Adhesive Capsulitis (Frozen Shoulder) — What It Is and How It's Treated

What Is Adhesive Capsulitis?

The joint capsule becomes inflamed, thickens, and progressively contracts. The result: severe loss of mobility and pain. It evolves slowly (over months to years) but resolves in the vast majority of cases.

Who Is at Risk?

• People with diabetes (2-4x higher risk)
• Women aged 40-60
• After immobilization (due to fracture or surgery)
• Thyroid diseases
• Occurs bilaterally in about 20% of cases

The 3 Phases

Phase 1 — Freezing (2-9 months): Progressive, severe pain. Mobility decreases. Intense night pain.

Phase 2 — Frozen (4-12 months): The pain improves, but stiffness becomes maximal. You cannot comb your hair or reach for the seatbelt.

Phase 3 — Thawing (5-24 months): Mobility gradually returns.

Diagnosis

Clinical diagnosis: loss of both active and passive mobility, with no structural cause seen on X-ray. The key distinction: in capsulitis, passive mobility is limited (unlike in tendinopathy).

Treatment

Physical therapy — the foundation. Gentle stretching, pendulum exercises. Aggressive forcing is contraindicated.

Medication — anti-inflammatories and analgesics in phase 1.

Cortisone injections — accelerate the resolution of the painful phase.

Hydrodilatation — injection of a large volume of fluid under ultrasound guidance.

Manipulation under anesthesia — in refractory cases.

The Key Message

It gets better. It may take longer than you'd like, but with the right treatment, mobility returns. Do not ignore progressive shoulder pain, especially if you have diabetes.

→ Shoulder Pain — Common Causes

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