Adhesive capsulitis (Frozen Shoulder)

Adhesive Capsulitis (Frozen Shoulder) – Treatment Options

Introduction
Adhesive capsulitis, commonly known as frozen shoulder, is a painful condition characterized by progressive stiffness and restricted range of motion of the glenohumeral joint. It is caused by thickening and contracture of the joint capsule, often associated with synovial inflammation. The condition develops in stages—painful, stiff, and thawing—and may last 1–3 years if untreated. Risk factors include diabetes mellitus, thyroid disorders, prolonged immobilization, and prior shoulder injury or surgery. Treatment aims to relieve pain, restore function, and prevent long-term disability.

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1. Conservative and Non-Pharmacological Management

• Patient education: Explaining natural history and emphasizing adherence to therapy.

• Physical therapy:

  • Gentle stretching and range-of-motion exercises.

  • Supervised physiotherapy programs improve recovery.

• Home exercise program: Daily stretching to maintain mobility.

• Heat and cold therapy: To reduce stiffness and pain before exercises.

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2. Pharmacologic Therapy

• Analgesics:

  • NSAIDs (ibuprofen, naproxen) for pain and inflammation.

  • Acetaminophen as an alternative.

• Corticosteroids:

  • Oral steroids (short course) for acute pain relief.

  • Intra-articular corticosteroid injections to reduce inflammation and improve short-term mobility.

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3. Interventional and Procedural Options

• Hydrodilatation (distension arthrography):

  • Injection of saline (± steroid/anesthetic) into the joint to expand the capsule and break adhesions.

• Manipulation under anesthesia (MUA):

  • Performed when conservative therapy fails.

  • Risk of complications (fractures, soft tissue injury) if not carefully executed.

• Arthroscopic capsular release:

  • Surgical option for refractory cases.

  • Allows direct division of contracted capsule to restore range of motion.

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4. Lifestyle and Supportive Measures

• Maintain activity within pain limits—avoid complete immobilization.

• Optimize control of underlying conditions (diabetes, thyroid disease).

• Use of ergonomic adaptations for daily tasks during recovery phase.

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5. Monitoring and Long-Term Care

• Regular assessment of range of motion, pain levels, and functional improvement.

• Long-term follow-up to prevent recurrence or contralateral shoulder involvement.

• Post-procedure rehabilitation is critical for maintaining surgical or MUA benefits.

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6. Multidisciplinary Care

• Primary care physicians: Early diagnosis and initiation of conservative therapy.

• Physiotherapists: Core role in rehabilitation and exercise guidance.

• Orthopedic surgeons: For advanced interventions (MUA, arthroscopic release).

• Endocrinologists: For management of associated metabolic conditions (diabetes, thyroid).