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Frozen Shoulder (Adhesive Capsulitis): Symptoms, Causes and Treatment Methods

Frozen shoulder (adhesive capsulitis) is a condition in which the shoulder joint capsule thickens and stiffens, leading to restricted movement. This condition, which negatively affects daily life, typically begins with pain and gradually causes significant limitations in range of motion.

In this article, you will find detailed information about the symptoms, causes, diagnostic methods, and the most effective current treatment options for frozen shoulder. Following the recommendations of orthopedic experts such as Assoc. Prof. Dr. Serhat Mutlu and Assoc. Prof. Dr. Harun Mutlu, we will discuss disease management and the treatment process.

What Is Frozen Shoulder?

Frozen shoulder, medically known as adhesive capsulitis, is a condition characterized by thickening of the shoulder joint capsule and loss of flexibility, which restricts shoulder movements.

This condition develops in three stages:

1. Painful Stage (Freezing Phase)

- A dull, gradually worsening pain is felt in the shoulder.

- Pain often increases at night and with movement.

2. Stiffening Stage (Frozen Phase)

- The shoulder joint begins to stiffen, resulting in significant movement restrictions.

- Daily activities, especially lifting the arm overhead or reaching behind the back, become difficult.

3. Thawing Stage (Recovery Phase)

- Pain gradually lessens and shoulder mobility slowly improves.

- However, this process can take several months and, in some cases, even years to complete.

What Are the Symptoms of Frozen Shoulder?

✅ Shoulder pain: pain that worsens at rest and during the night.

✅ Limited range of motion: difficulty moving the arm overhead, to the side, or behind the back.

✅ Muscle weakness: unused muscles may become weak.

✅ Difficulty with daily activities: tasks such as dressing, combing hair, or lifting objects overhead become challenging.

✅ Progressive stiffness: starting as mild restriction and gradually becoming more severe.

Important Note: If shoulder pain persists and movement is limited, you should consult an orthopedic specialist.

What Causes Frozen Shoulder?

The exact cause is unknown, but several risk factors can trigger its development:

✔ Diabetes: People with diabetes have a 2–4 times higher risk of developing frozen shoulder.

✔ Shoulder injuries and surgeries: Trauma, fractures, or previous shoulder surgeries can increase the risk.

✔ Immobility: Prolonged disuse of the shoulder can lead to capsular stiffening.

✔ Thyroid disorders: Conditions like hypothyroidism or hyperthyroidism may play a role.

✔ Neurological conditions: Diseases such as Parkinson’s disease and stroke that limit shoulder use can contribute.

How Is Frozen Shoulder Diagnosed?

Diagnosis is typically made by orthopedic specialists such as Assoc. Prof. Dr. Serhat Mutlu and Assoc. Prof. Dr. Harun Mutlu based on clinical evaluation and imaging tests.

- Physical Examination: Assessment of active and passive shoulder range of motion.

- X-ray: Examines bone structures and rules out other pathologies.

- Magnetic Resonance Imaging (MRI): Evaluates capsular thickening and soft tissues.

- Ultrasound: Visualizes muscles and tendons around the shoulder.

Treatment Options for Frozen Shoulder

1. Conservative (Non-Surgical) Treatments

✅ Physical Therapy and Exercises: Exercises aimed at increasing shoulder mobility are among the most effective treatments. Regular exercise helps improve capsular flexibility and restore range of motion.

✅ Pain Relievers and Anti-Inflammatory Medications: Non-steroidal anti-inflammatory drugs (NSAIDs) reduce pain and inflammation.

✅ Corticosteroid Injections: Injections into the shoulder joint reduce inflammation and facilitate movement.

✅ Manual Therapy and Chiropractic: Mobilization techniques performed by specialists can help loosen the joint capsule.

2. Interventional Treatments

✔ Intra-articular Hydrodilatation (Fluid Injection): Sterile fluid is injected into the shoulder joint to expand the capsule and increase range of motion.

✔ Nerve Block: Blocking the nerves around the shoulder can help reduce pain.

3. Surgical Treatment

If conservative treatments fail:

- Closed Manipulation: Under general anesthesia, the doctor manipulates the shoulder to break up adhesions and improve motion.

- Arthroscopic Capsular Release: Arthroscopic surgery is used to cut the tight capsule and increase shoulder mobility.

Post-operative physical therapy is crucial to prevent re-stiffening of the capsule.

How to Prevent Frozen Shoulder

✔ Perform shoulder exercises regularly.

✔ Avoid prolonged immobility.

✔ Manage diabetes and thyroid disorders effectively.

✔ Seek early intervention for shoulder injuries.

Conclusion

Frozen shoulder is a progressive condition that can significantly impair daily life. However, with early diagnosis and appropriate treatment strategies, it can be largely controlled. Assoc. Prof. Dr. Serhat Mutlu and Assoc. Prof. Dr. Harun Mutlu emphasize the importance of individualized physical therapy programs in management.

If you have limited shoulder mobility or persistent pain, consult an orthopedic specialist without delay. Early intervention is the key to rapid recovery!