Overview
Adhesive capsulitis, more commonly known as frozen shoulder, is a condition in which the lining of the shoulder joint becomes inflamed, painful, and progressively stiff. Unlike many other shoulder conditions, it usually develops without a specific injury. It most commonly affects middle-aged women and is seen more frequently in patients with diabetes, thyroid disorders, and around the time of menopause.
Frozen shoulder typically follows a predictable course. The shoulder begins with significant inflammation and pain, gradually becomes stiff, and eventually "thaws." Left alone, this process is usually self-limiting but may take up to two years to resolve. I often compare it to the seasons. It begins in summer—hot, inflamed, and painful. It progresses into winter, where the pain begins to improve but the shoulder becomes frozen and stiff. Finally, it begins to thaw, with gradual return of motion and function.
Presentation
Patients usually develop symptoms gradually without any significant injury. Common symptoms include progressive shoulder pain, night pain, increasing stiffness, difficulty reaching overhead, difficulty reaching behind the back (such as fastening a bra or reaching into a back pocket), and pain with nearly all shoulder movement. The hallmark of adhesive capsulitis is loss of shoulder motion, particularly internal and external rotation. Many patients have already completed therapy before seeing me but remain frustrated because the underlying inflammation has not yet been adequately treated.
One of the biggest misconceptions about adhesive capsulitis is that people think it is simply a problem of stiffness. In reality, it begins as inflammation. Until that inflammation is controlled, therapy alone often does not produce the improvement patients are hoping for. MRI studies are usually normal, overread, or show only minimal findings. The diagnosis is primarily made from the patient's history and physical examination findings.
Conservative Treatment
My goal is not simply to wait for the shoulder to improve naturally—it is to speed up the recovery process while making patients significantly more comfortable.
Treatment typically includes:
- Corticosteroid injection into the glenohumeral joint
- Often an additional subacromial injection, when indicated
- Formal physical therapy
- Transition to a home stretching program
- Daily stretching exercises, particularly the Sleeper Stretch
Most patients experience significant pain relief within days of their injection. As pain improves, therapy becomes much more effective and shoulder motion gradually returns over the following months. Occasionally, a second injection is helpful around three months if progress begins to plateau.
Surgical Treatment
Fortunately, surgery is rarely necessary, requiring intervention in less than 5% of patients.
Recovery
With my treatment protocol, approximately 90% of patients achieve at least 90% resolution of their symptoms within about six months. Pain generally improves first, followed by gradual improvement in motion. Once frozen shoulder resolves, it almost never returns in the same shoulder. Most patients return to normal daily activities with excellent function and are very satisfied with their outcome.