Adhesive Capsulitis: Symptoms, Causes & Treatment

Adhesive capsulitis is a condition in which the capsule surrounding the shoulder becomes inflamed and stiff. Over time, adhesions and fibrous tissue may develop and restrict movement of the shoulder joint.

Also known as frozen shoulder, adhesive capsulitis can cause pain, stiffness, a feeling that the shoulder is “stuck,” and a reduced range of motion. It may develop after the shoulder has been immobilized for a long period due to surgery or an injury.

Treatment for adhesive capsulitis is guided by an orthopedic specialist and may include anti-inflammatory medications, physical therapy, corticosteroid injections, and, if symptoms do not improve, surgery.

Frozen shoulder symptoms

The main symptoms of adhesive capsulitis include:

• Shoulder pain that worsens at night

• Shoulder pain that gradually increases while at rest

• Shoulder stiffness

• Difficulty raising the arms

• A feeling that the shoulder is stuck

Frozen shoulder symptoms are usually most severe in the early stages. Pain typically affects the outer shoulder and may spread to the upper arm.

Confirming a diagnosis

Adhesive capsulitis is diagnosed based on a person's symptoms, medical history, and a physical examination of the shoulder. An orthopedic surgeon or another healthcare provider may make the diagnosis.

In most cases, additional tests are not needed. According to the American Academy of Orthopaedic Surgeons, X-rays may help rule out other causes of shoulder pain and stiffness, while an MRI or ultrasound may be used to identify soft-tissue injuries such as a rotator cuff tear.

Stages of frozen shoulder

Adhesive capsulitis is divided into different stages based on how the condition progresses. The main stages are:

1. Freezing stage

Pain spreads throughout the shoulder and gradually becomes more severe. It is usually worse when the arm is moved to the limits of its range of motion.

This stage typically lasts about 2 to 9 months.

2. Frozen stage

Pain begins to improve and generally occurs only with movement. However, shoulder movement remains limited, and the person may compensate by moving the shoulder blade.

This stage typically lasts about 4 to 12 months.

3. Thawing stage

Pain continues to improve or may resolve completely, and shoulder mobility gradually returns. Some stiffness may still be present early in this stage but continues to improve over time.

This stage typically lasts about 12 to 42 months.

Restricted shoulder movement is present throughout all stages of adhesive capsulitis. Pain is usually most severe during the freezing stage and gradually improves as the condition progresses.

Tips for sleeping

Before bed, applying a warm or cold compress, taking pain medication, and doing gentle shoulder mobility exercises recommended by an orthopedic surgeon may help relieve discomfort.

Sleeping on your back or on the unaffected side is also recommended. The affected shoulder can be supported with pillows to reduce pain and avoid placing pressure on the joint.

Possible causes

Factors that may contribute to the development of adhesive capsulitis include:

• Diabetes

• Hypothyroidism or hyperthyroidism

• Degenerative changes in the cervical spine, such as cervical spondylosis

• Cardiovascular disease

• Neurological conditions, such as stroke or Parkinson’s disease

• High cholesterol or triglyceride levels

Shoulder injuries, such as fractures or rotator cuff tears, may also increase the risk of frozen shoulder. Prolonged shoulder immobilization after shoulder, breast, or spine surgery can also contribute to its development.

Adhesive capsulitis may also be associated with hormonal changes during menopause, which can increase the tendency toward joint stiffness and inflammation.

Emotional factors

Adhesive capsulitis is caused by inflammation and fibrosis of the shoulder capsule, not by emotional factors. However, anxiety, stress, and other psychological factors may affect pain perception and make discomfort or movement limitations feel more severe.

Treatment options

Treatment for adhesive capsulitis is guided by an orthopedic surgeon and depends on the stage of the condition. Treatment options may include:

1. Medication

During the early stage of adhesive capsulitis, the doctor may recommend anti-inflammatory medications, such as aspirin or ibuprofen, to relieve pain and reduce swelling.

2. Physical therapy

Physical therapy should be performed under the guidance of a physical therapist. According to the American Academy of Orthopaedic Surgeons, stretching and range-of-motion exercises can help restore shoulder movement in people with adhesive capsulitis.

The physical therapist may also recommend transcutaneous electrical nerve stimulation, or TENS, based on the person’s individual needs. TENS can help relieve pain and improve shoulder joint function.

3. Corticosteroid injections

A corticosteroid injection is administered by an orthopedic surgeon directly into the shoulder joint, particularly during the early stage of adhesive capsulitis.

The corticosteroid helps reduce inflammation and may provide short-term pain relief, making it easier to improve shoulder movement through physical therapy.

4. Suprascapular nerve block

A suprascapular nerve block may be performed in a doctor's office or hospital. During the procedure, a local anesthetic, sometimes combined with a corticosteroid, is injected near the suprascapular nerve to help relieve shoulder pain.

This procedure may be recommended when medications do not provide enough relief or when pain makes it difficult to participate in physical therapy.

5. Hydrodilatation

Hydrodilatation involves injecting a large volume of sterile saline into the shoulder joint, sometimes together with a local anesthetic or corticosteroid. The fluid expands and stretches the joint capsule, which may help relieve pain and improve shoulder mobility.

6. Joint manipulation

Manipulation under anesthesia (MUA) may be recommended by an orthopedic surgeon when other treatments have not relieved frozen shoulder symptoms.

During the procedure, the patient is placed under general anesthesia while the doctor gently moves the shoulder through its range of motion. This helps stretch and release the tight joint capsule, improving shoulder mobility and range of motion.

7. Surgery

Surgery may be recommended by an orthopedic surgeon if adhesive capsulitis symptoms do not improve after 9 to 12 months of conservative treatment.

The most common surgical procedure is arthroscopic capsular release. During this minimally invasive procedure, the surgeon cuts through the thickened, tight areas of the shoulder capsule to improve range of motion. Physical therapy is usually needed afterward to help restore shoulder function.

In rare cases, an open capsular release may be recommended when arthroscopic surgery is not appropriate or has not been successful. During this procedure, the surgeon makes a larger incision to directly access the shoulder capsule and release the tight tissue limiting shoulder movement.