Adhesive Capsulitis

Abstract

Adhesive capsulitis of the shoulder, also known as frozen shoulder, is an idiopathic condition that presents with pain and stiffness. It is characterized by initial inflammation followed by fibrotic alterations in the glenohumeral capsule without previous injury. Its prevalence is 3–5%, affecting adults between the fifth and sixth decades of life. The association with diabetes mellitus is strong.

The clinical course has three phases: the initial freezing phase, lasting 2–9 months, courses with intense shoulder pain and progressive development of stiffness. Later, in the frozen phase (4–12 months), the pain progressively disappears, and stiffness persists. Finally, in the thawing phase (5–26 months), the stiffness slowly disappears, but 30% of cases will have persistent stiffness.

The diagnosis is fundamentally clinical. On physical exam, there is loss of passive range of motion, with preserved strength. Magnetic resonance imaging will show inflammatory changes and capsular thickening and will help exclude osteoarthritis, rotator cuff disease, or calcifying tendinitis.

Oral NSAIDs and intra-articular steroid injections can provide short-term pain relief. Physical therapy is recommended, but intensive therapy has poorer outcomes than self-administered, home-based, exercises. When symptoms persist for 3–6 months without improvement, arthroscopic capsular release should be considered.