Shoulder
Adhesive Capsulitis (Frozen Shoulder)
유착성 관절낭염 (오십견)
Global shoulder stiffness from capsular fibrosis — all directions restricted equally
- How common
- Common (Diabetics, Women 40–60)
- Typical age
- Ages 40–60
What is it?
Capsular fibrosis with synovial proliferation reduces joint volume from normal 30mL to <10mL. Progresses through 3 phases: freezing (pain dominant) → frozen (stiffness dominant) → thawing (resolution).
Commonly affected: Entire shoulder capsule — especially anterior-inferior pouch (axillary recess)
How it develops
- Freezing Phase (2–9 months)Capsular synovitis, pain dominant, gradual ROM loss, night pain
- Frozen Phase (4–12 months)Pain decreases but severe global stiffness — ROM maximally restricted
- Thawing Phase (5–24 months)Gradual spontaneous resolution of stiffness — full recovery 2–3 years (not always complete)
- Capsular FibrosisCollagen deposition thickens capsule; joint volume reduced 30→<10mL
Symptoms
- Global ROM RestrictionAll planes equally restricted (flexion, abduction, ER, IR) — distinguishes from RC pathology
- External Rotation First LostExternal rotation is first and most restricted motion — key diagnostic feature
- Active = Passive RestrictionBoth active and passive ROM equally restricted — key finding (cf. RC tear: passive > active)
- Pain (Freezing Phase)Severe aching pain, worse at night — dominant in freezing phase
- ADL LimitationCannot comb hair, dress, or reach behind back (seat belt/bra strap)
How it is examined
- External Rotation <30° (Hallmark)Passive external rotation <30° with elbow at side — most consistent finding
- Active Equals PassiveBoth active and passive ROM restricted — if passive > active, consider RC tear instead
- Normal Neurological ExamNo weakness, sensory changes, or reflex abnormalities
Imaging
X-ray usually normal. Used to exclude OA, calcific tendinitis, or avascular necrosis.
- Usually normal
- Normal joint space
- May show osteopenia
MRI shows capsular thickening (coracohumeral ligament >4mm), joint effusion, and axillary recess obliteration. Rules out concurrent RC tear.
- Coracohumeral ligament thickening (>4mm)
- Reduced joint volume
- Inferior capsule/axillary recess thickening
Non-surgical care
- Physical Therapy + Stretching (Thawing)Pendulum exercises, wall climbs, Codman exercises — most effective in thawing phase
- Intra-articular Steroids (Freezing Phase)Intra-articular corticosteroid injection accelerates resolution in early/freezing phase
- NSAIDs + Oral SteroidsShort course oral corticosteroids speed up pain resolution in acute freezing phase
Conservative options are generally tried first. Medications listed here can have side effects — discuss them with your prescriber.
When surgery is considered
Failed 12–18 months conservative care; disabling stiffness
Procedures that may be discussed
- Manipulation under anesthesia (MUA)
- Arthroscopic capsular release
Outlook
Most resolve spontaneously in 2–3 years. Diabetics have more severe, prolonged course — up to 40% have residual stiffness.