Also known as “frozen shoulder,” adhesive capsulitis (AC) is an insidious inflammatory condition characterized by a painful, gradual loss in passive or active glenohumeral range of motion (ROM) resulting from progressive fibrosis and ultimate contracture of the glenohumeral joint capsule.1
In 1872, first physician to describe this pathology was Simon-Emmanuel Duplay who named the pathology as “scapulohumeral periarthritis”, an entity separate from arthritis with radiographic preservation of the joint. The term “frozen shoulder” was later established by Earnest and Codman in 1934 to demonstrate the loss of shoulder motion in patients affected with this disease. The disease was redefined as “adhesive capsulitis” by Julius Neviaser in 1945 with the establishment of inflammatory and fibrotic changes observed in the capsule and adjacent bursa.2
AC has been described to be either primary or secondary. Primary (Idiopathic) disease can occur spontaneously without any specific inciting event. Primary adhesive capsulitis is often associated with other conditions such as diabetes mellitus, thyroid dysfunction, dyslipidemia, Dupuytren’s contractures, autoimmune disease, and operative procedures (e.g. axillary dissection for malignancy).1,3
The secondary form of the disease usually follows trauma or direct injury to the shoulder such as surgical interventions, fractures, rotator cuff tears or other severe articular trauma.3
Conditions such as calcific tendonitis, bicipital tenosynovitis, glenohumeral and acromioclavicular arthritis, and rotator cuff tears can also potentially lead to a stiff and painful shoulder4-5 causing apparent limitation of active ROM, but they lack pathognomonic features of true capsular contracture with subsequent restriction in passive ROM. These conditions are distinct from AC and, therefore, should not be diagnosed as such. Given that the treatment differs between these conditions, an accurate diagnosis is essential.4
Epidemiology including risk factors and primary prevention
The prevalence of AC in the general population is reported to be 3-5% and upwards of 20% in individuals with diabetes. 5,6 AC has a peak incidence between 40 to 60 years of age.5 Females are four times more often affected than males.7 The non-dominant shoulder is most often involved, although bilateral involvement has been reported up to 40-50% of cases.6
Twenty to 30% of patients will report a history of trauma to the shoulder8,9, and one study reported that more than 60% of patients with AC had supraspinatus pathology.10
Despite its prevalence, the etiology of AC is poorly understood although many risk factors have been established. Well cited conditions associated with AC include both diabetes mellitus type I and II, thyroid disorder, cerebrovascular disease and Dupuytren’s disease. Recently, Prodromidis, et al.suggested a genetic predisposition to AC, noting a higher predilection of the condition in Caucasian patients, positive family history and HLA-27 positivity.
AC involves an inflammatory process and subsequently a reactive fibroblastic proliferation of the joint capsule leading to thickening and contracture of the joint capsule, a hallmark of the disease. An initial release of inflammatory cytokines (Interleukins, TNF-a, COX-1&2) and cells (T cells, B cells, Mast cells) play a crucial role in the later fibrotic process of the disease. Histological features demonstrate a mix of type I and type II collagen and an imbalance between extracellular matrix tissue degradation, remodeling and regeneration.
Anatomical findings include a loss of synovial layer of the capsule and an overall decreased capsular volume. Key structures involved include the coracohumeral ligament (CHL) and the rotator cuff interval. The rotator interval is a triangular region between the anterior border of the supraspinatus and the superior border of the subscapularis that contains the superior glenohumeral ligament and CHL. The structure usually affected first is the CHL at the roof of the rotator cuff interval. Contraction of the CHL can limit external rotation of the arm that may be seen early on in AC. In later stages, thickening and contracture of the glenohumeral joint capsule itself can limit range of motion in additional planes. The thickened, tight glenohumeral joint capsule with adhesions can lead to obliteration of the axillary fold. The fibrotic capsule adheres to itself and to the anatomic neck of the humerus. This leads to a minimal synovial fluid in the joint, and the overall joint volume is diminished.
Disease progression including natural history, disease phases or stages, disease trajectory (clinical features and presentation over time)
Four stages of the disease have been described, based on the arthroscopic appearance of the joint capsule as it progresses from capsular inflammation to fibrosis.13 These have been summarized in Table 1.
|Stage 1||Stage 2||Stage 3||Stage 4|
|Disease process||Fibrinous inflammation reaction without adhesions||Synovium proliferates, early adhesions||Mature adhesions||Scarred capsule|
|ROM||Full||Mild loss of ROM||Significantly restricted ROM||Limited ROM|
|Symptoms||Pain at night, non-specific symptoms that may be easily misdiagnosed||Pain is prominent with active and passive movement||Less pain than stage 1 and 2||May have painless ROM, but pain with sudden movement beyond scarred capsule|
Specific secondary or associated conditions and complications
Patients with AC may demonstrate residual stiffness. Axillary nerve injuries are possible with a capsular release depending on the technique used. Patients are prone to proximal humerus fractures, dislocations, rotator cuff tears and brachial plexopathy with manipulation in the setting of osteopenic bone. Evaluation may present significant increases in scapular upward rotation on the affected side as compared to their nonaffected side. Secondary conditions might include cervical pain or thoracic pain.
Essentials of Assessment
In early stages, patients complain of shoulder pain and stiffness with both passive and active movement. This rapidly progresses to joint global stiffness actively and passively. In some cases, there is no glenohumeral motion at all, just scapulothoracic motion. In other cases, loss of ROM is only at the shoulder end ranges. It is important to extrapolate associated conditions, especially diabetes mellitus which has shown to have worse outcomes.
Inspection for muscle atrophy and scars denoting prior surgery at the start of the examination given this may be a risk factor for the development of AC. Point tenderness is unlikely and non-specific for AC. Examination does not reveal a specific point of tenderness. Occasionally, the long head of the biceps tendon is tender because its synovium is confluent with the synovium of the glenohumeral joint. Rotator cuff strength is usually normal in the preserved range of motion. Both passive and active ROM of the shoulder is restricted with loss of external ROM with the arm at the patient’s side a hallmark of this condition. Loss of passive external ROM is the single most important finding on examination and helps to differentiate the diagnosis from rotator cuff pathology, since the latter does not result in loss of passive ROM.14 Rotator cuff testing may be limited given the loss of range of motion. Impingement sign, superior labrum anterior and posterior (SLAP) tear and biceps exam maneuvers may appear positive. An additional physical examination sign with good sensitivity is the shrug sign.15 The shrug sign is classically described as the inability to lift the arm to 90° abduction without elevating the whole scapula or shoulder girdle.
Patients are often asked to actively demonstrate the limits of shoulder motion. If loss of motion is observed, the physician may assist passively, with scapular stabilization to ensure an accurate measurement of movement. The most widely accepted method for measuring internal rotation is the Apley scratch test, usually expressed in terms of the highest vertebral level reached. Full ROM in all planes suggests another diagnosis. It is important to compare these maneuvers on the affected and unaffected sides to accurately assess deficits.16
Patients may experience sleep disturbances due to pain or inability to sleep on their affected side. It might prevent them from performing activities of daily living (such as reaching for a wallet in the back pocket, combing the hair, fastening a bra in the back). It also might affect activities at work, particularly, those that require reaching. Furthermore, it may affect recreational activities that feature significant use of the upper extremity such as swimming, throwing a ball, etc.14 There is a significant correlation between functional disability related to lack of shoulder ROM and quality of life. 17
Usually no lab studies are needed unless there is a need evaluate for an underlying condition that is known to be a high risk factor such as diabetes mellitus (Hemoglobin A1C), thyroid dysfunction (Thyroid Stimulating Hormone), rheumatological disorders.
Although radiographs are typically normal, they are important to exclude other causes and evaluation of osteoarthritis and dislocations. Recommended views include anterior-posterior in neutral position, scapular-Y and axillary lateral. The most common finding on radiographic imaging is disuse osteopenia.13
Magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) may reveal thickening of the joint capsule, a contracted glenohumeral joint space and diminished filling of the axillary pouch.18,19 Emig, et al.found thickness of the capsule >4 mm and of the synovium adjacent to the axillary recess to be highly specific for AC.
Dynamic ultrasonography may also reveal a thickening of the joint capsule and limited sliding movement of the supraspinatus tendon.21
The consistency of these findings are demonstrated in intraoperative visualization of the primary thickening of the rotator interval and coracohumeral ligament (CHL).22
Supplemental assessment tools23
Recommended validated functional outcome measures include the Disabilities of the Arm, Shoulder and Hand (DASH), the American Shoulder and Elbow Surgeons shoulder scale (ASES) and the Shoulder Pain and Disability Index (SPADI) are commonly utilized before and after interventions.24
The Constant-Murley Shoulder Outcome Score is one of the most commonly used outcome measures for assessing the treatment of shoulder disorders. It is the recommended scoring system of the European Society of Shoulder & Elbow Surgery (SECEC/ESSE) and has the benefit of including the pain score, functional assessment, range of motion and strength measures. 24
- 30-question patient self-report questionnaire
- Score range: 0 to 100
- 0 indicates no disability
- Self-report patient scale
- Range 0 to 100
- 50 point maximum scale for pain (1 Question)
- 50 point maximum scale for activities/participation (10 Questions)
- 100 indicates maximum shoulder use
- 13-item patient self-report tool
- 2 domains:
- Pain (5 items)
- Disability (8 items)
- Score range 0 to 100
- 0 indicates no pain or difficulty
Early predictions of outcomes
Risk factors for the disease process particularly diabetes mellitus and thyroid disease have been identified to have poor prognostic value for patients with primary AC receiving nonsurgical or conservative treatments.25
Surgical review has corroborated that patients with diabetes had a higher failure rate of conservative management and increasing needs for multiple surgeries.26
The literature has originally suggested that AC is a self-limited disease. In 1934, Codman counseled his patients that their symptoms would gradually subside over time without treatment on an average of 2 years.12 However, clinicians have reported patients with residual pain and dysfunction beyond 2 years of disease as demonstrated by a survey by Kim, et al. in 2020 on 234 patients who received conservative treatment.
A recent study by Yang et. al revealed CHL thickness to represent a predictor of outcomes. The investigators reported that a CHL of less than 3 mm on ultrasound highly correlated with a greater short-term improvement and these patients had a tendency of achieving a minimal detectable change in the Shoulder Pain and Disability Index (SPADI) scores in patients with primary AC after receiving hydrodilatation with corticosteroids.25
AC is more common in those with sedentary vocations than in manual laborers.1
It is important when examining the shoulder to expose the entire shoulder; not all clinicians do. This will rule out atrophy, winging scapulae and other asymmetries.
Rehabilitation Management and Treatments
Available or current treatment guidelines
The goal of treatment of AC is to relieve pain and restore mobility of the shoulder joint. Several treatments are available for AC depending on the phase of the disease. However, few of them have a high level of evidence to support them. A recent appraisal article reviewed the available treatments and assigned a level of confidence based on the criteria from the Centre for Evidence-Based Medicine in Oxford, UK. The strongest recommendation was for intraarticular corticosteroid injections combined with mobility and stretching exercises to provide short-term (i.e., 4-6 weeks) relief and improved mobility.28,29 Limited evidence was available for other modalities such as short wave diathermy, ultrasound, and electrical stimulation combined with stretching and mobilization to help reduce pain and increase motion.28
Medical treatments include non-steroidal anti-inflammatory drugs, physical therapy, and oral corticosteroids. Injection type treatments include glenohumeral joint injection of corticosteroids, hydrodilation, suprascapular nerve blocks (SSNB), manipulation under anesthesia, arthroscopic release, and open release.1,30 There has been some thought that intra-articular injection of visco-supplementation may improve outcomes with AC of the shoulder, but research has not shown additive benefits compared to conventional therapy. 31
The cornerstone for treatment of adhesive capsulitis involves patient education, oral NSAIDs, intraarticular injections, and stretching exercises.32
When combined with other treatments, rehab therapy can result in better outcomes.16 The goals are to minimize capsular adhesions and restrictions of motion and to reduce pain and inflammation.16Optimal intervention should be individualized to the patient, depending on disease stage, symptoms, adjunctive therapies, sex, and complex comorbid conditions such as diabetes that portend a poor outcome.33
Proprioceptive neuromuscular facilitation (PNF) involves rotational and diagonal movements along a single plane such as flexion, abduction, or rotation. Hold-relax and contract-relax exercises in upper limb D2 flexion pattern (shoulder flexion, abduction and external rotation, forearm supination, wrist and finger extension)were shown to reduce pain, reduce disability, improve ROM, and improve function.34Additionally, dynamic scapular recognition exercises using a wireless biofeedback mechanism shows improved scapular upward rotation and shoulder flexion and abduction.35
A systematic review and network meta-analysis by Kitridis, et al.showed that intraarticular administration of corticosteroids alone and with distension of the shoulder capsule produced statistically significant and clinically meaningful improvements in the short term. There was no significant difference over placebo in the other pharmacological interventions, including subacromial corticosteroid injection, oral corticosteroids, platelet-rich plasma, subcutaneous adalimumab, intraarticular hyaluronate, collagenase clostridium histolyticum, shoulder joint distension with corticosteroids and hypertonic saline, distension with sodium hyaluronate, and NSAIDs administered orally and transcutaneously. Although the effect sizes of some of these interventions were large, none were statistically significant.36
- Capsular Distension
- Hydraulic distension: there have been some conflicting reports regarding the use of hydraulic distension with corticosteroids, however most studies have shown improvement in pain and ROM after distension.
- Hydraulic distension with steroids provides pain relief and an immediate improvement in the range of motion, but the greatest clinical improvement is in capsule-preserved hydraulic distension compared to capsule-ruptured hydraulic distension37
- Capsule-preserving distension with hypertonic saline has been shown to decrease tissue edema and superior than normal saline when measuring shoulder passive ROM as well as assessing pain scores.38
- A retrospective review found that additional stretching of the preserved capsule using a “pumping technique” during hydraulic distension with steroids improved SPADI disability score and improved ROM.39
- Another 10-year retrospective review found that there was a low rate of repeat intervention following distension arthrography in patients with adhesive capsulitis, and greater volumes of distension were correlated with lower rates of recurrence of capsule rupture.40
- Jellad, et al.concluded that intra-articular distension before physical therapy is more beneficial than intra-articular distension after physical therapy. They also concluded that intra-articular distension alone does not significantly improve pain compared to physical therapy alone – this is in contrast to the studies previously cited.
- Hydraulic distension: there have been some conflicting reports regarding the use of hydraulic distension with corticosteroids, however most studies have shown improvement in pain and ROM after distension.
- Extracorporeal Shockwave Therapy.
- Chen, et al.believe that ESWT stimulates soft-tissue healing, increases blood flow to the treated site, and induces an inflammatory-mediated healing process.
- Shown to improve functional outcome in patients with diabetes and a potentially desirable alternative to corticosteroids.43
- Laser Therapy
- Low-level and high-intensity laser therapy (HILT) have been used for pain relief with some evidence of improving mobility and minimal adverse effects. In a 2020 publication, Atan, et al.demonstrated HILT plus therapeutic exercises were found beneficial for pain and quality of life compared with sham-laser plus therapeutic exercises and therapeutic exercises alone in the treatment of AC. Disability and ROM of shoulder joint were comparable between the groups after the intervention and follow up.
Surgical Interventions 45-47:
Surgical management is indicated when nonsurgical management, including NSAIDs, PT and injections have failed to provide relief of symptoms by 6 to 12 months. Those who undergo surgical options have been cited to be a younger age (mid-50s) with no difference in sex. Surgical options include manipulation under anesthesia (MUA) or arthroscopic capsular release with or without MUA. Evidence for the indication and timing of operative treatment or ideal technique is limited. Complications of manipulation includes fractures, dislocations, rotator cuff or labral tears and brachial plexus palsies. Axillary nerve injury may be a complication with capsular release.
Coordination of care
A stage-based approach and treatment in conjunction with physical therapy is the best approach. Treatment failures will require an orthopedic surgeon’s input. Continuous communication with the patient, explaining of the course of the disease and treatment plan, along with a well-prepared and guided home exercise program, will provide better results.
Patient & family education
As mentioned previously, home therapy is one of the pillars of treatment. In order to have better results, the patient has to understand his role in the recovery process, as well as the importance of his active participation from the beginning of treatment.
Translation into practice: practice “pearls”/performance improvement in practice (PIPs)/changes in clinical practice behaviors and skills
Designing the appropriate treatment plan depends on recognition of the clinical stage. Because immobilization should be avoided, physical therapy and a guided home exercise program will be the pillars of treatment, in conjunction with a clear communication with the patient. Medical and rehabilitation treatments will be the first step, progressing to more invasive treatments, depending on the patient’s response.
Cutting Edge/ Emerging and Unique Concepts and Practice
Cutting edge concepts and practice
Targeting inflammatory cytokines in early stages (1 and 2) and decreasing fibrosis as well as enhancing capsular remodeling in late states (3 and 4) are the main goals of new agents.16 For better results with intra-articular corticosteroid injection, hydrodilatation, and SSNB in early stages, the use of ultrasound or radiographically guided procedures is recommended.1Manipulation under anesthesia was formerly the standard of care for recalcitrant cases, however, arthroscopy has shown good and sustained results.48,49 Additionally, the use of ultrasound to assess the thickness of the coracohumeral ligament (CHL) as a diagnostic imaging modality to determine CHL thickness in adhesive capsulitis of the shoulder has been shown to be effective in diagnosing AC given that a thickened CHL is suggestive of adhesive capsulitis and a thickness less than 3 mm may show a positive outcome with certain therapies.25Below are newer treatment strategies that are developing to present positive results at different stages of the disease process or combined with physiotherapy.
- Whole-body cryotherapy (WBC)50
- Administered for two to three minutes on the surface of the body in minimal clothing at −110°C to −140°C. Ma et al. hypothesized that WBC could have a positive effect on the rate of post-injury recovery after conservative AC treatment.
- Their study suggested that WBC provided a significant improvement in all outcome measures and ROM measures from pre to post treatment.
- This therapy along with joint manipulation demonstrated to be more effective in shoulder mobility, pain and ASES scores. Further RCTs suggested to enhance these conclusions for AC of the shoulder.
- Neuromodulation Techniques
- Pulsed Radiofrequency
- Stimulation lesioning of the suprascapular nerve demonstrated for shoulder pain control.33
- Peripheral Nerve Stimulation (PNS)
- Case report demonstrating improved pain and shoulder ROM in all planes at 3-month follow-up period after permanent implantation of a suprascapular nerve stimulator. Authors proposed a nerve block may help select patients who may respond to peripheral stimulation.51
- Axillary Nerve Stimulation Mansfield and Desai demonstrated a small retrospective case series supporting the evidence of the use of axillary (PNS) therapy for management of chronic shoulder pain although higher-level studies are required to further support its use.52
- Pulsed Radiofrequency
- Collagenase Injections
- Subacromial collagenase injections in rats byKarahan, et al. demonstrated an effective result in shoulder abduction angle compared to steroid and saline. The authors suggest a potential for adhesive capsulitis treatment in patients with an intact rotator cuff.
- Recently, Fitzpatrick, et al.refuted the use of this treatment due to a lack of statistical significance and adverse events and potential risk of the procedure. The authors recommended against this treatment for AC of the shoulder unless further studies demonstrated more significant results.
- Role of Platelet Rich Plasma (PRP)
- Demonstrated positive outcomes in shoulder pain and ROM in a case report by Aslani, et al.using PRP for frozen shoulder. The authors suggest future randomized control trials using this therapy for frozen shoulder.
- Wearable Motion Sensor Device to Facilitate Rehabilitation
- Advancing technology has demonstrated to have benefits in the rehabilitation community. Chen, et al. demonstrated shoulder ROM measured using a motion sensor device, exhibited positive results in shoulder mobility, functional recovery and exercise completion rate during and after 3 months of rehabilitation. This treatment strategy may be beneficial for the telerehabilitation model overcoming obstacles of home-based physiotherapy.
Gaps in the Evidence- Based Knowledge
There is a need of high-level evidence studies on different treatment alternatives for each stage of the disease. Information on the number, type, and timing and stages of targeted treatment of office-based injections and procedures is needed to best optimize participation in therapy and improve functional outcomes. Intra-articular injection techniques including capsular distension and steroid injections are currently prevailing nonsurgical treatments for frozen shoulder. Non-invasive strategies include ESWT and laser therapy show promising outcomes in pain relief and shoulder ROM. Neuromodulation techniques including peripheral nerve stimulation require larger scale studies. Technological advancements for rehabilitation provide a means of gaining and measuring progressive functional gains. Interventions at the different stages of the AC of the shoulder are required to decide the most effective treatment algorithm. The difficulty of individualized treatment continues to depend on factors such as comorbid conditions, particularly diabetes, symptoms, disease stage and other demographic characteristics.
- Neviaser AS, Hannafin JA. Adhesive capsulitis: a review of current treatment. Am J Sports Med. 2010;38(11):2346-2356.
- Le HV, Lee SJ, Nazarian A, Rodriguez EK. Adhesive capsulitis of the shoulder: review of pathophysiology and current clinical treatments. Shoulder Elbow. 2017;9(2):75-84.
- St Angelo JM, Fabiano SE. Adhesive Capsulitis. In: StatPearls. Treasure Island (FL)2020.
- Hsu JE, Anakwenze OA, Warrender WJ, Abboud JA. Current review of adhesive capsulitis. J Shoulder Elbow Surg. 2011;20(3):502-514.
- Uppal HS, Evans JP, Smith C. Frozen shoulder: A systematic review of therapeutic options. World J Orthop. 2015;6(2):263-268.
- Manske RC, Prohaska D. Diagnosis and management of adhesive capsulitis. Curr Rev Musculoskelet Med. 2008;1(3-4):180-189.
- Mezian K, Coffey R, Chang KV. Frozen Shoulder. In: StatPearls. Treasure Island (FL)2020.
- Hand C, Clipsham K, Rees JL, Carr AJ. Long-term outcome of frozen shoulder. J Shoulder Elbow Surg. 2008;17(2):231-236.
- Hannafin JA, Chiaia TA. Adhesive capsulitis. A treatment approach. Clin Orthop Relat Res. 2000(372):95-109.
- Yoo JC, Ahn JH, Lee YS, Koh KH. Magnetic resonance arthrographic findings of presumed stage-2 adhesive capsulitis: focus on combined rotator cuff pathology. Orthopedics. 2009;32(1):22.
- Prodromidis AD, Charalambous CP. Is There a Genetic Predisposition to Frozen Shoulder?: A Systematic Review and Meta-Analysis. JBJS Rev. 2016;4(2).
- Codman EA. The shoulder; rupture of the supraspinatus tendon and other lesions in or about the subacromial bursa. Boston, Mass: [T. Todd Company, printers]; 1934.
- Neviaser AS, Neviaser RJ. Adhesive capsulitis of the shoulder. J Am Acad Orthop Surg. 2011;19(9):536-542.
- Frontera WR, Silver JK. Essentials of physical medicine and rehabilitation. Philadelphia ; [Great Britain]: Hanley & Belfus; 2002.
- Hegedus EJ, Goode AP, Cook CE, Michener L, Myer CA, Myer DM, Wright AA. Which physical examination tests provide clinicians with the most value when examining the shoulder? Update of a systematic review with meta-analysis of individual tests. Br J Sports Med. 2012;46(14):964-978.
- Ewald A. Adhesive capsulitis: a review. Am Fam Physician. 2011;83(4):417-422.
- Fernandes MR. Correlation between functional disability and quality of life in patients with adhesive capsulitis. Acta Ortop Bras. 2015;23(2):81-84.
- Lee MH, Ahn JM, Muhle C, Kim SH, Park JS, Kim SH, . . . Kang HS. Adhesive capsulitis of the shoulder: diagnosis using magnetic resonance arthrography, with arthroscopic findings as the standard. J Comput Assist Tomogr. 2003;27(6):901-906.
- Sofka CM, Ciavarra GA, Hannafin JA, Cordasco FA, Potter HG. Magnetic resonance imaging of adhesive capsulitis: correlation with clinical staging. Hss j. 2008;4(2):164-169.
- Emig EW, Schweitzer ME, Karasick D, Lubowitz J. Adhesive capsulitis of the shoulder: MR diagnosis. AJR Am J Roentgenol. 1995;164(6):1457-1459.
- Ryu KN, Lee SW, Rhee YG, Lim JH. Adhesive capsulitis of the shoulder joint: usefulness of dynamic sonography. J Ultrasound Med. 1993;12(8):445-449.
- Omari A, Bunker TD. Open surgical release for frozen shoulder: surgical findings and results of the release. J Shoulder Elbow Surg. 2001;10(4):353-357.
- Kelley MJ, Shaffer MA, Kuhn JE, Michener LA, Seitz AL, Uhl TL, . . . McClure PW. Shoulder pain and mobility deficits: adhesive capsulitis. J Orthop Sports Phys Ther. 2013;43(5):A1-31.
- Angst F, Schwyzer HK, Aeschlimann A, Simmen BR, Goldhahn J. Measures of adult shoulder function: Disabilities of the Arm, Shoulder, and Hand Questionnaire (DASH) and its short version (QuickDASH), Shoulder Pain and Disability Index (SPADI), American Shoulder and Elbow Surgeons (ASES) Society standardized shoulder assessment form, Constant (Murley) Score (CS), Simple Shoulder Test (SST), Oxford Shoulder Score (OSS), Shoulder Disability Questionnaire (SDQ), and Western Ontario Shoulder Instability Index (WOSI). Arthritis Care Res (Hoboken). 2011;63 Suppl 11:S174-188.
- Yang CY, Fu LH, Lee CC, Wang KA, Chou CL, Wang JC. Short-Term Outcome Predictors in Patients With Primary Adhesive Capsulitis Treated With Ultrasound-Guided Hydrodilatation With Corticosteroids. Am J Phys Med Rehabil. 2020;99(8):719-724.
- Barbosa F, Swamy G, Salem H, Creswell T, Espag M, Tambe A, Clark D. Chronic adhesive capsulitis (Frozen shoulder): Comparative outcomes of treatment in patients with diabetes and obesity. J Clin Orthop Trauma. 2019;10(2):265-268.
- Kim DH, Kim YS, Kim BS, Sung DH, Song KS, Cho CH. Is frozen shoulder completely resolved at 2 years after the onset of disease? J Orthop Sci. 2020;25(2):224-228.
- Alsubheen SA, MacDermid JC. Appraisal of Clinical Practice Guideline: Shoulder Pain and Mobility Deficits: Adhesive Capsulitis. J Physiother. 2020.
- Linaker CH, Walker-Bone K. Shoulder disorders and occupation. Best Pract Res Clin Rheumatol. 2015;29(3):405-423.
- Binder AI, Bulgen DY, Hazleman BL, Roberts S. Frozen shoulder: a long-term prospective study. Ann Rheum Dis. 1984;43(3):361-364.
- Lee LC, Lieu FK, Lee HL, Tung TH. Effectiveness of hyaluronic acid administration in treating adhesive capsulitis of the shoulder: a systematic review of randomized controlled trials. Biomed Res Int. 2015;2015:314120.
- Cho CH, Lee YH, Kim DH, Lim YJ, Baek CS, Kim DH. Definition, Diagnosis, Treatment, and Prognosis of Frozen Shoulder: A Consensus Survey of Shoulder Specialists. Clin Orthop Surg. 2020;12(1):60-67.
- Zhang J, Zhong S, Tan T, Li J, Liu S, Cheng R, . . . Ye X. Comparative Efficacy and Patient- Specific Moderating Factors of Nonsurgical Treatment Strategies for Frozen Shoulder: An Updated Systematic Review and Network Meta-analysis. Am J Sports Med. 2020:363546520956293.
- Tedla JS, Sangadala DR. Proprioceptive neuromuscular facilitation techniques in adhesive capsulitis: a systematic review and meta-analysis. J Musculoskelet Neuronal Interact. 2019;19(4):482-491.
- Mohamed AA, Jan YK, El Sayed WH, Wanis MEA, Yamany AA. Dynamic scapular recognition exercise improves scapular upward rotation and shoulder pain and disability in patients with adhesive capsulitis: a randomized controlled trial. J Man Manip Ther. 2020;28(3):146-158.
- Kitridis D, Tsikopoulos K, Bisbinas I, Papaioannidou P, Givissis P. Efficacy of Pharmacological Therapies for Adhesive Capsulitis of the Shoulder: A Systematic Review and Network Meta-analysis. Am J Sports Med. 2019;47(14):3552-3560.
- Cho JH. Updates on the treatment of adhesive capsulitis with hydraulic distension. Yeungnam Univ J Med. 2020.
- Lee JH, Kim SB, Lee KW, Lee SJ, Lee JU. Effect of Hypertonic Saline in Intra-Articular Hydraulic Distension for Adhesive Capsulitis. Pm r. 2015;7(7):721-726.
- Kim YW, Shin S, Chang WH, Lee SC. Hydraulic Distension with Pumping Technique for Treating Frozen Shoulder: A Case-Controlled, Retrospective, Comparative Study with 6-Month Follow-Up. Pain Physician. 2019;22(6):E563-E572.
- Nicholson JA, Slader B, Martindale A, McKie S, Robinson CM. Distension arthrogram in the treatment of adhesive capsulitis has a low rate of repeat intervention. Bone Joint J. 2020;102-b(5):606-610.
- Jellad A, May W, Zrig A, Kalai A, Jguirim M, Frih ZBS, Golli M. Intra-articular distension preceded by physical therapy versus intra-articular distension followed by physical therapy for treating adhesive capsulitis of the shoulder. J Back Musculoskelet Rehabil. 2020;33(3):443-450.
- Chen CY, Hu CC, Weng PW, Huang YM, Chiang CJ, Chen CH, . . . Cheng CK. Extracorporeal shockwave therapy improves short-term functional outcomes of shoulder adhesive capsulitis. J Shoulder Elbow Surg. 2014;23(12):1843-1851.
- Santoboni F, Balducci S, D’Errico V, Haxhi J, Vetrano M, Piccinini G, . . . Vulpiani MC. Extracorporeal Shockwave Therapy Improves Functional Outcomes of Adhesive Capsulitis of the Shoulder in Patients With Diabetes. Diabetes Care. 2017;40(2):e12-e13.
- Atan T, Bahar-Ozdemir Y. Efficacy of high-intensity laser therapy in patients with adhesive capsulitis: a sham-controlled randomized controlled trial. Lasers Med Sci. 2020.
- Redler LH, Dennis ER. Treatment of Adhesive Capsulitis of the Shoulder. J Am Acad Orthop Surg. 2019;27(12):e544-e554.
- Schoch B, Huttman D, Syed UA, Patel MS, Lazarus MD, Abboud JA. Surgical Treatment of Adhesive Capsulitis: A Retrospective Comparative Study of Manipulation Under Anesthesia and/or Capsular Release. Cureus. 2020;12(7):e9032.
- Yip M, Francis AM, Roberts T, Rokito A, Zuckerman JD, Virk MS. Treatment of Adhesive Capsulitis of the Shoulder: A Critical Analysis Review. JBJS Rev. 2018;6(6):e5.
- Braman J, Neviaser A, Parsons B. What’s new in shoulder and elbow surgery. J Bone Joint Surg Am. 2014;96(20):1753-1758.
- Barnes CP, Lam PH, Murrell GA. Short-term outcomes after arthroscopic capsular release for adhesive capsulitis. J Shoulder Elbow Surg. 2016;25(9):e256-264.
- Ma SY, Je HD, Jeong JH, Kim HY, Kim HD. Effects of whole-body cryotherapy in the management of adhesive capsulitis of the shoulder. Arch Phys Med Rehabil. 2013;94(1):9-16.
- Elahi F, Reddy CG. Neuromodulation of the suprascapular nerve. Pain Physician. 2014;17(6):E769-773.
- Mansfield JT, Desai MJ. Axillary Peripheral Nerve Stimulation for Chronic Shoulder Pain: A Retrospective Case Series. Neuromodulation. 2020;23(6):812-818.
- Karahan N, Ozdemir G, Kolukısa D, Duman S, Arslanoğlu F, Çetin M. Can Collagenase Be Used in the Treatment of Adhesive Capsulitis? Med Princ Pract. 2020;29(2):174-180.
- Fitzpatrick J, Richardson C, Klaber I, Richardson MD. Clostridium histolyticum (AA4500) for the Treatment of Adhesive Capsulitis of the Shoulder: A Randomised Double-Blind, Placebo-Controlled Study for the Safety and Efficacy of Collagenase – Single Site Report. Drug Des Devel Ther. 2020;14:2707-2713.
- Aslani H, Nourbakhsh ST, Zafarani Z, Ahmadi-Bani M, Ananloo ME, Beigy M, Salehi S. Platelet-Rich Plasma for Frozen Shoulder: A Case Report. Arch Bone Jt Surg. 2016;4(1):90-93.
- Chen YP, Lin CY, Tsai MJ, Chuang TY, Lee OK. Wearable Motion Sensor Device to Facilitate Rehabilitation in Patients With Shoulder Adhesive Capsulitis: Pilot Study to Assess Feasibility. J Med Internet Res. 2020;22(7):e17032.
Original Version of the Topic:
Erik Hoyer, MD, MA. Critical illness myopathy. Publication Date:11/27/2012
Previous Version of the Topic:
Jason L. Zaremski, MD. Adhesive Capsulitis. Publication Date: 8/18/2016
Mooyeon Oh-Park, MD
Nothing to Disclose
Mohammad Zaidi, MD
Nothing to Disclose
Safwan Zar, MD
Nothing to Disclose