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Condition

Frozen Shoulder

Adhesive capsulitis, commonly referred to as frozen shoulder, is a painful and functionally limiting condition characterised by progressive restriction of both active and passive glenohumeral movement. It most frequently affects individuals between the ages of 40 and 60, with a higher prevalence reported in women and in those with metabolic and endocrine conditions such as diabetes mellitus and thyroid disorders. The condition is typically classified into three overlapping clinical phases: the “freezing” phase, marked by increasing pain and early loss of motion; the “frozen” phase, where pain may reduce but stiffness and capsular restriction are pronounced; and the “thawing” phase, involving gradual restoration of movement. Pathophysiologically, evidence suggests a combination of synovial inflammation and capsular fibrosis, leading to thickening and contracture of the joint capsule.
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A thorough, evidence-based assessment is essential to differentiate adhesive capsulitis from other causes of shoulder pain such as rotator cuff pathology or referred cervical spine symptoms. Diagnosis is primarily clinical, with hallmark findings including global restriction of passive external rotation, abduction, and internal rotation, often accompanied by pain at end range. Identifying risk factors, stage of presentation, and functional limitations is critical in guiding management and prognosis.

The natural history of frozen shoulder has traditionally been described as self-limiting; however, contemporary evidence challenges the effectiveness of a purely “wait and see” approach, with many patients experiencing prolonged symptoms and incomplete recovery lasting up to 2–3 years. Early, active management is therefore recommended to reduce pain, restore function, and minimise long-term disability. Conservative treatment forms the cornerstone of care and includes patient education, activity modification, and structured rehabilitation. Manual therapy techniques may help improve joint mobility and reduce pain, while progressive, stage-appropriate exercise therapy is supported by evidence to enhance range of motion and functional outcomes.

Adjunctive interventions may also be beneficial in selected cases. Image-guided intra-articular corticosteroid injections have demonstrated short- to medium-term improvements in pain and function, particularly in the early inflammatory phase. Hydrodilatation (distension arthrography), which involves the injection of fluid into the joint capsule to expand and disrupt adhesions, has also shown promising evidence for improving range of motion and reducing pain when combined with rehabilitation. While timelines for recovery vary, a multimodal, individualised approach offers the most favourable outcomes. At Core Body Clinic, emphasis is placed on early diagnosis, targeted intervention, and progressive rehabilitation to optimise recovery and support patients in regaining near-normal shoulder function as efficiently as possible.

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