From the Guidelines
Frozen shoulder, or adhesive capsulitis, is a condition that should be managed with a stepwise approach, prioritizing pain control and physical therapy to improve range of motion and reduce stiffness, as evidenced by recent guidelines 1. Frozen shoulder is characterized by progressive stiffness and significant restriction of shoulder movement, occurring when the capsule surrounding the shoulder joint becomes inflamed, thickened, and tight, limiting motion in all directions.
Key Management Strategies
- Pain control using NSAIDs like ibuprofen or naproxen
- Physical therapy with gentle stretching exercises to maintain and improve range of motion, focusing on external rotation and abduction 1
- Corticosteroid injections into the joint space for temporary relief during the painful freezing phase
- Heat application before exercises and ice afterward to manage discomfort
Additional Considerations
- For severe cases unresponsive to conservative treatment, options include hydrodilatation, manipulation under anesthesia, or arthroscopic capsular release
- Recovery progresses through three phases—freezing, frozen, and thawing—and can take 1-3 years for complete resolution
- Early intervention with consistent physical therapy offers the best outcomes, as the condition can self-limit but often with residual stiffness if not properly addressed, highlighting the importance of evidence-based management strategies 1
From the Research
Definition and Characteristics of Frozen Shoulder
- Frozen shoulder, also known as adhesive capsulitis, is a condition characterized by significant reduction in both active and passive range of motion (ROM) accompanied by stage-dependent pain 2.
- It is regarded as a distinct clinical entity showing a benign and regular course, with primary and secondary forms, the former having an unknown etiology and increased occurrence in patients with metabolic disorders 2.
- The condition progresses in three stages: freezing (painful), frozen (adhesive), and thawing, and is often self-limiting 2, 3.
Management and Treatment of Frozen Shoulder
- Treatment should be adjusted to the stages of the condition, with recommendations including analgesics and joint injections in the first stage and physiotherapy in combination with manual therapy in the second and third stages 2.
- Physical therapy exercises targeted at adhesive capsulitis can be used in combination with common analgesics 3.
- Nonsurgical treatments include nonsteroidal anti-inflammatory drugs, short-term oral corticosteroids, intra-articular corticosteroid injections, physiotherapy, acupuncture, and hydrodilatation 4.
- Surgical treatment options for patients who have minimal improvement after six to 12 weeks of nonsurgical treatment include manipulation under anesthesia and arthroscopic capsule release 4.
Diagnosis and Clinical Presentation
- Adhesive capsulitis is predominantly an idiopathic condition and has an increased prevalence in patients with diabetes mellitus and hypothyroidism 4.
- A finding of coracohumeral ligament thickening on noncontrast magnetic resonance imaging yields high specificity for adhesive capsulitis 4.
- The condition is characterized by pain and decreased range of motion, especially in external rotation 4.
- Imaging is not necessary to make the diagnosis, but can be used to support the diagnosis 4.
Current Evidence and Research
- The most effective treatment for adhesive capsulitis is uncertain, and recent evidence has challenged the theory that the condition progresses through a painful phase to a recovery phase with full resolution of symptoms without treatment 4.
- Substantial on-going research is required to better understand the epidemiology, patho-aetiology, assessment, best management, health economics, patient satisfaction, and prevention of frozen shoulder 5.
- The current evidence base for management strategies is limited, and there remains a lack of consensus in clinical management for this condition 6.