On this page· 4 sections
  1. 01Causes and Who is Affected?
  2. 02Stages
  3. 03Diagnosis
  4. 04Treatment

Frozen shoulder (adhesive capsulitis) is a condition that occurs when the fibrous capsule surrounding the shoulder joint becomes inflamed, thickens, and restricts movement by enveloping the joint. A characteristic finding of the disease is a decrease in both active and passive shoulder movements in all directions.

Causes and Who is Affected?

The exact cause of the disease is not fully known, but an inflammatory process starting in the capsule leads to the formation of scar tissue. Risk factors include:

  • Ages 40-60, female gender
  • Diabetes (incidence is significantly higher in diabetics)
  • Thyroid diseases (hypo/hyperthyroidism)
  • Prolonged immobilization of the shoulder (fracture, post-surgery)
  • Neurological conditions such as heart disease and Parkinson’s

Stages

  1. Freezing stage (6-12 weeks): Gradually increasing shoulder pain, especially at night, and the onset of loss of motion.
  2. Frozen stage: Pain may decrease, but shoulder movements are significantly restricted in all directions; daily activities (dressing, reaching behind) become difficult.
  3. Thawing stage: Gradual regaining of range of motion over months.

Diagnosis

Diagnosis is largely made by clinical examination: restricted active and passive movements in both directions are typical. X-rays may be requested to rule out other conditions (osteoarthritis, non-arthritic calcifications); MRI may be requested to identify accompanying pathologies such as rotator cuff tears.

Treatment

Non-Surgical Treatment (first-line)

  • Intra-articular corticosteroid injections: Rapidly reduce pain in the freezing stage.
  • Physical therapy and stretching exercises: The primary method for regaining capsule elasticity.
  • Pain relievers and anti-inflammatory medications.
  • Hot compresses and home exercise program.

Surgical Treatment (for refractory cases)

In patients who do not improve despite prolonged regular treatment:

  • Manipulation under anesthesia: Controlled loosening of the capsule.
  • Arthroscopic capsular release: Cutting of the thickened capsule to restore range of motion; more controlled and durable than manipulation.

Regular physical therapy initiated in the early stages leads to complete or near-complete recovery in most patients without the need for surgery.

Frequently Asked Questions

Who is affected by frozen shoulder?
It is generally seen between the ages of 40-60, more frequently in women. The risk increases in individuals with diabetes, thyroid diseases, heart conditions, and in shoulders that have been immobilized for a long time.
What are the stages of frozen shoulder?
There are three stages: the freezing stage (pain is prominent, 6-12 weeks), the frozen stage (restriction of movement is dominant), and the thawing stage (gradual regaining of motion).
Does frozen shoulder resolve on its own?
The condition is self-limiting; however, if left untreated, it can last for 1-3 years and may lead to permanent loss of motion. Treatment speeds up the process and prevents permanent disability.
When is surgery necessary for frozen shoulder?
In patients whose range of motion does not improve despite long-term and regular conservative treatment, manipulation under anesthesia or arthroscopic capsular release may be performed.
Are intra-articular injections beneficial?
Yes. In the freezing stage, intra-articular corticosteroid injections rapidly reduce pain and facilitate adherence to physical therapy.