Frozen Shoulders – Adhesive Capsulitis

Frozen Shoulder is a condition of shoulder stiffening and pain that results in restricted movement in the shoulder. It is usually painful. Most cases of Adhesive Capsulitis are idiopathic in nature, although it occurs after certain injuries or the advent of surgeries. 

Adhesive Capsulitis is the thickness and inflammation of the tissues around the shoulder joint. The greater the pain, the higher the restriction of the shoulder. The pain leads to the gradual inability to make use of the shoulder it affects. 

Types Of Adhesive Capsulitis

There are two different types of adhesive Capsulitis. They are:

  1. Primary Adhesive Capsulitis

The primary frozen shoulder is the loss of range of motion in all directions. It occurs without a known cause and is accompanied by chronic inflammation. This might be because of a disruption in the immune system.

  1. Secondary Adhesive Capsulitis

This type of adhesive Capsulitis occurs after accidents, an injury to the shoulder, or post-surgery. It is also described by loss of motion. The secondary frozen shoulder could also result from diseases like diabetes, cardiovascular disease, etc.  

What causes Adhesive Capsulitis

There is no certain cause known for Adhesive Capsulitis, but speculations have been made. However, it can result as a cause of injuries or shoulder immobilization post-surgery.

Adhesive Capsulitis can also occur due to complications of diseases such as diabetes, stroke, shoulder arthritis, heart diseases, imbalanced hormones, etc.

As people get older, the possibility of having frozen shoulders also increases.

Signs And Symptoms Of Adhesive Capsulitis

● Pain and stiffness

This is the first sign of a frozen shoulder. The shoulder becomes stiff and is accompanied by bouts of pain. Starting at the outer part of the shoulder and even around the upper arm. The pain occurs gradually; it could start as dull and then increases over time. It tends to get worse at night. As the pain increases, so does the stiffness.

● Frozen Shoulder Test

The frozen shoulder can be tested at home. For correct diagnosis, it is advisable to see a medical practitioner.

The frozen shoulder can be diagnosed through the signs and symptoms. 

To take the self-test:

● A mirror is needed. You place yourself in front of the mirror and raise both arms overhead. If there is a frozen shoulder case, there will be a noticeable pain in the shoulder. The arm also stops above parallel with the floor, and the shoulder blade moves towards the ear.

● The arms can be slowly moved to the side. If the shoulder is painful or moves towards the ear, it shows the shoulder is frozen.

● You can also be placed by the sides and bent at the elbow. Proceed to rotate the arms at an external rotation. A frozen shoulder is indicated by the non-rotation of the painful shoulder.

The Healthcare Professional:

● An X-ray or MRI test may be conducted to check the causes of the frozen shoulder. It, however, doesn’t show if there is adhesive Capsulitis. 

● A range-of-motion test can be observed by the healthcare professional. The active range shows how far the shoulder can be moved. The passive range shows how the shoulder can be moved by someone else. A frozen shoulder is limited in both range-of-motion tests.

Complications Of Adhesive Capsulitis

Leaving adhesive Capsulitis untreated can lead to the following:

● Humeral fracture.

● Residual shoulder pain and stiffness.

● Reduced range of motion.

● Rotator cuff injury.

● Biceps and subscapularis tendons are rupturing.

How Can Frozen Shoulder Be Avoided?

There is no particular way to avoid adhesive Capsulitis. Precautions can be taken by undergoing constant physical exercises, stretching, or following medical advice.

 It is preferred to see a medical professional on time to prevent complications.

Treatments for Adhesive Capsulitis

  1. Pain Relievers

Medications such as aspirin, ibuprofen, etc., can be used to relieve the pains felt in the shoulders. However, if simple pain relief drugs don’t cut it, the medical practitioner can prescribe stronger pain relief drugs. Examples could be corticosteroids for the joints, narcotics, etc.

  1. Therapy

A physical therapist introduces and teaches home exercises or stretching exercises to treat Adhesive Capsulitis. Therapy is a gradual and continuous process that requires patience. The treatment program could be as long as nine months or less. The exercise should be carried out as demonstrated by the physical therapist.

  1. Surgery

The surgical procedure is the next option when anti-inflammatory medications and therapy don’t work out. There are two types of surgical procedures;

●    Arthroscopic Capsular Release is the insertion of a small camera into the shoulder joint. The tight muscle is cut, and instruments are inserted to release the capsule around the shoulder socket. This is for free movement of the shoulder. It is the most selected surgical procedure for the frozen shoulder because it is less painful. Physical therapy follows after the surgical procedure.

●    Manipulation under anesthesia (MUA) involves the passive stretching of the shoulder after inducing sleep. It is usually done alongside the arthroscopic capsular release.

●    Open Capsular Release involves the division of the shoulder capsule by creating an open incision. It is the least done procedure.

Stages of Adhesive Capsulitis Treatment

The physical therapy treatment occurs in stages, like:

  1. STAGE 1:

During the first phase or Pre-freezing stage of Adhesive Capsulitis, the pain is not that severe. The shoulder becomes painful and is noticeable when the arm is being lifted. There’s a gradual reduction in the use of the shoulder. This occurs for a while before the diagnosis is made.  

Physiotherapy methods for easing pain and stiffness are introduced.

  1. STAGE 2:

Also known as the Freezing stage, the symptoms have been reoccurring for three and up to nine months. By now, the pain has escalated with a limitation in how much movement is made in the shoulder. There is also stiffness in the affected shoulder.

More therapy procedures are introduced to improve movement and also reduce pain.

  1. STAGE 3:

After 9 to 13 months, the Frozen stage begins. In this stage, there is a great reduction in the motion range of the shoulder. 

Stretching and other manual therapy procedures are introduced to decrease the pain. The range of motion in the shoulder is better, and pain is only noticed when the shoulder is moved to the motion range limit.

  1. STAGE 4:

The fourth stage is the Thawing stage. At this stage, the pain has completely or almost completely reduced. The movement range in the shoulder has almost returned to its normal functioning. The shoulder has begun to loosen up. Stretching and manual therapy are still continued. 


Adhesive Capsulitis, also called Frozen Shoulder, is a painful condition that leads to pain and stiffness in the shoulder. It also leads to a restriction in shoulder movement. Although its causes are majorly unknown, it stems from injuries or surgeries. People with ailments such as diabetes and heart diseases are also at risk. There are treatment processes such as physical therapy, medications, or surgical process available. Frozen Shoulder is unpredictable but can be prevented by following medical advice or avoiding accidents.