Adhesive Capsulitis (frozen Shoulder)

Adhesive capsulitis ("frozen shoulder") is characterized by progressive inflammation and thickening of the glenohumeral joint capsule, leading to painful restriction of shoulder motion — both active and passive — in all planes. It follows a classic three-phase course: a painful freezing phase (3–9 months), a frozen phase with stiffness and less pain (4–12 months), and a thawing phase of gradual spontaneous recovery (5–24 months). Total duration is typically 1–3 years.

The most common precipitating factors are diabetes, thyroid disorders, prior shoulder injury, prolonged immobilization, and cardiac or pulmonary conditions. It is more common in women and in the non-dominant shoulder.

Diffuse shoulder pain with restricted motion in all planes — a key distinguishing feature from rotator cuff problems, where passive motion is typically preserved. Loss of external rotation is the most sensitive finding. X-rays are usually normal. MRI may show capsular thickening and enhancement.

1. Hydrodilatation

   Distension of the joint capsule with saline and steroid under fluoroscopic guidance — can provide rapid improvement in motion.

Surgery is considered for patients with persistent severe restriction (typically > 6 months) that has not responded to injections and therapy.

External patient-education references and related OSI pages for additional background:

• Britannica — Shoulder (anatomy)
• AAOS OrthoInfo — patient education library
• OSI glossary — orthopedic terminology in plain language