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Shoulder

Frozen Shoulder

What is the shoulder capsule?

The shoulder capsule is a thin, flexible layer of connective tissue that surrounds the ball-and-socket joint of the shoulder. It helps hold the joint in place while allowing smooth movement in all directions.

Frozen shoulder, or adhesive capsulitis, is a condition where the shoulder capsule becomes thickened, stiff, and inflamed. Over time, this restricts movement and leads to pain and significant loss of shoulder range of motion.

The exact cause is often unknown, but it can develop after shoulder surgery, injury, or prolonged immobility. It’s more common in people with diabetes, thyroid disease, or autoimmune conditions. In many cases, it arises gradually without a clear trigger.

Symptoms develop in three phases:

  1. Freezing phase: Gradual onset of pain and stiffness.
  2. Frozen phase: Stiffness remains, but pain may lessen.
  3. Thawing phase: Motion begins to improve.

Overall, the condition causes pain, especially at night, and major limitations in movement.

Diagnosis is based on a physical exam showing limited active and passive motion. X-rays are often used to rule out arthritis or other causes. MRI may show inflammation and thickening of the shoulder capsule, especially in more complex cases.

Most cases improve over time with non-surgical treatment:

  • Physical therapy
  • Anti-inflammatory medications
  • Steroid injections
  • Home stretching

If stiffness is severe or long-lasting, surgical options may be considered.

In this procedure, the shoulder is gently moved through a full range of motion while the patient is under anesthesia. This breaks up scar tissue and helps restore movement without surgical incisions.

This minimally invasive surgery involves using a small camera and instruments to cut and release the tight, scarred portions of the capsule. It allows for more precise control and is often used when manipulation alone is not enough.

Recovery starts immediately with physical therapy to maintain motion gained during surgery. Most patients regain significant range of motion over several weeks to months. Full recovery can take 3 to 6 months, depending on the severity of stiffness and adherence to rehab.

At a Glance

Sachin Allahabadi, MD

  • Board-Certified & Fellowship-Trained Sports Medicine Surgeon
  • Expertise in Minimally Invasive Knee & Shoulder Surgeries
  • Assistant Professor of Clinical Orthopaedic Surgery, Houston Methodist Hospital & Weill Cornell Medical College
  • Learn more
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