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Adhesive capsulitis (shoulder)

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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First introduced by Codman in 1934, the term 'frozen shoulder' describes a glenohumeral disorder characterised by shoulder pain or limitations, or both on active and passive elevation and external rotation (1).

  • the condition is also known as adhesive capsulitis
  • commonly seen in people who are in their 50s

The pathophysiology of the condition is unknown.

  • thought to result from fibrosis and thickening of the joint capsule and adherence to the humeral head
  • can occur in one shoulder or both shoulders simultaneously.
    • non-dominant shoulder is slightly more likely to be affected (2)

Frozen shoulder is a self limiting condition

  • time from onset to recovery is usually between 12 - 42 months (3)
  • nearly all patients recover, but normal range of movement may never return (2)
  • long term disability is seen in 15% of the patients (3)

Frozen shoulder can be

  • primary or idiopathic
  • secondary to another cause
    • most common association is diabetes
      • a patient with diabetes has a lifetime risk of 10%-20% of developing frozen shoulder (1)

A review notes (4):

  • diabetes patients are at higher risk of developing frozen shoulder and having bilateral symptoms than the general population
  • recovery times are variable
    • can be years, and some patients are left with residual pain or functional impairment

  • physiotherapy is the most commonly used intervention and can be supplemented by intra-articular steroid injections

  • treatments offered in secondary care include joint manipulation under anaesthesia, arthroscopic capsular release, and hydrodilatation

  • the UK FROST trial compared manipulation under anaesthetic, arthroscopic capsular release, and early structured physiotherapy with intra-articular corticosteroid injections, and found that none of the interventions were clinically superior


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