Adhesive Capsulitis

“Frozen shoulder” — despite the traditional name “adhesive capsulitis,” there is no true adhesion: capsular tightness and contracture, without evidence of adhesions, make the shoulder tight, painful and stiff. Usually self-limiting (over 1–3 years).

• Associations: women, diabetes (and autoimmune thyroid disease); classic age 40–60. Can be spontaneous, or follow injury/surgery (e.g. rotator cuff repair).

Clinical stages

Stage	Features	Duration
Freezing (painful)	Gradual-onset pain	6 weeks–9 months
Frozen (stiff)	Reduced ROM, pain settling	4–9+ months
Thawing	Motion gradually returns	5–26 months

Pain typically precedes stiffness; it is present at rest and with movement and disturbs sleep. Examination: loss of both active and passive ROM (esp. external rotation). X-ray helps exclude glenohumeral OA.

Management

• Analgesia (paracetamol/NSAIDs) and intra-articular corticosteroid — most effective early (painful/freezing phase).
• Physiotherapy — gentle stretching over 3–6 months.
• Hydrodilatation (image-guided capsular distension) if conservative therapy fails — consider before orthopaedic referral.
• Surgery (manipulation under anaesthesia or arthroscopic capsular release) for refractory cases — avoid MUA in the early inflammatory phase, and note its high failure rate in diabetics (~50%).