Degenerative

Frozen Shoulder (Adhesive Capsulitis)

Inflammation and thickening of the joint capsule. 3 phases over 12-24 months. Diabetes = major risk factor.

Frozen shoulder (or adhesive capsulitis) is a progressive inflammation and thickening of the shoulder joint capsule, causing painful loss of mobility. It affects 2-5% of the population, peaking between ages 40 and 60, more common in women. Diabetes is the main risk factor (prevalence 10-36% in diabetic patients). It progresses through 3 phases: inflammatory/painful phase (2-9 months), stiffening phase (4-12 months), recovery phase (12-24 months). Recovery is usual but may leave residual external rotation limitations in 40% of cases.

Characteristics

  • Inflammatory phase: intense pain, especially at night, progressive onset. Developing mobility limitation. Pain at rest and sleep disturbance.
  • Stiffening phase: progressive loss of all ranges of motion, especially external rotation (most affected), abduction and internal rotation. Pain gradually decreasing.
  • Arthrography: reduced capsular volume (< 10 ml vs 15-35 ml normal). Capsular thickening visible on MRI. Resolution of signs on contrast injection.
  • Associated risk factors: diabetes (main factor, prevalence 10-36%), thyroid disease, Dupuytren's disease, prolonged immobilization, post-surgical.

Medical and surgical management

  • Inflammatory phase: corticosteroid injection intra-articular (significant short-term improvement on pain and mobility). Oral corticosteroids possible for 2-3 weeks.
  • Persistent stiffening phase: hydraulic distension (saline + corticosteroid injection under pressure to stretch the capsule). Arthrographic capsular distension.
  • Resistant stiffening: manipulation under anesthesia or arthroscopic capsular release (circumferential capsulotomy). Reserved for severe cases resistant to 6 months of treatment.

Physiotherapy rehabilitation

  • Inflammatory phase: gentle and respectful mobilization of the pain threshold. Codman pendular exercises. Analgesic techniques (TENS, heat).
  • Stiffening phase: capsular stretching progressively intensified. End-range mobilization in external rotation, flexion, internal rotation. Sustained postures.
  • Recovery phase: active mobilization and strengthening. Range of motion recovery. Proprioception and functional reintegration.
  • Throughout: daily self-rehabilitation essential (30-45 min/day). Self-pendular, stick exercises, wall climbing, pulley work.

Classification

  1. Phase 1 — Inflammatory/Painful

    Intense pain, especially at night. Progressive loss of mobility. Duration 2-9 months.

  2. Phase 2 — Stiffening

    Pain decreasing, stiffness dominant. External rotation most affected. Duration 4-12 months.

  3. Phase 3 — Recovery

    Progressive range of motion recovery. Residual limitation possible (40% for external rotation).

  4. Phase 4 — Functional recovery

    Gradual recovery of mobility and function.

  5. Phase 5 — Reintegration

    Strengthening and gradual reintegration of activities.

Average duration

6 to 18 months (self-limiting disease)

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Scientific sources

General information only: this content cannot provide a diagnosis or prescription. A healthcare professional must assess your situation.