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Adhesive Capsulitis (Frozen Shoulder)


by Dr Kalman Piper
Sydney Orthopaedic Shoulder Surgeon

  1800 746 853

What Is It?


Adhesive capsulitis, also known as frozen shoulder, is a common condition that causes pain and stiffness of the shoulder joint. The shoulder joint is a ball and socket joint surrounded by a fibrous joint capsule, ligaments and tendons (the rotator cuff). Adhesive capsulitis is inflammation within the joint capsule, which causes chronic pain and severely reduces the range of movement of the shoulder joint.

What Causes Adhesive Capsulitis?


There are several trigger factors that can cause adhesive capsulitis; however, its exact cause is unknown, and it is not known why some people are affected and not others. The common trigger factors include:
  • Diabetes
  • A shoulder injury (may be relatively minor)
  • Shoulder surgery
  • An injury to the forearm or wrist
  • A prolonged period of time in a sling
  • Open heart surgery
  • Stroke
  • Hyperthyroidism

How Long Does Frozen Shoulder Last?


Adhesive capsulitis is a self-limited condition, however, the recovery period can be prolonged. The condition follows a series of “stages” as listed below:

  • Stage one: The “freezing” or painful stage.
    1. Duration: between 6 weeks and 9 months.
    2. Slow onset of pain
    3. As the pain worsens, the shoulder loses motion.
  • Stage two: The “frozen” stage
    1. Duration: 4 – 9 months
    2. Slow improvement in pain
    3. Stiffness remains.
  • Stage three: The “thawing” or recovery stage.
    1. Duration: 5 – 26 months.
    2. Shoulder motion slowly returns toward normal.

How Is It Treated?


Frozen Shoulder Treatment: Treatment for adhesive capsulitis involves one or more of the following:

  • Pain relieving and anti-inflammatory medication.
  • Injection of local anaesthetic and corticosteroid.
    1. Injections of local anaesthetic and corticosteroid (a powerful anti-inflammatory) into the joint can help reduce pain, but usually does not affect the shoulder stiffness.
  • Surgical synovectomy and capsule release.
    1. Surgery involves removing the inflamed tissue from inside the shoulder joint and releasing the contractures around the shoulder joint. Surgery is not recommended while the shoulder is painful, but can help recover range of motion after the painful phase has finished.
    2. Adhesive capsulitis can recur after a surgical release.
    3. Surgery is usually indicated if there is delayed recovery in shoulder range of motion.
  • Physiotherapy is not useful for the shoulder while it is very painful, but should be commenced as soon as the pain starts to settle.

Key Features of Adhesive Capsulitis


  • The cause is unknown.
  • There is a strong association with diabetes.
  • Adhesive capsulitis can take 2 – 3 years to recover.
  • Treatment options include:
    1. Medication.
    2. Injections.
    3. Physiotherapy (after the painful (active) phase is complete).
    4. Surgical capsule release (after the painful (active) phase is complete).
  • Surgery results are unpredictable and the frozen shoulder can recur.
To make an appointment to see Sydney Orthopaedic Shoulder Surgeon, Dr Kalman Piper, phone 1800 746 853.