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What is a frozen shoulder “Adhesive Capsulitis” ? and how to manage it?

Painful Shoulder? Frozen Shoulder?

What is adhesive capsulitis?

Adhesive capsulitis, colloquially referred to as frozen shoulder, is a debilitating and painful condition that affects the shoulder joint and can contribute to significant disability.


It is often prevalent in adults (40 – 60 years old) and is more common in women.

As the name frozen shoulder implies, this condition is principally characterised by partial or complete stiffness of the glenohumeral (shoulder) joint. Such capsular stiffness limits both the passive and active movements of the shoulder. In the early stages of the condition, significant shoulder pain often accompanies the joint stiffness.


There are two forms of adhesive capsulitis; primary and secondary:

  1. Primary – the cause of the shoulder stiffness and pain is unknown, and may occur spontaneously
  2. Secondary – the condition is associated to precipitating factors affecting the shoulder such as prior injury or trauma, shoulder surgery, disuse or prolonged immobilisation.

shoulder anatomy

Frozen shoulder is also increasingly prevalent in those with diabetes, thyroid diseases, high cholesterol or heart disease.

With adhesive capsulitis, the shoulder joint capsule and surrounding ligaments become inflamed, thickened, scarred and stiff. These factors reduce the normal elasticity of the joint which contribute to the pain and restricted mobility.


The condition is discussed in three phases:

  • Acute (Freezing) stage – characterised by pain restricted mobility
  • Chronic (Frozen) stage – characterised by rigid shoulder with limited mobility with pain at the end of the available movement
  • Recovery (Thawing) stage – characterised as pain eases and shoulder range of motion begin to improve

The recovery of adhesive capsulitis can be tiresome process, often resolving between one to two years.

Treatment and Physiotherapy:

Physiotherapy can be beneficial in treating adhesive capsulitis to facilitate and restore shoulder joint range and prescribe a functional and task specific rehabilitation plan. Physiotherapy advice surrounding the condition and pain management strategies is also advised throughout the progression of the condition.

Image result for treatment of frozen shoulder

Other strategies may include capsular release surgery, joint manipulation under anaesthetic, corticosteroid injection, or hydrodilation procedure however results are highly variable and should be discussed and advised by your physiotherapist. Of note, 60-80% of patients respond favourably to conservative management.

At Total Physiocare we are treat hundreds of shoulder conditions and many post-surgical shoulders to prevent the onset of frozen shoulder and restore normal shoulder movement and function.

This was compiled by our Physiotherapist Christian Bonello.