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What is Frozen Shoulder?

What to Know About Adhesive Capsulitis

Adhesive capsulitis, more commonly known as Frozen Shoulder, is frequently treated in the physical therapy setting due to the pain and loss of upper extremity function that can occur as a result of the development of the pathology. 

The cause of adhesive capsulitis is still unknown, but researchers have found that certain populations typically develop frozen shoulder more than others:

  1. People who are 40-65 years old
  2. Occurs in females more than males
  3. People with Thyroid Disease
  4. People with Diabetes
  5. Those who have already experienced frozen shoulder in the opposite shoulder

Adhesive capsulitis typically takes 12-18 months to resolve.  There are four stages that occur after the onset of symptoms:

Stage 1: Pre-adhesive stage:  Patients typically present with symptoms similar to rotator cuff impingement. At this stage, patients can be misdiagnosed with rotator cuff tendonitis or impingement.  Often when we see these types of patients in therapy following the diagnosis of impingement, but we find that their shoulder may start to freeze after the initiation of PT.  It is important for our patients to communicate their symptoms to us so we can modify our treatment strategy in order to address their adhesive capsulitis as well as refer them back to their physician to discuss the benefits of potentially getting a cortisone injection in order to maximize a patient’s outcomes and manage their symptoms. Studies have found that intra-articular corticosteroid injections combined with stretching and mobility exercises can provide more relief and function in the first 4-6 weeks compared to stretching and mobility exercises alone. 

Stage 2: Acute adhesive stage, or the “freezing” stage:  Patient’s symptoms are typically worsening at this point and will begin having more severe pain at end ranges of motion with more significant losses of motion.  Patients in this phase begin having significant trouble with their activities of daily living including bathing, dressing, and reaching tasks.

Stage 3:  Fibrotic or “frozen” stage:  At this stage in the disease, the pain decreases, but the shoulder remains very stiff and restricted.  This is due to the decreased inflammation in the shoulder with more mature adhesions in the shoulder capsule.

Stage 4: Thawing stage:  During this stage, the patient will still be stiff, but will have no pain. As the adhesions in the capsule begin to remodel, the patient will slowly regain their motion.  


Mild symptoms may persist for years following the onset of adhesive capsulitis.  This can be dependent on the severity of the adhesions that developed during the stages of the disease process. Physical therapy can certainly help to improve our patient’s function and decrease their pain throughout the course of the syndrome.  The benefit of seeking an evaluation by a physical therapist is that we can tailor the treatment plan based on the needs of each specific patient.  Since adhesive capsulitis requires both active assisted stretching exercises performed by the patient as well as manual stretching and joint mobilizations performed by the therapist, we can advise the patient to adjust the stretching times based on the level of irritability in the individual’s shoulder.  Once the patient has regained a significant level to motion and mobility and their symptoms have calmed down, physical therapists will also provide the patient with strengthening exercises to help to restore normalized movement in the shoulder.  Once the patient is satisfied with their progress, we will discharge them to a home program that they can continue with on their own.

Heather Harrison, PT, DPT received her BA in Exercise and Sports Science from UNC-Chapel Hill in 2004 and her doctorate in Physical Therapy from Duke University in 2007. Licensed as a physical therapist for eight years, she has worked in a variety of settings including outpatient orthopedics, outpatient neurological rehabilitation and home health. She is based at OrthoCarolina Huntersville’s physical therapy office. 

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