Duration of the Painful "Freezing" Phase in Adhesive Capsulitis
The painful "freezing" phase of adhesive capsulitis typically lasts 2–9 months, with most patients experiencing peak pain during the first 3–6 months before transitioning to the "frozen" (adhesive) phase.
Clinical Stages and Timeline
The natural history of frozen shoulder progresses through three distinct phases 1, 2, 3, 4:
- Freezing Phase (Painful Phase): Lasts approximately 2–9 months, characterized by progressive pain and gradual loss of range of motion, with pain often worse at night 1, 2, 4
- Frozen Phase (Adhesive Phase): Follows the freezing phase and lasts 4–12 months, marked by persistent stiffness with gradual reduction in pain 1, 2, 4
- Thawing Phase (Recovery Phase): Extends 5–24 months, during which range of motion slowly improves 1, 2, 4
Total Disease Duration
The entire disease course typically persists for 1–3 years if left untreated 1, 4, 5. However, recent evidence challenges the older assumption that adhesive capsulitis is completely self-limiting with full resolution—many patients experience persistent functional limitations even after this timeframe 1.
Critical Clinical Implications
Early intervention during the freezing phase is essential because delaying formal physical therapy beyond 6–8 weeks can result in permanent shoulder dysfunction 6, 7. The American College of Physical Medicine and Rehabilitation emphasizes that treatment should be initiated immediately rather than waiting for spontaneous resolution 6.
Key Prognostic Factors
External rotation is the most severely restricted motion and correlates most strongly with pain onset 8, 6, 9. Up to 72% of post-stroke patients develop shoulder pain within the first year, with 67% progressing to shoulder-hand-pain syndrome when motor, sensory, and visuoperceptual deficits coexist 8, 6, 9.
Common Pitfall to Avoid
Do not adopt a "wait and see" approach based on outdated teaching that frozen shoulder always resolves spontaneously in 1–2 years 1. Current evidence demonstrates that untreated adhesive capsulitis frequently results in persistent pain and functional limitation beyond the typical disease course 1, 4.