3 years, some individuals may continue to experience stiffness or pain long-term. Regular adherence to stretching exercises and early mobilization after shoulder injury or surgery can help minimize the risk. Managing underlying medical conditions like diabetes and thyroid disorders is also important for both prevention and minimizing recurrence.

Reference:
1. 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.
2. Ramirez J. Adhesive Capsulitis: Diagnosis and Management. Am Fam Physician. 2019 Mar 1;99(5):297-300. PMID: 30811157.
3. Page P, Labbe A. Adhesive capsulitis: use the evidence to integrate your interventions. N Am J Sports Phys Ther. 2010 Dec;5(4):266-73. PMID: 21655385; PMCID: PMC3096148.