Frozen Shoulder/Adhesive Capsulitis

The notes on this page are written as a source of information to both patients and health professionals. It is a general overview and its content should not be seen as direct medical advice. Further information regarding diagnosis and treatment specific to your condition can be made via a consultation with Dr Amaranath.

Anatomy of the Shoulder

The shoulder is mobile ball and socket joint. It is surrounded by a number of soft tissues structures that help maintain its mobility, but also aid in its stability. The capsule is a thin structure surrounding the shoulder which has multiple functions. It produces synovial fluid which reduces friction in the joint helping enabling to glide smoothly through a range of motion. In other areas it thickens to form ligaments which help in the stability of the joint. 

What is frozen shoulder?

Frozen shoulder is also known as adhesive capsulitis. It is an inflammatory condition involving the capsular layer of the shoulder leading to it becoming thickened and inflamed.

It is self-limiting in most cases and has 3 primary stages:

      I.  Freezing – This is a painful stage where the shoulder becomes stiff (3-6 months)

    II.   Frozen – During this stage the pain can subside and the shoulder remains stiff (6-18 months)

  III.   Thawing – The inflammation subsides and the capsule begins to relax allowing more mobility (18-24 months)

What are the common causes?

  1. Unknown (Idiopathic) – Some patients will develop a frozen shoulder without any known cause. There are risk factors such as middle age (40-60 yrs. old), female, diabetic, etc, which can predispose you to it.

  2. Secondary causes – There are some conditions which can lead to a frozen shoulder. These include recovery from any injury to the shoulder e.g. rotator cuff repair/tear, fractures of the shoulder, acromioclavicular joint injuries, etc.

What are the preferred Investigations/Imaging? 

  1. Plain X-ray of the shoulder – This is to rule out other causes of a stiff shoulder such as arthritis, fracture, etc. This should include an Anterior/Posterior, Lateral and Axillary view.

  2. MRI Shoulder – This is not commonly needed as frozen shoulder is a clinical diagnosis. However, it can help rule out other causes such as rotator cuff tears, shoulder pain generators (AC joint arthritis, biceps tendonitis), etc. MRI findings of a frozen shoulder include a loss of joint laxity via narrowing of the axillary recess.

What are the treatment options?

  1. Non-operative – The majority of cases will resolve with time and physiotherapy. Understanding where you may be in the stage of a frozen shoulder will help guide the treatment plan. In the freezing phase analgesia along with hydrodilatation can be useful. While in later stages initiating a gradual physiotherapy programme may be more beneficial.

  2. Arthroscopic capsular release – In a small number of cases non- operative measure fail and key hole surgery can help. It involves placing a camera into the joint and releasing the thickened capsule in a 360° manor. Following this a guided physiotherapy programme is initiated.

What does the rehabilitation/recovery involve?

To find out more about rehabilitation and recovery after shoulder surgery please see our Rehabilitation Protocols here.