Frozen Shoulder (Adhesive Capsulitis)

Also known as: Adhesive capsulitis, Frozen shoulder, Shoulder adhesive capsulitis, Idiopathic adhesive capsulitis, Primary adhesive capsulitis, Secondary adhesive capsulitis, Stiff shoulder syndrome

Last updated: December 18, 2024

Frozen shoulder (adhesive capsulitis) is a condition marked by gradually increasing shoulder pain and stiffness caused by thickening and tightening of the joint capsule. Pain may be diffuse or centered near the deltoid and is often worse at night, sometimes disrupting sleep. Both active and passive shoulder motion progressively declines. It typically lasts 1–3 years or longer and may leave lasting stiffness.

Key Facts

  • •Frozen shoulder, also known as adhesive capsulitis, is a condition characterized by progressive pain and stiffness of the shoulder joint due to thickening and contracture of the joint capsule
  • •Shoulder pain that be diffuse or localized to the deltoid region
  • •Diagnosed through history, physical exam, and imaging
  • •First-line treatment includes exercise, weight management, and activity modification

What It Is

Frozen shoulder, also known as adhesive capsulitis, is a condition characterized by progressive pain and stiffness of the shoulder joint due to thickening and contracture of the joint capsule. The condition typically develops gradually and progresses through distinct phases over months to years before eventually resolving, though significant stiffness may persist in some cases.

Affected Anatomy

This condition affects several structures in and around the joint:

  • •Glenohumeral joint capsule
  • •Synovial lining of the shoulder joint
  • •Coracohumeral ligament
  • •Inferior glenohumeral ligament
  • •Rotator interval
  • •Surrounding shoulder muscles may develop secondary weakness

Common Symptoms

Symptoms can vary in intensity and may change over time. Common experiences include:

  • •Shoulder pain that may be diffuse or localized to the deltoid region
  • •Progressive loss of both active and passive range of motion
  • •Pain that is often worse at night and may disrupt sleep
  • •Difficulty with daily activities such as reaching overhead, behind the back, or to the side
  • •External rotation is typically the most limited motion
  • •Symptoms that progress through freezing (painful), frozen (stiff), and thawing (recovery) phases
  • •Pain may decrease as stiffness becomes more prominent

Causes and Risk Factors

Multiple factors can contribute to the development of this condition:

Causes

  • •The exact cause is often unknown (primary or idiopathic frozen shoulder)
  • •Secondary frozen shoulder may follow injury, surgery, or prolonged immobilization
  • •Inflammatory and fibrotic changes in the joint capsule
  • •May be associated with systemic conditions such as diabetes, thyroid disorders, or autoimmune diseases
  • •Hormonal or metabolic factors may play a role

Risk Factors

  • •Age between 40 and 60 years, with peak incidence in the 50s
  • •Female sex, with women more commonly affected
  • •Diabetes mellitus (significantly increased risk and often bilateral)
  • •Thyroid disorders (hypothyroidism or hyperthyroidism)
  • •Previous shoulder injury, surgery, or prolonged immobilization
  • •Cardiovascular disease or stroke
  • •Dupuytren contracture and other fibrotic conditions
  • •Parkinson disease

How It's Diagnosed

Diagnosis typically involves a combination of clinical assessment and imaging studies:

  • •Medical history focusing on symptom progression, associated conditions, and functional limitations
  • •Physical examination demonstrating loss of both active and passive range of motion
  • •Characteristic pattern with external rotation most limited
  • •X-rays typically appear normal but may show osteopenia or rule out other conditions
  • •MRI may show capsular thickening but is often not required for diagnosis
  • •Blood tests may be used to screen for diabetes or thyroid disease
  • •Diagnosis is primarily clinical based on history and examination findings

Treatment Options

Treatment approaches range from conservative measures to surgical interventions, often starting with the least invasive options:

Self-Care and Activity Modification

  • •Hydrodilatation (distension arthrography) may be considered in some cases
  • •Manipulation under anesthesia may be used for refractory cases
  • •Patient education about the typically prolonged but self-limiting course

Physical Therapy and Exercise

  • •Physical therapy focusing on gentle stretching and range of motion exercises
  • •Heat application before stretching exercises

Medications

  • •NSAIDs for pain management

Injections and Office-Based Procedures

  • •Corticosteroid injections into the glenohumeral joint may reduce pain and improve motion in some patients

Surgery

  • •Arthroscopic capsular release may be considered when other treatments fail

Prognosis and Recovery

The course of this condition varies between individuals:

  • •The condition typically follows a prolonged course lasting 1 to 3 years or longer
  • •Most individuals eventually recover significant motion, though some residual limitation may persist
  • •Treatment may help reduce symptom duration and severity but may not dramatically alter natural history
  • •Patients with diabetes may have more prolonged and severe courses
  • •Recurrence in the same shoulder is uncommon, but the contralateral shoulder may be affected

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