Summary
Adhesive capsulitis, (commonly known as frozen shoulder) is a condition characterized by shoulder pain and stiffness that progresses through three stages: freezing (painful), frozen (stiff), and thawing (recovery). The primary treatment goals are pain control, restoration of range of motion, and functional recovery. Conservative management typically involves oral analgesics and physical therapy; if these fail, interventional options such as hydrodilatation, intra-articular corticosteroid injections, and manipulation under anesthesia may be considered, ideally combined with physiotherapy and home exercises to maximize pain relief and joint mobility.
Introduction
Adhesive capsulitis (also called frozen shoulder ) is a painful, disabling disorder marked by shoulder pain, stiffness, and restricted range of motion. It most commonly affects adults aged 40–60, particularly women. The condition evolves through three phases: freezing (pain-dominant), frozen (stiffness-dominant), and thawing (gradual recovery).
Clinical Presentation
- Early on, patients report a dull, poorly localized ache in the shoulder and upper arm that worsens with movement and at night.
- As the disease progresses, pain intensifies and daily activities—such as dressing, reaching behind the back, or lifting objects overhead—become increasingly difficult; many patients are awakened by pain during sleep.
- Later, pain may subside but stiffness persists; in the final phase, stiffness gradually improves, though without proper management some patients may never fully regain shoulder function.
Three-stage progression:
- Painful (freezing) stage: Increasing pain with decreasing range of motion; lasts ~6 weeks to 9 months.
- Stiff (frozen) stage: Marked stiffness and severe motion restriction with less prominent pain; lasts ~1 to 10 months.
- Recovery (thawing) stage: Gradual return of shoulder motion; may take over a year.
Diagnosis
Adhesive capsulitis is primarily a clinical diagnosis based on history and physical examination. Imaging—such as ultrasound or MRI—is often used to delineate pathology and exclude other causes of shoulder symptoms.
Pathophysiology and Risk Factors
The condition is thought to begin with an inflammatory response in the shoulder, where inflammatory mediators trigger synovitis and capsular inflammation, leading to pain and subsequent fibrosis that restricts movement. It is frequently associated with risk factors including diabetes, thyroid disease, prior shoulder injury, and prolonged immobility.
Treatment Goals
- Control pain
- Improve shoulder range of motion
- Restore normal shoulder function
Conservative Management
First-line treatment includes oral analgesics and structured physical therapy focusing on stretching and specific shoulder exercises to improve mobility.
Interventional Options (for refractory or intolerant cases)
- Hydrodilatation (capsular distension): Injection of a defined volume of fluid (often with corticosteroid and local anesthetic) into the glenohumeral joint under imaging guidance to stretch the capsule and disrupt adhesions.
- Intra-articular corticosteroid injection: Ultrasound-guided steroid injection into the joint capsule to reduce inflammation, relieve pain, and improve motion.
- Manipulation under anesthesia (MUA): After sedation or regional anesthesia, controlled manual techniques are used to break adhesions and restore motion; modern approaches can achieve results with less intensive anesthesia than historically required.
Interventional treatments are most effective when combined with physiotherapy and a home exercise program to sustain gains in pain relief and flexibility.
Rehabilitation Exercises
Rehabilitation is essential throughout all stages of frozen shoulder. A tailored exercise program aims to restore mobility, strength, and function, helping patients progress through the freezing, frozen, and thawing phases and optimizing long-term outcomes.
Information provided by Dr Lee Yuk Ming, Sunny, Specialist in Pain Medicine
