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Adhesive Capsulitis (Frozen Shoulder)


What is it?

Adhesive capsulitis, commonly known as frozen shoulder, is a painful condition that limits the range of motion in the shoulder joint. The condition affects about 2% to 5% of the general population, with women being more likely to develop it than men. As an expert physical therapist with years of experience treating adhesive capsulitis, I’ve seen firsthand how debilitating this condition can be. In this article, I will explain the different stages, symptoms, causes, and treatment approaches.


What are the stages?

There are four stages of adhesive capsulitis that patients should be aware of. These stages describe how the condition progresses over time, and understanding them can help patients better understand their condition and what to expect.

  • Stage 1: Pre-Freezing During this stage, patients may experience mild to moderate pain and discomfort in the shoulder joint. They may also notice a gradual loss of range of motion in the shoulder. At this stage, the condition is relatively mild, and patients may be able to manage their symptoms with rest, ice, and over-the-counter pain medication. Early intervention with a physical therapist can also prevent excessive loss of motion in the shoulder and maintain your functional movement.

  • Stage 2: Freezing In this stage, the pain and stiffness in the shoulder become more severe, and patients may notice a significant loss of range of motion. The shoulder joint may become so stiff that patients have difficulty performing even simple tasks like brushing their hair or reaching for objects. This stage can last for several months, and patients may require more aggressive treatment, such as physical therapy and/or corticosteroid injections, to manage their symptoms.

  • Stage 3: Frozen During this stage, the shoulder joint is extremely stiff and immobile, and patients may experience severe pain. The loss of range of motion can be significant, and patients may not be able to perform even basic activities of daily living without assistance. This stage can last for several months, and patients may require more intensive treatment, such as surgery, to break up the adhesions in the shoulder joint.

  • Stage 4: Thawing The final stage of adhesive capsulitis is the thawing stage. This is the most mysterious of all the stages. During this stage, the stiffness in the shoulder gradually begins to improve, and patients may notice a gradual return of their shoulder mobility. Pain and discomfort may still be present, but they are gradually less severe than in earlier stages. This stage can last for several months, and patients may continue with physical therapy or other treatments to help improve shoulder function.


What is causing this to happen?

The exact cause of adhesive capsulitis is not fully understood, but it’s believed to be due to inflammation and thickening of the shoulder joint capsule, a connective tissue that surrounds the joint. This inflammation and thickening can lead to the formation of adhesions, which cause the shoulder joint to become stiff and immobile.


Certain factors can increase your risk of developing adhesive capsulitis. These include:

  • Diabetes: People with diabetes are at a higher risk of developing frozen shoulder

  • Age: the condition is more common in people over the age of 40

  • Injury or surgery: A previous shoulder injury or surgery can increase the risk of development

  • Immobilization: Prolonged immobilization of the shoulder joint, such as being in a sling or cast, can increase the risk of developing frozen shoulder.


What are the symptoms?

The primary symptoms of adhesive capsulitis is shoulder pain, which can range from mild to severe. The pain is often described as a deep, aching pain in the shoulder joint. As the condition progresses, the shoulder joint becomes stiff, making it difficult to move the arm. Other symptoms of adhesive capsulitis include:

  • Limited range of motion: You may find it difficult to raise your arm above your head, reach behind your back, or perform other daily activities. You may even think that you’re experiencing some form of shoulder impingement.

  • Shoulder weakness: You may experience weakness in the affected shoulder due to the limited range of motion.

  • Difficulty sleeping: The pain and stiffness in the shoulder joint can make it difficult to get comfortable at night, leading to disrupted sleep.


How can this be treated?

The goal of the treatment for adhesive capsulitis is to reduce pain and improve range of motion for your shoulder. Treatment options vary depending on the severity of the condition and may include:

  • Physical Therapy: At Hybrid Physical Therapy, we can help develop specific exercises to improve your shoulder range of motion and reduce pain. We will provide you thorough education on the process and guide you along the way. Our goal is to help you maintain as much of your function as possible to help with your daily tasks.

  • Medications: Pain relievers and anti-inflammatory medications may be prescribed to help manage pain and inflammation.

  • Corticosteroid injections: Corticosteroid injections can help reduce inflammation in the shoulder joint, leading to reduce pain and improved range of motion. This intervention works very well in conjunction with physical therapy.

  • Surgery: In severe cases of adhesive capsulitis, surgery may be necessary to break up adhesions (manipulation under anesthesia) in the shoulder joint and improve range of motion.


How can Hybrid Physical Therapy help with your recovery?

We know that stiffness and pain in your shoulder can be debilitating and affect your quality of life. We want to provide you with the best care possible to help maintain your function throughout these different stages of adhesive capsulitis. We will listen to your goals and develop a plan that’s right for you.


Let Hybrid Physical Therapy be the ones to guide you to the road to success and optimize your performance.




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