Overview of adhesive capsulitis (frozen shoulder)

Kitridis, 2019Yip, 2018

Figure 1. Key practice points for adhesive capsulitis (frozen shoulder). [NB1]
  • Adhesive capsulitis is associated with debilitating shoulder pain for up to 9 months.
  • The condition is self-limiting but can last 18 months to 3 years.
  • Treatment should prioritise oral analgesia, avoidance of aggravating activities, and support for the person’s mental health.
  • Intra-articular (glenohumeral joint) corticosteroid injection and arthrographic hydrodilation of the glenohumeral joint may be recommended for symptomatic improvement, but do not alter the natural history.
  • Surgery is rarely required.
Note: NB1: This list is a summary guide only; refer to full text.

Adhesive capsulitis (frozen shoulder) is the second most common cause of shoulder pain after subacromial pain syndrome. Key practice points for adhesive capsulitis (frozen shoulder) lists some key practice points for adhesive capsulitis (frozen shoulder). It is estimated to affect 2 to 5% of the general population and 10 to 20% of people with diabetes. It is most common in people between 50 and 60 years of age and affects females slightly more often than males. The condition is associated with diabetes, cardiovascular disease, stroke, neurosurgery and thyroid disease.

Note: Adhesive capsulitis generally has a self-limiting course that may last 18 months to 3 years.

The aetiology and pathophysiology of adhesive capsulitis are poorly understood. Adhesive capsulitis generally has a self-limiting course that may last 18 months to 3 years. It classically evolves through 3 overlapping phasesReeves, 1975:

  • an initial painful phase usually lasting 2 to 9 months. This phase is characterised by the insidious development of diffuse, severe and disabling shoulder pain. Pain is worse at night and people are unable to sleep lying on the affected side
  • an intermediate stiff (frozen) phase lasting 4 to 12 months. In this phase, stiffness and severe loss of shoulder movement predominate. Pain is less pronounced but still present, particularly at the end of the ranges of shoulder movement
  • a recovery phase lasting 5 to 24 months, during which time there is a gradual return of shoulder movement.

In each phase management is symptomatic. If pain and stiffness persist despite nonoperative management, consider specialist referral.