It is also advisable to acknowledge that full range of motion may never be restored.

Explaining the natural history of the condition often helps to reduce frustration, increase compliance and allay fears for the patient. Clinicians are encouraged to start the treatment with patient education. Most frozen shoulder cases can be managed in the primary care setting. During the thawing stage, the patient experiences a gradual return of range of motion that takes about 5–26 months to complete.( 7, 8) Although adhesive capsulitis is often self-limiting, usually resolving in 1–3 years,( 9) it can persist, presenting symptoms that are commonly mild pain is the most common complaint.( 10, 11) The pain will begin to subside during the frozen stage with a characteristic progressive loss of glenohumeral flexion, abduction, internal rotation and external rotation. In the freezing stage, which lasts about 2–9 months, there is a gradual onset of diffuse, severe shoulder pain that typically worsens at night. These patients develop pain from the shoulder pathology, leading to reduced movement in that shoulder and thus developing frozen shoulder.įrozen shoulder often progresses in three stages: the freezing (painful), frozen (adhesive) and thawing phases ( Fig.

rotator cuff tendon tear, subacromial impingement, biceps tenosynovitis and calcific tendonitis). Secondary adhesive capsulitis can occur after shoulder injuries or immobilisation (e.g. Primary idiopathic frozen shoulder is often associated with other diseases and conditions, such as diabetes mellitus, and may be the first presentation of a diabetic patient.( 3) Patients with systemic diseases such as thyroid diseases( 4, 5) and Parkinson’s disease( 6) are at higher risk. Frozen shoulder, also known as adhesive capsulitis, is defined as “ a condition of uncertain aetiology, characterised by significant restriction of both active and passive shoulder motion that occurs in the absence of a known intrinsic shoulder disorder”.( 1) Patients with frozen shoulder typically experience insidious shoulder stiffness, severe pain that usually worsens at night, and near-complete loss of passive and active external rotation of the shoulder.( 2) There are typically no significant findings in the patient’s history, clinical examination or radiographic evaluation to explain the loss of motion or pain.įrozen shoulder can be classified as primary or secondary.

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