Overview
Adhesive capsulitis, commonly known as frozen shoulder, is a condition characterized by stiffness, pain, and limited range of motion in the shoulder joint. It develops gradually, often without a clear cause, and can significantly impair daily activities. The condition progresses through stages and may take months to years to fully resolve, even with treatment.
What is Adhesive Capsulitis?
Adhesive capsulitis occurs when the connective tissue surrounding the shoulder joint, called the joint capsule, becomes inflamed and thickened. Over time, bands of scar tissue (adhesions) form, reducing the joint’s mobility. The condition typically affects one shoulder and is most common in people between the ages of 40 and 60.
Symptoms
The symptoms of frozen shoulder develop gradually and usually follow three stages:
- Freezing stage (6 weeks to 9 months):
- Gradual onset of shoulder pain
- Increasing stiffness
- Reduced range of motion
- Frozen stage (4 to 12 months):
- Pain may decrease
- Stiffness remains
- Shoulder becomes very difficult to move
- Thawing stage (6 months to 2 years):
- Range of motion slowly improves
- Pain continues to lessen
Causes
The exact cause of adhesive capsulitis is often unknown (idiopathic), but it may result from:
- Shoulder injury or surgery: Immobilization can trigger the condition
- Inflammatory processes: Such as those related to autoimmune diseases
- Scar tissue formation: Inside the joint capsule
- Postural or biomechanical stress
Risk Factors
Several factors can increase the risk of developing adhesive capsulitis:
- Age and sex: Most common in people aged 40–60, especially women
- Diabetes: Strongly associated with frozen shoulder
- Thyroid disorders: Both hyperthyroidism and hypothyroidism
- Previous shoulder injury or surgery
- Immobilization: After fractures or rotator cuff tears
- Cardiovascular disease or Parkinson’s disease
Complications
If left untreated or if treatment is delayed, adhesive capsulitis may lead to:
- Persistent shoulder stiffness
- Chronic pain
- Long-term loss of range of motion
- Difficulty performing daily tasks (e.g., dressing, reaching)
Prevention
While not always preventable, the following strategies may help reduce risk:
- Regular shoulder stretching and mobility exercises
- Early rehabilitation after shoulder injury or surgery
- Managing diabetes and thyroid conditions
- Avoiding prolonged immobilization of the shoulder
Treatment Options Korea
1. Physical Therapy
- Core treatment to restore shoulder motion
- Includes gentle stretching, range-of-motion exercises, and manual therapy
- Widely available in orthopedic and rehabilitation clinics across Korea
- Home exercise programs often provided for daily practice
2. Pain and Inflammation Management
- NSAIDs (e.g., ibuprofen, celecoxib) for pain and swelling
- Hot packs or ultrasound therapy used in physical therapy sessions
- May include oral corticosteroids in the early “freezing” stage
3. Intra-Articular Steroid Injections
- Corticosteroid injection directly into the shoulder joint
- Reduces inflammation and improves mobility in the early phase
- Performed by orthopedic specialists or physiatrists under ultrasound guidance
4. Joint Distension (Hydrodilatation)
- Saline and steroid injected to stretch the joint capsule
- Done under fluoroscopy or ultrasound guidance
- Increasingly common in Korean sports medicine and pain clinics
5. Manipulation Under Anesthesia (MUA)
- Shoulder gently forced through range of motion while patient is under anesthesia
- Reserved for refractory cases not improving with therapy
- Performed in orthopedic hospitals or surgical centers
6. Arthroscopic Capsular Release (Surgery)
- Minimally invasive surgery to cut tight portions of the joint capsule
- Used only in severe, long-standing cases
- Post-op rehabilitation essential for full recovery
