FROZEN SHOULDER/ADHESIVE CAPSULITIS is a condition characterized by painful progressive stiffness of the shoulder due to inflammation and thickening of the shoulder capsule. It is common in people aged 40–65 years and is more frequent in women and people with diabetes.
SYMPTOMS :
Early (Painful/FREEZING Stage)
Gradual onset of shoulder pain, often without major injury
Pain worsens at night, especially when lying on the affected side
Pain with reaching overhead or behind the back
Difficulty dressing, fastening a bra, combing hair, or putting on a shirt
Increasing stiffness.
Middle (FROZEN Stage)
Pain gradually decreases
Marked stiffness becomes the main complaint
Difficulty with:
Overhead activities
Reaching the back pocket
Tucking in a shirt
Lifting objects
Loss of both active and passive range of motion, especially:
External rotation (first and most affected)
Abduction
Internal rotation.
Late (THAWING Stage)
Gradual improvement in shoulder movement
Minimal pain
Slow return of function.
MANAGEMENT :
1. Pain Relief (Most Important in Early Stage)
Activity modification
Heat therapy before exercises
Ice after exercises if painful
Pain relievers such as Paracetamol or NSAIDs (if appropriate)
2. Physiotherapy
Pendulum exercises
Passive stretching
Active-assisted range-of-motion exercises
Capsular stretching
Scapular strengthening
Avoid aggressive stretching during the painful stage, as it may worsen symptoms.
3. Corticosteroid Injection
An intra-articular corticosteroid injection (preferably ultrasound-guided) is most effective:
During the first 3–6 months
For reducing pain
For improving early motion
Best when combined with physiotherapy
4. Hydrodilatation
Injection of saline with steroid to stretch the joint capsule can improve pain and movement, particularly in the early frozen stage.
5. Manipulation Under Anesthesia (MUA)
Consider if:
Symptoms persist beyond 4–6 months despite conservative treatment
Significant functional limitation remains
Risks include fractures, rotator cuff tears, and dislocation, so patient selection is important.
6. Arthroscopic Capsular Release
Recommended for patients with:
Severe stiffness
Failure of 6–9 months of non-operative treatment
Especially useful in diabetic patients with resistant frozen shoulder.
Postoperative physiotherapy is essential to maintain the improved range of motion.
PROGNOSIS :
Most patients recover substantially with appropriate treatment.
Recovery may take 12–36 months.
Patients with diabetes often experience a longer course and may have residual stiffness.
